Takahashi Yohei, Goseki Toshiaki, Tatsui Sonoko, Ishikawa Hitoshi, Shoji Nobuyuki
Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, JPN.
Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, JPN.
Cureus. 2024 Aug 8;16(8):e66433. doi: 10.7759/cureus.66433. eCollection 2024 Aug.
A conjunctival cyst is a rare yet significant complication following strabismus surgery. This report describes a nine-year-old girl who developed a conjunctival cyst after undergoing bilateral lateral rectus recession surgery for intermittent exotropia. Despite an uneventful surgery and standard postoperative care, she presented with a gradually enlarging subconjunctival mass in the left eye three months later. Initial conservative treatment with topical antibiotics and steroids proved ineffective, leading to surgical excision six months postoperatively. Histopathological examination confirmed the cyst as a conjunctival epithelial inclusion cyst, characterized by cuboidal epithelium containing goblet cells. The patient's postoperative course was uneventful, with no recurrence of the cyst at six months follow-up, stable visual acuity, and maintained strabismus correction. In managing this case, two crucial lessons were learned. Firstly, the need for precise surgical techniques and the use of adequate pre- and intraoperative disinfection measures to prevent postoperative complications. Ensuring that the conjunctival tissue is not inadvertently included in the wound closure and maintaining a sterile environment throughout the surgery are critical steps. Secondly, the importance of early recognition and timely intervention for postoperative complications. The patient's cyst developed three months post-surgery and did not respond to conservative treatments, necessitating surgical excision. This reinforces the need for heightened awareness and prompt surgical intervention when conservative measures fail, ensuring optimal patient outcomes and avoiding unnecessary discomfort or cosmetic issues. In conclusion, meticulous surgical technique and proper pre- and intraoperative disinfection are paramount in preventing postoperative complications such as conjunctival cysts. Early recognition and timely surgical intervention are essential for managing these cysts effectively. This case reinforces the importance for ophthalmic surgeons to remain vigilant in their surgical practices and to promptly address any postoperative complications, thereby improving surgical outcomes and enhancing patient care in strabismus surgery.
结膜囊肿是斜视手术后一种罕见但严重的并发症。本报告描述了一名9岁女孩，她在接受间歇性外斜视双侧外直肌后徙手术后出现了结膜囊肿。尽管手术过程顺利且术后进行了标准护理，但3个月后她左眼出现了一个逐渐增大的结膜下肿物。最初使用局部抗生素和类固醇进行的保守治疗无效，导致在术后6个月进行了手术切除。组织病理学检查证实该囊肿为结膜上皮包涵囊肿，其特征为含有杯状细胞的立方上皮。患者术后恢复顺利，随访6个月时囊肿未复发，视力稳定，斜视矫正效果维持良好。在处理该病例时，吸取了两个关键教训。首先，需要精确的手术技术以及采取充分的术前和术中消毒措施以预防术后并发症。确保结膜组织在伤口缝合时不被意外纳入，并在整个手术过程中保持无菌环境是关键步骤。其次，术后并发症早期识别和及时干预的重要性。患者的囊肿在手术后3个月出现，对保守治疗无反应，因此需要手术切除。这强化了在保守措施失败时提高认识并及时进行手术干预的必要性，以确保患者获得最佳治疗效果，避免不必要的不适或美容问题。总之，细致的手术技术以及适当的术前和术中消毒对于预防结膜囊肿等术后并发症至关重要。早期识别和及时的手术干预对于有效处理这些囊肿至关重要。该病例强化了眼科外科医生在手术操作中保持警惕并及时处理任何术后并发症的重要性，从而改善斜视手术的治疗效果并提高患者护理质量。
