Transcript Conjunctival Lymphangiectasia: Clinicopathological

Conjunctival Lymphangiectasia:
Clinicopathological Features and Surgical
Management
Douglas Lyall 1
Fiona Roberts 2
Sathish Srinivasan 1,3
1 Department
of Ophthalmology, Ayr Hospital, Ayr, Scotland
2 Department of Pathology, Western Infirmary, Glasgow, Scotland
3 University of Glasgow, Glasgow, Scotland
The authors have no financial interest in the subject matter of this poster
Introduction
• Conjunctival Lymphangiectasia (CL) is a localised or diffuse
dilatation of the lymphatic channels of the conjunctiva
• This gives the clinical appearance of chemosis or of a
mobile cyst within the conjunctiva
• When localised it may be in response to underlying
conjunctival disease
• In diffuse cases it may be idiopathic or associated with
systemic disease
• Patients may complain of symptoms of ocular surface
disease including irritation, epiphoria and blurred vision
• Previously reported management strategies include simple
excision, marsupialization and cryotherapy
Purpose
• To report the clinicopathological features of CL
• To describe surgical options available in managing
this condition
Methods
• Retrospective case note review of patients with a
confirmed histopathological diagnosis of CL
• Cases were identified from records of a regional
ocular pathology centre
•
Age at presentation
• Data recorded:
•
Gender
•
•
•
Presenting signs and symptoms
Histopathological features
Management and outcomes
Results
• Demographics:
Patients
13
Male : Female
7:6
Number of eyes (n)
14
Mean age at presentation (years)
45.4
• Presenting Characteristics:
Chemosis ± hyperaemia
14
* Diffuse chemosis
8
* Localised chemosis
6
Time from onset of
symptoms to biopsy
2 months
to 10 years
• Ocular Co-morbidity:
Previous Ocular Surgery:
Blepharitis
Meibomianitis
Trabeculectomy
Allergic conjunctivitis
Ectropion
Cataract Surgery
Clinical Appearances
Fig. 1
Fig. 3
Fig. 2
Fig. 4
• Inferotemporal translucent swelling of the bulbar conjunctiva in both eyes
(arrowed)
Anterior Segment OCT
Fig. 5
Fig. 6
• Anterior segment OCT images of both eyes showing cystic spaces within the
conjunctiva
Management of Cases
• 14 eyes underwent simple excisional biopsy
• 2 eyes had excisional biopsy combined with
amniotic membrane transplantation (AMT) and
fibrin glue
Outcomes
• 4 eyes undergoing excisional biopsy had
recurrence of chemosis and associated symptoms
• 2 eyes undergoing excisional biopsy with AMT
had no recurrence of chemosis
Surgical Excision with AMT
Supplemental Video File
Post Operative Appearance
Fig. 7
Fig. 8
• Fig. 7: Appearances 2 weeks following
surgery in the right eye (OD) with AMT.
Minimal inflammation with no
evidence of wound dehiscence
• Fig. 8 & 9: Bilateral absorption of AMT
with a well healed conjunctival surface
and no recurrence of chemosis at 6
months
Fig. 9
Histopathology Findings
• Squamous metaplasia of the
surface mucosa (arrow)
Fig. 10
• Marked edema of the lamina
propria and stroma with
numerous dilated lymphatic
channels (asterisk)
• Chronic inflammation of the
stroma including lymphocytes
and plasma cells (arrow head)
Fig. 11
Conclusions
• Clinical Findings of Conjunctival Lymphangiectasia
– Chemosis and hyperaemia occurs in both diffuse and
localised forms
– It is associated with various ocular surface disease
conditions and previous ocular surgery
• Histopathological Findings
– Diffuse dilatation of conjunctival lymphatic channels
and secondary stromal oedema
– Associated with secondary chronic conjunctival
inflammation
Conclusions
• Surgical management options of CL in our series
include:
– Total excisional biopsy
– Total excisional biopsy with amniotic membrane
transplantation and fibrin glue
• Proposed benefits of performing excision with
AMT and fibrin glue:
– Eliminates need for suturing and shortens operating
time
– Reduces postoperative inflammation and discomfort