Background: Epithelial ingrowth to the anterior chamber is a rare event after ocular injury or intraocular surgery. We report on four patients with primary cystic epithelial ingrowth (with primary curative cystic formation when treated with block excision) who underwent Nd:YAG-laser puncture of the cysts elsewhere. This treatment led to a change from a cystic to a diffuse form with a poor prognosis for the eye.
Patients: Three women and one man were seen in our outpatient department. Cystic epithelial ingrowth happened after intraocular surgery (1 x goniotomy, 2 x cataract surgery) or perforating injury (1 x). All four patients were treated elsewhere with puncture of the cysts (by Nd:YAG-laser). At first presentation in our department a change of cystic to diffuse epithelial ingrowth was noticed. Curative treatment by block excision was no longer possible. Diffuse epithelialisation of the anterior chamber resulted in secondary glaucoma with a poor prognosis.
Conclusions: In our experience puncture of intraocular epithelial cysts may lead to a transformation to diffuse epithelial ingrowth with possible loss of the eye. Surgical opening of the cyst or subtotal excision is therefore contraindicated from our point of view. In case of cystic epithelial ingrowth of less than 5 hours of the limbal circumference, block excision in toto is indicated.