Metaplastic squamous epithelial downgrowth after clear corneal cataract surgery

Intraocular Invasion of Ocular Surface Squamous Neoplasia Through a Corneal Wound

Purpose

We report a case of intraocular invasion of ocular surface squamous neoplasia (OSSN) through a cataract surgery wound that manifested as an anterior chamber membrane, and perform a review of the literature.

Methods

An 87-year-old woman with history of an incompletely excised OSSN 10 days prior presented with decreased vision due to an anterior chamber membranous film that seemed connected to an old cataract wound. The membrane was biopsied, and histopathology revealed dysplastic squamous epithelial cells of conjunctival origin. Ten days later the tumor expanded to cover the entire iris surface, and a modified enucleation was performed.

Results

Histopathology revealed invasive OSSN extending deep to the ciliary body and laterally into the anterior chamber. The patient developed a submandibular node metastasis 7 months later. Literature review revealed six cases of invasive OSSN resulting from extension through a corneal wound, with varied presentations and outcomes.

Conclusion

Our case is the first to report invasive OSSN presenting as an anterior chamber membrane as a result of incomplete excision of an ocular surface malignancy adjacent to a corneal wound poses a risk for intraocular tumor extension and distant metastasis.

Electronic supplementary material

The online version of this article (10.1007/s40123-020-00294-2) contains supplementary material, which is available to authorized users.

Ocular surface squamous neoplasia with intraocular tumour extension: a study of 23 patients

PURPOSE

To describe the clinical features, histopathology and treatment of ocular surface squamous neoplasia (OSSN) with intraocular tumour extension.

METHODS

Retrospective study of 23 patients.

RESULTS

The mean age at presentation of OSSN with intraocular tumour extension was 48 years. Mass (52%) and pain with redness (30%) were the most common presenting complaints. The mean duration of symptoms was 9 months. History of human immunodeficiency virus (HIV) infection was present in eight (35%) patients and one (4%) had xeroderma pigmentosum. History of prior tumour excision was noted in 16 (70%) patients. The mean basal diameter was 17 mm and the mean tumour thickness was 4 mm. Fifteen (65%) tumours had a nodulo-ulcerative tumour pattern at the time of detection of intraocular extension of OSSN. Anterior chamber cells and flare was noted in five (24%) cases and two (9%) patients had secondary glaucoma. Ultrasound biomicroscopy (UBM) (n = 11) revealed blunting of anterior chamber in three (27%) cases and uveal thickening in seven (67%) cases. Over the course of follow-up, extended enucleation (n = 6; 26%) or orbital exenteration (n = 17; 74%) was required for tumour control. At a mean follow-up period of 18 months, locoregional lymph node metastasis was seen in two (9%) patients, and one patient died with systemic metastasis. On histopathology, ciliary body was involved in all (100%) cases.

CONCLUSION

Multiple tumour recurrences with history of prior tumour excision and nodulo-ulcerative tumour pattern are commonly associated with intraocular tumour extension of OSSN. UBM is a useful tool to detect intraocular extension of OSSN.

Intracorneal and Intraocular Invasion of Ocular Surface Squamous Neoplasia after Intraocular Surgery: Report of Two Cases and Review of the Literature

PURPOSE

The aim of this paper was to describe 2 cases of ocular surface squamous neoplasia (OSSN) of the conjunctiva with intracorneal and intraocular extension following intraocular surgery.

METHODS

We conducted a clinical pathological retrospective case series.

RESULTS

Case 1 underwent cataract surgery in the setting of an unnoticed adjacent OSSN. An excisional biopsy with cryotherapy and intraoperative mitomycin C was subsequently performed, confirming OSSN. The patient had two recurrences treated topically with resolution. While the conjunctiva remained clear, a corneal haze emanating from the cataract incision site was noted. Penetrating keratoplasty (PK) for this haze revealed midstromal infiltrative carcinoma. Case 2 had a history of herpes simplex keratitis that ultimately required corneal grafts. Fifteen years later, he developed an OSSN treated with excisional biopsy and had clear margins. Eight months later, he presented with a recurrence of his OSSN and was treated briefly with topical interferon for 4 weeks; however, he developed an infectious keratitis with a corneal perforation requiring another PK. Four months after PK, low-grade inflammation was noted. Cytology of the anterior chamber aspirate revealed neoplastic squamous cells. Another PK was then performed. Pathology confirmed extensive intraocular neoplasia. Limited exenteration was performed.

CONCLUSION

Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.

Epithelial downgrowth after cataract surgery: an atypical presentation with scleral thinning and massive seeding in anterior chamber

PURPOSE

To report an atypical presentation of epithelial downgrowth (ED) after clear cornea cataract extraction, characterized by mixed clinical expression of both cystic and diffuse form and massive epithelial debris seeding in anterior chamber, associated with scleral involvement.

METHODS

In this case report, fine needle anterior chamber aspiration cytology was performed to identify pathologic tissue invading iris, cornea, and angular structures. The patient was treated with anterior chamber membrane surgical excision.

RESULTS

Epithelial downgrowth was identified by cytologic assessment. The patient was treated with epithelial membrane peeling and scleral defect conjunctival covering. This conservative surgical approach led to a significant reduction of ocular pain. During follow-up, residual epithelial tissue was present in anterior chamber without tendency to regrowth.

CONCLUSIONS

In doubtful cases of ED, histocytopathologic analysis should be performed without hesitation. Avoiding more invasive procedures, early detection and prompt surgical approach can result in improved outcome even in case of extensive intraocular involvement.

Clinical and pathological report of an unusual anterior chamber lesion: A case report

To describe an unusual anterior chamber lesion found on routine eye examination of a 71 year-old Hispanic gentleman who presented for cataract evaluation. The lesion was biopsied at the time of cataract surgery and its pathology presented.

A 71 year-old Hispanic gentleman presented for routine cataract evaluation. We found an unusual lesion in the anterior chamber of the right eye. The patient underwent uneventful phacoemulsification surgery. The lesion was biopsied at the time of cataract surgery and sent for pathology. Clinical photos and its pathology are presented in this article.

Despite biopsy and several ancillary testings, the nature of this lesion remains unknown. Only long-term follow-up of the left eye might reveal clues as to the origins of this unusual lesion.