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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