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First Author: MajaMerlak CROATIA
Co Author(s): Marijana Bilen Babic Andrea Dekanic Renata Grzetic-Lenac
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Aim of the poster is to present case report of ocular surface squamous neoplasia ( OSSN ) with very low incidence ( from 0.02 - 3.5 / 100 000 per year ) and to highlight clinical features, our diagnostic algoritm and managment of squamous cell epithelium tumor of conjunctiva and cornea.
: In march 2013 73 -year-old man presented with symptoms of redness, itching and pain with later visual disturbance and tumefaction in the left eye during last 7 months at emergency ambulance of Department of Ophthalmology Clinical Hospital Center Rijeka, Croatia. Following examination, diagnostics and treatment were performed.
Our initial managment of OSSN included complete ophthalmologic examination ( visual acuity, slit lamp examination, intraocular pressure, fundus examination, gonioscopy). Ocular surface changes were photodocumented. Impression cytology of the corneal–conjunctival lesion performed reported malignant cells of squamous epithelium. Magnetic resonance imaging of the left orbit reported no intraocular/intraorbital invasion. Patient was also presented to the oncologist. Therapy consisted of : complete surgical eradication ( excisional biopsy with resection of tumor-free margin of 3-4 mm and deep to Bowman layer ) and intraoperative cryotherapy of the cut conjunctival edge and base. Following topical chemotherapy with 0.02% Mitomycin (MMC) drops administered daily for 2 minutes during 14 days. Control excisional biopsy of conjunctival edge and corneal abrasion was performed following the last day of therapy. At the end of surgical treatment, three days after control excisional biopsy, amniotic membrane was transplanted for ocular surface reconstruction.
Control excisional conjunctival-corneal biopsy after mitomycin aplication revealed negative conjunctival and tumor cells positive corneal tissue. 0,04% Mitomycin drops were administered 4 times daily for 3 weeks. Follow up visit was done at the end of the chemotherapy and 2 weeks after, following mothly visits. At present moment slit lamp examination shows complete resolution of the lesion with only light macula on prior surgical treated cornea. At the time of writing, the patient has been followed-up for 6 months with no recurrence. There were no recorded complications due to use of MMC. Patient will be carefully monitored for following period.
OSSN is very rare, occurs in sun damaged ocular surface, usually at the limbus in elderly men. Recurrence of OSSN after treatment is common with significantly increased risk for older patients, following surgical treatment has been reported in up to 50% of cases. Incomplete excision with positive surgical margins has been identified as a major risk factor for recurrence .Topical MMC has been established as an effective adjuntive treatment option that delivers high drug concentrations and can help in treatment of diffuse or deep lesions. In our case, combination of surgical exision with topical 0,02% MMC drops for 14 days was followed after 15 days with the second cycle of 0.04% MMC for 3 weeks. The result of the treatment algorithm produced eradication of OSSN with special caution for future monitoring of the patient. FINANCIAL INTEREST: NONE