Avoiding Blindness After Successful Management Of A Total Corneal Leukoma Due To Squamous Cell Carcinoma. Case Report.

To report the challenging diagnosis in an ocular surface squamous cell neoplasia with an atypical clinical presentation. We also provide insight into its treatment management and the current knowledge for comparable situations. 

 

Ophthalmology department. Hospital Universitario Virgen de la Victoria, Málaga.

A 65-year-old male complaining of severely decreased vision in his left eye (OS) with a previous diagnosis of corneal leukoma, was referred to our corneal consultation. There was no history of surgery or ocular trauma. Snellen’s best-corrected visual acuity was 20/200 in his right eye (OD) due to amblyopia, and 20/100 in his OS. Slit-lamp anterior chamber examination revealed a diffuse corneal infiltration with two nodular lesions affecting the visual axis in OS. Inferior 180 degrees of limbus was also affected. A presumptive diagnosis of ocular surface squamous cell carcinoma was made for OS based on clinical features. Corneal anterior segment tomography was performed. Surgical alcohol epitheliectomy for the corneal component and partial lamellar scleroconjunctivectomy with wide margins for the conjunctival component, followed by double freeze‑thaw cryotherapy to the remaining adjacent bulbar conjunctiva was done. Histopathology of the corneal sample showed a squamous carcinoma, and was unable to confirm the absence of neoplasia infiltration. The  limboconjuntival sample revealed a subepithelial elastosic degeneration with mild dysplasia. Due to the extensive corneal component and anatomopathological results, topical mitomycin C 0.02% for two cycles with close patient monitoring was used. After three months of follow-up, Snellen´s best-corrected visual acuity was 20/30 in OS, achieving tumour regression evidenced by slit-lamp examination and anterior segment tomography.

 

Visual repercussion related to the correct treatment of cornea and conjunctiva neoplastic lesions, highlights the importance of referring patients to specialized centres. The quality of life of our patients depends on their quality of vision.