A Novel Approach to Treatment of Conjunctival Cyst Ablation Using Atmospheric Low-Temperature Plasma

Figures & data

Figure 1 Steps of the PANIS method to remove the conjunctival cyst. (A) Place the patient behind the slit lamp and use the white handpiece of Plexr device (B) The cyst of patient No. 5 (C) Apply the first spot to drain the fluid of the cyst (D) Apply consecutive spots at the edge of the cyst (E) Continue the spots and reach the initial spot (F) Apply some spots to the base of the cyst to prevent recurrence and around the cyst to fuse conjunctival tissue to the underlying layers (G) End of the surgery and complete removal of the cyst.

Table 1 Patients Characteristics and Parameters Measured in Different Examinations

Case 1: Female (51-Year-Old), Cyst Site: Inferior Temporal Forniceal, Cyst Size: 3.6 X 1.8 Mm
Examination time	UDVA (Decimal)	Refraction			CDVA (Decimal)	IOP (mmHg)	TBUT (s)	TMH (mm)	CFS grade ^†	Schirmer (mm)	OSDI score*	CS (logMAR)	Total aberration (Micron)
		Sphere	Cylinder	Axis
Preop.	0.7	0.5	0	0	0.9	16	5	0.2	I	4	8.33	1.64	0.894
1 month postop.	1	0	0	0	1	15	3	0.15	0	3	8.33	1.68	0.551
6 months postop.	1	0	0	0	1	12	4	0.15	0	4	8.33	1.56	0.513
Case 2: Female (50-year-old), Cyst site: Temporal, Cyst size: 3.4 x 0.9 mm
Examination time	UDVA (Decimal)	Refraction			CDVA (Decimal)	IOP (mmHg)	TBUT (s)	TMH (mm)	CFS grade ^†	Schirmer (mm)	OSDI score*	CS (logMAR)	Total aberration (Micron)
		Sphere	Cylinder	Axis
Preop.	0.8	0	−1	90	0.9	12	12	0.2	II	8	8.33	1.36	0.638
1 month postop.	0.7	0.5	−1.5	90	0.8	16	8	0.3	0	5	6.25	1.4	0.488
6 months postop.	0.8	0	−1	90	0.9	12	18	0.2	0	10	0	1.36	0.3
Case 3: Female (34-year-old), Cyst site: Temporal, Cyst size: 4 x 4 mm
Examination time	UDVA (Decimal)	Refraction			CDVA (Decimal)	IOP (mmHg)	TBUT (s)	TMH (mm)	CFS grade ^†	Schirmer (mm)	OSDI score*	CS (logMAR)	Total aberration (Micron)
		Sphere	Cylinder	Axis
Preop.	0.7	−0.75	0	0	1	11	22	0.2	0	6	7.5	1.76	0.836
1 month postop.	0.9	−0.5	0	0	1	10	18	0.2	0	6	7.5	1.76	0.486
6 months postop.	0.9	−0.5	0	0	1	11	20	0.2	0	6	0	1.76	0.766
Case 4: Male (69-year-old), Cyst site: Nasal, Cyst size: 6.1 x 3.5 mm
Examination time	UDVA (Decimal)	Refraction			CDVA (Decimal)	IOP (mmHg)	TBUT (s)	TMH (mm)	CFS grade ^†	Schirmer (mm)	OSDI score*	CS (logMAR)	Total aberration (Micron)
		Sphere	Cylinder	Axis
Preop.	CF	10	−8	80	0.1	5	10	0.2	III	6	14.58	0.24	3.974
1 month postop.	CF	10	−8	80	0.05	4	12	0.2	II	5	0	0.24	7.266
6 months postop.	CF	5	−7	60	CF	6	10	0.2	0	6	0	0.48	6.815
Case 5: Male (63-year-old), Cyst site: Nasal, Cyst size: 6 x 2.6 mm
Examination time	UDVA (Decimal)	Refraction			CDVA (Decimal)	IOP (mmHg)	TBUT (s)	TMH (mm)	CFS grade ^†	Schirmer (mm)	OSDI score*	CS (logMAR)	Total aberration (Micron)
		Sphere	Cylinder	Axis
Preop.	0.6	0	−1	160	0.6	17	5	0.2	I	9	22.72	1.44	0.275
1 month postop.	0.6	0	−0.5	115	0.6	16	5	0.2	0	8	2.7	1.44	0.399
6 months postop.	0.6	−0.25	−0.25	130	0.6	11	5	0.2	0	8	2.7	1.44	0.455

Notes: ^†An Oxford grading scheme was used to determine the corneal staining, which shows the severity of dry eye. This grading has six different degrees including 0, I, II, III, IV, and V, which are described as absent, minimal, mild, moderate, marked and severe, respectively.²⁸ *The OSDI questionnaire consists of 12 questions. The answer to each question is graded on a scale of 0 to 4, which 0 corresponds to “none of the time” and 4 corresponds to “all of the time”. This score, which is a number between 0 and 100, is calculated using this formula: OSDI score= [(sum of scores for all questions answered) x 100]/[(total number of questions answered) x 4]. A score between 0 and 12 indicates normal, 13 to 22 indicates mild dry eye, 23 to 32 indicates moderate dry eye, and more than 33 indicates severe dry eye.²⁹

Figure 2 Patient slit lamp images (A) before (B) six months after treatment.

Table 2 Various Methods for Removing Conjunctival Cysts

Author (s) (Year)	Methods	Office-Based	Type of Anesthesia	Eyes (n)	Cyst Size (mm)	Follow-Up Time (month)	Complications	Eyes with Recurrence (n)
Bustros and Michels (1984)^Citation11	Nd: YAG laser	Yes	Topical	1	N/M	3	No	0
Hawkins and Hammin (2001)^Citation4	Thermal cautery	Yes	Local	3	Small	1–2	No	0
Yien et al (2009)^Citation6	Use of sodium hyaluronate and indocyanine green for conjunctival cyst excision	N/M	N/M	1	4.5	N/M	N/M	N/M
Kothari (2009)^Citation5	Isopropyl alcohol with paired injection technique	Yes	Topical	2	Small	9	Patient burning sensation during exam.	0
Han et al (2012)^Citation10	Argon laser photoablation	N/M	Topical	1	3	6	No	0
Eom et al (2014)^Citation8	Sutureless small-incision conjunctival cystectomy	N/M	Topical then local	4	N/M	2–6	N/M	0
Park et al (2015)^Citation7	High-frequency radio-wave electrosurgery	N/M	Topical	21	N/M	6–14	Mild foreign body sensation for two days in two patients	0
Yang et al (2017)^Citation22	Pattern scan laser photocoagulation (PASCAL)	N/M	Topical	1	3.5	6	Minimal amount of subconjunctival hemorrhage	0
El-Abedin Rajab and Demer (2019)^Citation2	Surgical excision of conjunctival retention cyst using trypan blue with methylcellulose	No	2 Local 1 General	3	N/M	24	N/M	1
Han et al (2020)^Citation21	Modified argon laser photoablation	Yes	Topical	17	4.8 (range 3–8)	6–28	Hemorrhage in one patient during surgery, two eyes developed mild conjunctival swelling and foreign body sensation post-operative	3

Abbreviations: Cyst size, mean of horizontal and vertical diameters; N/M, not mentioned.

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