Murillo Juan C, Galor Anat, Wu Michael C, Kye Natasha K, Wong James, Ahmed Ibrahim O, Joag Madhura, Shalabi Nabeel, Lahners William, Dubovy Sander, Karp Carol L
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Fla, USA.
Department of Ophthalmology at Group Health Cooperative, Seattle, Wash, USA.
Ocul Oncol Pathol. 2017 Jan;3(1):66-72. doi: 10.1159/000450752. Epub 2016 Oct 21.
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.
We conducted a clinical pathological retrospective case series.
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.
Patients with a history of OSSN may be at increased risk of neoplastic intraocular extension following intraocular surgery.
本文旨在描述2例结膜眼表鳞状上皮肿瘤（OSSN）在眼内手术后出现角膜内及眼内蔓延的病例。
我们开展了一项临床病理回顾性病例系列研究。
病例1在未被注意到的相邻OSSN情况下接受了白内障手术。随后进行了切除活检并联合冷冻疗法及术中丝裂霉素C治疗，确诊为OSSN。该患者有两次复发，经局部治疗后缓解。虽然结膜保持清晰，但注意到白内障切口部位出现角膜混浊。针对这种混浊进行穿透性角膜移植术（PK）显示为基质浸润性癌。病例2有单纯疱疹性角膜炎病史，最终需要进行角膜移植。15年后，他患上了OSSN，接受了切除活检且切缘清晰。8个月后，他的OSSN复发，接受了4周的局部干扰素短期治疗；然而，他发展为感染性角膜炎并伴有角膜穿孔，需要再次进行PK。PK术后4个月，发现低度炎症。前房穿刺液细胞学检查发现肿瘤性鳞状细胞。随后又进行了一次PK。病理证实存在广泛的眼内肿瘤。进行了有限性眼球摘除术。
有OSSN病史的患者在眼内手术后发生肿瘤性眼内蔓延的风险可能会增加。
