Ablation Of The Large Conjunctival Cyst (21.68 × 10.5 Mm) Using Plasma-Assisted Noninvasive Surgery (Panis) With 1-Year Follow-Up; A Clinical Case Report

A conjunctival cyst is a fluid-filled sac on the conjunctiva of the eye which can consist of clear or turbid fluid. Using YAG laser, thermal cautery, isopropyl alcohol with paired injection technique, argon laser, sutureless excision, high-frequency radio-wave electrosurgery, hydrodissection, and on block resection of the fibrous band, trypan blue with methylcellulose are techniques available so far. In the following study, we introduce plasma-assisted noninvasive surgery (PANIS) as a new method for large conjunctival cyst excision.

for this purpose, patient underwent some examinations. Visual parameters such as refraction error, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and ocular surface disease index (OSDI) were measured before the surgery, six months, and 1 year after the surgery.

Plasma spots were used to drain the large conjunctival cyst with a Plexr device in a 78-year-old female. A solitary, non-tender, soft, cystic mass was present on the inferior fornix of the left eye, which measured 21.68 × 10.5 mm and contained clear fluid. Her symptoms were tearing, foreign body sensation, difficulty in blinking, and visual disturbances. After local anesthesia with 0.5% topical tetracaine (Sina Darou, Tehran, Iran) 3 times and with 5 minutes intervals, the patient has placed behind the slit lamp and the surgeon used the white handpiece of the PLEXR device as our plasma generator to apply a spot to the highest site of the cyst. It ionizes air between the tip of the device and the target tissue and causing it to sublimate. Other spots were applied continuously at the boundary of the lesion. A few more spots were applied to the base of the cyst to prevent further recurrence by scar formation in the base of the conjunctiva. The patient was without any complications and with satisfaction. After six months and 1 year of follow-up, UCVA, BCVA, and refraction error have changed slightly and the OSDI has decreased significantly. No recurrence has been seen after one year of follow-up.

Cyst removal treatment with the PANIS method is a safe, office-based, minimally invasive, effective, and inexpensive way to remove a conjunctival cyst even in large ones.