Warren Nichelle, Mercer Ryan N, Haddad Jorge, Magrath George, Rocha Karolinne M
Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina Charleston, SC, USA.
Department of Ophthalmology, Mason Eye Institute, University of Missouri Hospital, Columbia, MO, USA.
Am J Ophthalmol Case Rep. 2020 Apr 20;19:100689. doi: 10.1016/j.ajoc.2020.100689. eCollection 2020 Sep.
Report a case of corneal melt in a patient with conjunctival intraepithelial neoplasia (CIN) treated with topical interferon (IFN) alpha-2B.
An 89-year-old man presented with gelatinous paralimbal lesions of the left eye extending onto the cornea with corneal neovascularization extending 5-6 clock hours. Nasally there was mild absence of the terminal vascular loops of the limbal palisades of Vogt and conjunctivalization. Diffuse punctate epithelial erosions were noted. The corneal graft displayed subepithelial and stromal edema. Anterior segment optical coherence tomography detected hyperreflectivity, sectional thickened epithelium, and abrupt transitions from normal to abnormal tissue. The patient was treated with excision of the corneal and conjunctival lesions with cryotherapy to the conjunctival borders. Excisional biopsy revealed CIN Grade 3 and carcinoma in situ of the cornea. Topical IFN alpha-2B four times daily was initiated postoperatively. Two months later, a central epithelial defect developed. The cornea progressively thinned and corneal melt ensued. The patient had several risk factors for corneal melt including neurotrophic cornea, early limbal stem cell deficiency, history of cryotherapy, keratoconjunctivitis sicca, and chronic use of glaucoma medications and steroid medications.
Interferon alpha-2B is an effective first line treatment for CIN with few side effects. It's side effects include punctate epithelial erosions, conjunctival hyperemia, and follicular conjunctivitis. We report a case of pre-existing keratoconjunctivitis sicca, early limbal stem cell deficiency, neurotrophic cornea, and newly diagnosed CIN Grade 3; it was treated with surgical excision, cryotherapy, and topical IFN alpha-2b with development of corneal melt 2 months later. Caution should be taken when using interferon alpha -2b in patients with pre-existing keratoconjunctivitis sicca, neurotrophic cornea, or limbal stem cell deficiency as it could exacerbate these conditions resulting in corneal melt.
报告1例使用局部干扰素α-2B治疗结膜上皮内瘤（CIN）患者发生角膜溶解的病例。
一名89岁男性，左眼出现胶冻样角膜缘病变并延伸至角膜，角膜新生血管延伸达5至6个钟点范围。鼻侧轻度缺乏Vogt角膜缘栅栏的终末血管袢并伴有结膜化。可见弥漫性点状上皮糜烂。角膜移植片表现为上皮下和基质水肿。眼前节光学相干断层扫描检测到高反射性、上皮层增厚以及从正常组织到异常组织的突然转变。患者接受了角膜和结膜病变切除术，并对结膜边缘进行冷冻治疗。切除活检显示为CIN 3级和角膜原位癌。术后开始每日4次局部使用干扰素α-2B。两个月后，出现中央上皮缺损。角膜逐渐变薄，随后发生角膜溶解。该患者存在多种角膜溶解的危险因素，包括神经营养性角膜病变、早期角膜缘干细胞缺乏、冷冻治疗史、干燥性角结膜炎以及长期使用青光眼药物和类固醇药物。
干扰素α-2B是治疗CIN的有效一线药物，副作用较少。其副作用包括点状上皮糜烂、结膜充血和滤泡性结膜炎。我们报告1例既往有干燥性角结膜炎、早期角膜缘干细胞缺乏、神经营养性角膜病变且新诊断为CIN三级的病例；该病例接受了手术切除、冷冻治疗和局部使用干扰素α-2b治疗，2个月后发生了角膜溶解。对于既往有干燥性角结膜炎、神经营养性角膜病变或角膜缘干细胞缺乏的患者，使用干扰素α-2b时应谨慎，因为这可能会加重这些病情，导致角膜溶解。
