Surgical Treatment of a Corneal Epithelial Cyst

Purpose: To describe a case of intracorneal epithelial cyst and present a surgical technique successfully used to treat this patient. Methods: This interventional case report presents a 4-year-old boy with a progressive intrastromal corneal opacity and decreased vision in his right eye. The patient had no previous history of trauma or ocular surgery. After clinical examination and corneal optical coherence tomography, a presumptive diagnosis of a developmental epithelial cyst was made, and surgery was indicated. Four years later, when the patient was 8 year old, he returned after having performed drainage of the cyst in another service but still complaining of low vision. The biomicroscopy showed an intrastromal recurrent cyst. At this time, we recommended the surgical retreatment. The cyst was drained, a lamellar keratosclerectomy was performed at the site of the limbus where the epithelial nest was placed, and distilled water was used to wash the corneal cyst - to eliminate the epithelial cells. A donor cornea button was cut manually and was transplanted to cover the area where the corneoscleral tissue was removed. Results: The surgical technique described resulted in nearly complete clearing of the opacity and improved vision, and no recurrence was documented up to 19 months of follow-up. The best-corrected visual acuity improved from 20/100 before surgery to 20/30 after surgery. Conclusions: This surgical technique may be a good alternative to other previously described treatments for intracorneal epithelial cysts aiming to avoid recurrence and without the need for central corneal transplantation.