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

Abstract

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.

Intraocular Invasion of Ocular Surface Squamous Neoplasia Through a Corneal Wound

“…Tumor extension can occur either through direct scleral invasion, invasion along the tract of the anterior ciliary vessels, or tumor inoculation through an intraocular surgery incision. A literature review revealed six reports of invasive OSSN specifically resulting from extension through a corneal wound (Table 1) [5][6][7][8][9].…”

“…There are very few cases in the literature describing intraocular OSSN tumor extension through a corneal wound, with clinical presentations ranging from intrastromal corneal opacities to anterior chamber masses [5][6][7][8][9]. Herein, we report a case of intraocular OSSN invasion through a prior cataract surgery incision that presented as a rapidly growing anterior chamber membrane, with treatment requiring modified enucleation with a dermis fat graft.…”

Conjunctival Squamous Cell Carcinoma with Corneal Stromal Invasion in Presumed Pterygia: A Case Series

“…This phenomenon's mechanism is thought to be associated with the disruption of the Bowman layer, which is thought to serve as a barrier for tumor invasion [7]. Patients with a history of OSSN who undergo intraocular surgery such as cataract surgery are at increased risk of neoplastic intraocular extension [39]. The only surgical procedure our patients reportedly had was the initial simple excision of the presumed pterygium; they did not have any subsequent intraocular surgery prior to the development of corneal invasion.…”

Management Issues in Conjunctival Tumours: Ocular Surface Squamous Neoplasia

“…OSSN is an uncommon condition in the UK [3]. However, if unrecognised, or if there is residual disease after treatment, it can be become invasive to the deeper tissues of the eye via a tract opened by intraocular surgery [73]. Intraocular spread of OSSN can present as a corneal opacity due to invasion of the corneal stroma, an intraocular mass or cells in the aqueous or vitreous.…”

“…Intraocular spread of OSSN can present as a corneal opacity due to invasion of the corneal stroma, an intraocular mass or cells in the aqueous or vitreous. If there is extensive invasion of squamous cell carcinoma, management by lid-sparing exenteration should be considered [73]. If the spread is limited to the cornea, topical chemotherapy or radiotherapy can be attempted.…”