Matos Diogo Bernardo, Guerra Paulo, José Patrícia, Ferreira Rui, Quintas Ana, Neves Carlos Marques
Centro Hospitalar Universitário Lisboa Norte - Serviço de Oftalmologia, Portugal; Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Portugal.
Centro Hospitalar Universitário Lisboa Norte - Serviço de Oftalmologia, Portugal; Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Portugal.
Int J Surg Case Rep. 2023 Jul;108:108394. doi: 10.1016/j.ijscr.2023.108394. Epub 2023 Jun 16.
Introduction and importance: Ocular Surface Squamous-cell Neoplasia (OSSN) is an infrequent diagnosis whose clinical suspicion assumes great importance and should not be overlooked. The following case-report aims to describe the diagnosis and treatment of a patient with OSSN whose complaints were mild in comparison to the severity of the disease. The chosen surgical technique was paramount for a disease-free outcome while minimizing the scarring effects of surgical removal.
Patient presented mild discomfort right eye and painless persistent hyperaemia. Slit-lamp observation showed a clear diagnosis and lesion's extent evaluated through multimodal imaging. After surgical excision the patient underwent topical ocular treatment with mitomycin-C for a higher margin of safety even before the pathology results were available.
Ancillary exam technology improvement has allowed a higher margin of safety while determining the extent of OSSN lesions. In the absence of clear diagnostic criteria and guidelines, clinical reasoning and OSSN awareness are critical for timely diagnosis and treatment, as several treatment options are available, allowing an increasing number of patients to be treated non-invasively. In this case-report, we highlight the importance of early-recognition and the reasoning for choosing a combined treatment option with a higher margin of safety.
Early recognition and prompt treatment of OSSN lesions is of paramount importance to avoid ocular invasiveness and potentially preclude both ocular and systemic complication. The choice of a combined surgical and medical approach may provide a higher margin of safety for suitable cases. This patient is currently disease-free at 6-month follow-up.
引言与重要性:眼表鳞状细胞癌(OSSN)是一种不常见的诊断,临床怀疑具有重要意义,不应被忽视。以下病例报告旨在描述一名OSSN患者的诊断和治疗,该患者的症状与疾病严重程度相比相对较轻。所选择的手术技术对于实现无病结局并最大限度减少手术切除的瘢痕形成影响至关重要。
患者右眼出现轻度不适和无痛性持续性充血。裂隙灯检查明确诊断,并通过多模态成像评估病变范围。手术切除后,即使在病理结果出来之前,患者也接受了丝裂霉素-C局部眼部治疗,以提高安全性。
辅助检查技术的改进在确定OSSN病变范围时提高了安全性。在缺乏明确诊断标准和指南的情况下,临床推理和对OSSN的认识对于及时诊断和治疗至关重要,因为有多种治疗选择,使越来越多的患者能够接受非侵入性治疗。在本病例报告中,我们强调了早期识别的重要性以及选择高安全性联合治疗方案的理由。
早期识别和及时治疗OSSN病变对于避免眼部侵袭并可能预防眼部和全身并发症至关重要。对于合适的病例,选择手术和药物联合治疗方法可能提供更高的安全性。该患者在6个月随访时目前无疾病。