En bloc Excision of Cystic Epithelial downgrowth using Auricular Cartilage
Bialasiewicz A. A., Ganesh A., Al-Fadhil N., Thakral A.
Dept. of Ophthalmology SQUH, University of Oman, Al Khod/MAO
Purpose: To describe a donor-material independent successful surgical management of cystic epithelial downgrowth (ED) by use of tectonic syngeneic auricular cartilage.
Method: In a prospective interventional case series lamellar/penetrating excision was performed on 2 patients (4 and 6 years old) and cartilage was used to cover the defects. History, ocular findings, procedures and outcomes are reported.
Results: Case 1 (5y): A 5mm injury (9-11h) with a knife had been repaired and a lens removed, followed after 3 months by a secondary posterior IOL implantation. 3 weeks later a progressive iris cyst from 9-2 h developed dislocating the IOL. VA was OS 0.05. A 7.2mm trephine was used for a sclerokeratoplasty approach. Cartilage was customized to 7.2mm x 0.4mm thickness. After suturing the cartilage was covered with tenon and conjunctiva. PostOP VA was +2.0/-2.0/90º = 0.05.
Case 2 (6y): A 1mm bird-beak corneal perforation at 2 oclock was not repaired, and downgrowth (10-3h) developed over 6 months with a decrease in VA OD 0.3 dissection of the sclera (7.5x4.5mm) was performed. Auricular cartilage 7.5mmx7.5mm was opposed to the cornea and sclera. PostOP VA: +1.75/-4.5/45º=0.5. Histopathological examination of both tissues confirmed the diagnosis of cystic epithelial downgrowth with few goblet cells.
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