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• W2072844354 abstract "Conjunctival cyst usually occurs in the setting of inflammation after ocular trauma or surgery but can also occur spontaneously.1Krachmer J, Mannis M, Holland E. Subepithelial neoplasms of the conjunctiva. In: Cornea. Fundamentals, Diagnosis and Management. Vol. 1, 3rd ed. Philadelphia, PA: Elsevier Mosby; 2010:488-9Google Scholar Complete surgical resection,2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar, 4Kobayashi A. Sugiyama K. Successful removal of a large conjunctival cyst using colored 2.3% sodium hyaluronate.Ophthalmic Surg Lasers Imaging. 2007; 38: 81-83PubMed Google Scholar, 5Chan R.Y. Pong J.C. Yuen H.K. Lai J.S. Use of sodium hyaluronate and indocyanine green for conjunctival cyst excision.Jpn J Ophthalmol. 2009; 53: 270-271Crossref PubMed Scopus (14) Google Scholar thermal cautery,6Hawkins A.S. Hamming N.A. Thermal cautery as a treatment for conjunctival inclusion cyst after strabismus surgery.J AAPOS. 2001; 5: 48-49Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar intracyst injection of isopropyl alcohol,7Kothari M. A novel method for management of conjunctival inclusion cysts following strabismus surgery using isopropyl alcohol with paired injection technique.J AAPOS. 2009; 13: 521-522Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar and argon laser photoablation8Han S.B. Yang H.K. Hyon J.Y. Removal of conjunctival cyst using argon laser photoablation.Can J Ophthalmol. 2012; 47: E6-E8Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar are suggested treatments for conjunctival cyst. Previous studies have demonstrated that surgical excision with visualization of the conjunctival cyst by tissue dyes and ophthalmic viscosurgical devices (OVDs) is one of the most effective methods to achieve complete removal of a conjunctival cyst.2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar, 4Kobayashi A. Sugiyama K. Successful removal of a large conjunctival cyst using colored 2.3% sodium hyaluronate.Ophthalmic Surg Lasers Imaging. 2007; 38: 81-83PubMed Google Scholar, 5Chan R.Y. Pong J.C. Yuen H.K. Lai J.S. Use of sodium hyaluronate and indocyanine green for conjunctival cyst excision.Jpn J Ophthalmol. 2009; 53: 270-271Crossref PubMed Scopus (14) Google Scholar In this study, we introduce a novel surgical technique, termed sutureless small incision conjunctival cystectomy. A 56-year-old female had foreign-body sensation and chemosis of the left eye that had been begun 2 months prior. On slit-lamp examination, an elevated transparent cystic lesion was observed at the temporal bulbar conjunctiva of the left eye (Fig. 1). After informed consent was obtained, she underwent a sutureless, small-incision conjunctival cystectomy. After instillation of 0.5% proparacaine hydrochloride (Alcaine; Alcon Laboratories, Fort Worth, Tex.), 0.05% Indocyanine green (ICG) dye was injected into the cyst through a 30-gauge needle using a repeated aspiration and injection technique. Approximately 0.05 mL cyst fluid was aspirated using a 1-mL syringe containing 0.3 mL ICG dye, and the cystic fluid was mixed with ICG dye in the syringe. Then, a similar amount of ICG dye was injected into the cyst over 1 second. Aspiration and injection was repeated about 6 to 8 times while leaving the needle in place. The needle was removed once the cyst was reduced in size and clearly distinguished (Fig. 2A; see Video 1 available online). Then, 2% lidocaine was injected in the subconjunctival space near the conjunctival cyst (Fig. 2B). A small conjunctival incision (about 4.5 mm) was made near the conjunctival cyst using Westcott scissors to expose the conjunctival cystic wall (Fig. 2C). Complete removal of the cyst was carefully achieved through a small incision using a cotton-tipped applicator (Fig. 2D). No leakage of the ICG dye was observed (Fig. 2E). Immediately after the surgery, 0.3% ofloxacin eye ointment (Tarivid; Santen, Osaka, Japan) was instilled. Postoperatively, the patient was treated with 0.5% levofloxacin (Cravit; Santen, Osaka, Japan) and 0.1% fluorometholone (Flucon; Alcon Laboratories, Fort Worth, Tex.) eye drops 4 times daily for 3 weeks. The patient was satisfied with the surgical results and showed cosmetic improvement. Surgical time was less than 10 minutes, and the conjunctival wound healed in 1 week with no complications. There was no recurrence of the conjunctival cyst over the 6-month follow-up period. Another 3 patients underwent a sutureless small-incision conjunctival cystectomy, and 1 patient with multiple conjunctival cysts underwent a small-incision conjunctival cystectomy with few sutures (Fig. 3). All patients were satisfied with the cosmetic improvement, and there was no recurrence of conjunctival cyst over the 2-month follow-up period (range 2–6 months). In this study, ICG dye was injected through a 30-gauge needle instead of a 27-gauge needle2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar, 4Kobayashi A. Sugiyama K. Successful removal of a large conjunctival cyst using colored 2.3% sodium hyaluronate.Ophthalmic Surg Lasers Imaging. 2007; 38: 81-83PubMed Google Scholar, 5Chan R.Y. Pong J.C. Yuen H.K. Lai J.S. Use of sodium hyaluronate and indocyanine green for conjunctival cyst excision.Jpn J Ophthalmol. 2009; 53: 270-271Crossref PubMed Scopus (14) Google Scholar into the cyst using a repeated aspiration and injection technique to prevent rupture of the conjunctival cyst while facilitating visualization of the cyst capsule. There was no leakage of ICG dye or cyst collapse during injection of the dye. In a comparison study between 27- and 30-gauge needles used for intravitreal injections, a 30-gauge needle caused less reflux than a 27-gauge needle.9Lorenz K. Zwiener I. Mirshahi A. Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle.Graefes Arch Clin Exp Ophthalmol. 2010; 248: 1573-1577Crossref PubMed Scopus (22) Google Scholar A 30-gauge needle is small enough to prevent cyst collapse or dye leakage. In addition, the repeated aspiration and injection technique used in this study reduced the size of the cyst by aspiration before injection, resulting in prevention of excessive swelling, overflow, and rupture of the cyst. In previous techniques,2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar large cysts required a large dissection of the conjunctiva, thus creating more patient discomfort. Thus, a minimal conjunctival incision with complete removal is important. In this study, the conjunctival cyst was removed through smaller incision compared with previous studies.2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar There are 2 possible reasons for this. First, the repeated aspiration and injection technique without OVDs reduced the size of the conjunctival cyst and facilitated to remove the cyst through a small incision. The cyst was easily removed with a cotton-tipped applicator because the shrunken cyst could change its shape to fit the incision size. Second, the conjunctival cyst is well separated from the surrounding tissue by injecting lidocaine in the subconjunctival space near the conjunctival cyst. Lidocaine injection was used not only to achieve topical anaesthesia, but also to release the cyst from the conjunctival tissue. Histologically, the central cavities of conjunctival cysts are lined by nonkeratinizing conjunctival epithelium with goblet cells and filled with cellular debris, including inflammatory cells.1Krachmer J, Mannis M, Holland E. Subepithelial neoplasms of the conjunctiva. In: Cornea. Fundamentals, Diagnosis and Management. Vol. 1, 3rd ed. Philadelphia, PA: Elsevier Mosby; 2010:488-9Google Scholar Thus, the conjunctival cyst can be separated from surrounding tissues and moves freely in the subconjunctival space. Those features allow sutureless small-incision conjunctival cystectomy. Although a few methods of staining conjunctival cyst with ICG dye and OVDs have already been introduced, the size reduction and separation of conjunctival cyst with this technique, which enables removal through smaller incision, is different from previous techniques.2Kobayashi A. Saeki A. Nishimura A. et al.Visualization of conjunctival cyst by indocyanine green.Am J Ophthalmol. 2002; 133: 827-828Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar The conjunctival incision size depends on the size and number of the cyst, and about one third to half the size of the cyst was enough to remove it. In this case, the incision size was about 4.5 mm. In this study, ICG dye was used to facilitate visualization of the cyst wall because ICG dye was readily accessible in our institute. Previous studies have already reported the effects of trypan blue on visualization of the conjunctival cyst.3Kobayashi A. Sugiyama K. Visualization of conjunctival cyst using Healon V and trypan blue.Cornea. 2005; 24: 759-760Crossref PubMed Scopus (20) Google Scholar, 4Kobayashi A. Sugiyama K. Successful removal of a large conjunctival cyst using colored 2.3% sodium hyaluronate.Ophthalmic Surg Lasers Imaging. 2007; 38: 81-83PubMed Google Scholar As an adjunct to cataract surgery, several dyes have been used to stain the lens capsule to improve visualization. Jacobs et al.10Jacobs D.S. Cox T.A. Wagoner M.D. et al.Capsule staining as an adjunct to cataract surgery: a report from the American Academy of Ophthalmology.Ophthalmology. 2006; 113: 707-713Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar reported that ICG, trypan blue, and fluorescein were each effective in staining lens capsule, but ICG and trypan blue provided better visualization of lens capsule than fluorescein. We think that ICG, trypan blue, and fluorescein can be used to stain the cyst capsule in this technique. However, when compared with the other dyes, fluorescein was less effective in staining lens capsule.10Jacobs D.S. Cox T.A. Wagoner M.D. et al.Capsule staining as an adjunct to cataract surgery: a report from the American Academy of Ophthalmology.Ophthalmology. 2006; 113: 707-713Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar Therefore, it would likely be less effective in staining the cyst capsule. To our knowledge, this is the first report of sutureless small-incision conjunctival cystectomy using an ICG dye through a 30-gauge needle. Small incision conjunctival cystectomy is an effective, time-saving, and less invasive surgical technique for complete removal of conjunctival cyst. This technique increases patient satisfaction by reducing postoperative discomfort and providing cost savings. Supported by: This article was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology ( 2010-0007817 ), Seoul, Republic of Korea. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3ZTk5Y2U3ZjhhZDA2YTkwNWE1M2ZiZGVlNzgzMmMyZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjY3MjI1MTU2fQ.A5Eg0S-BoW3sbj949DMYbcxIms3dABwCJiinBhvw6Q3Tt5OSGOGwxsWYeywLw8dPK3JGNZu8FziZkggBjXAWvUReNZxOg2L8FKzxxNgjHYziAcE7NhzkrSRU2jWTAGmq_4hCJzjvdqWTMZ0qYBijXAWh_Oj-tzaxIotFf814iBzHDDO1j15CEILNIEs3X-1j-8rJPvXIHscMpBB63QuRJYTJLFJqMediW89Womv5G-ublo6JBeSp1_KLC1jyKE29Ffon8Zd4_YbeEDyHlHuIC66HFCwBw1NIjXg7uyQzBjyddfFOfHB-p48ECWvS8w5D-3OLR8n9oCpaBc7eb8xIWA Download .mp4 (11.01 MB) Help with .mp4 files Supplementary Video 1" @default.
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• W2072844354 title "Sutureless small-incision conjunctival cystectomy" @default.
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