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First Author: MarijaRadenković SERBIA
Co Author(s): Predrag Jovanović Sonja Cekić Maja Petrović Boban Džunić
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The aim of case presentation is to document succesfull surgical treatment of corneoconjunctival neoplasthic lesion which may threaten visual function if not diagnosed early and treated adequately.
: Ocular surface squamous cell neoplasia is localized lesion of the surface epithelium (conjunctival/corneal intraepithelial neoplasia) or more-invasive squamous cell carcinoma. Variety of squamous cell neoplasia(CIN) is histopathologicaly classified as mild CIN(dysplasia, partial thickness) ,moderate and severe CIN (full-thickness, Ca in situ). Leukoplakia of the lesion is result of secondary hyperkeratosis.
N.R, 73 year male, in april 2013 referred with irritation due to corneoconjunctival mass of left eye. He had increased sun exposure and parkinsonism without comorbidity. Visual acuity of both eyes VOU= 0,5-0,6 ; TOU= 15mmHg; Slit lamp examination: nucleo-cortical opacities of the lens in both eyes, in his left eye temporal interpalpebral bulbar conjunctiva including limbal sector from 2 to 5 o’clock and corneal extension of 6 mm with flattened but sessile papillomatous growth mass and engorged limbal superfitial blood vessels was noted. Approximate diameter of the lesion was 6x8mm with white, gelatinous and opaque appearance. Fundus was atherosclerothicus. According to clinical presentation and size, corneo- conjunctival intraepithelial neoplasia(CCIN) was presumed, an initial surgical treatment is performed. Excisional biopsy using operating microscope and subconjunctival anesthesia is performed using “no –touch technique”. Corneal component is approached first using blade tumour ablation, epithelium and superfitial lamelae are removed. Full-thickness conjunctiva is dissected including underlying Tenon (conjunctivotenonectomy) and excision is made approximately 3- 4 mm outside the tumor margin in one piece without touching lesion or rinsing with balanced salt solution. Conjunctiva is mobilized and closed with interrupted sutures 6,0 leaving 2mm bared sclera.
There was no opportunity to use cryoprobe or antemethabolite at the site of resection. Patient is treated with topical antibiotic, corticosteroid and artifitial drops for 3 weeks. After corneal epithelisation islands of corneal opacities was not found. Pathohistological examination: Specimen exceded completely. Dg Leukoplakio epithelialis inflamans cum displasio gradus II. Ultrasound B scan: without bulbar extension. Orbit in echographic region was clear. Patient is followed in 2-3 month interval without reccurence, conjunctival scarring is present.
The management of ocular surface squamous cell neoplasia of corneoconjunctiva varies with the extent or recurrence of lesion.Treatment consists of serial observation, incisional or excisional biopsy, cryotherapy,topical chemotherapy (MMC 0,04%, 5-FU, interferon alfa 2b -1 million IU/ml), radiotherapy, enucleation, exenteration, mucous membrane grafts from the conjunctiva of the opposite eye, buccal mucosa or combinations of these methods. Advances in molecular markers(p53,Ki67AgNOR) are proposed in prognosis. This case presents that surgery as a timely, single therapeutic management was an effective treatment of these lesion( CIN grade II, moderate dysplasia of two thirds epithelium) in short-term follow up period. Larger controlled studies with longer follow-up periods are recommended to confirm the long-term efficacy and safety of treatment. FINANCIAL INTEREST: NONE