A Master Malignant Masquerader Under Amnion Graft Influence

To determine firstly the diagnosis of the conjunctival and corneal lesion which had enveloped 270 degrees of the limbus of a female patient's left eye, and secondly to discusss the management process once the lesion had been removed and diagnosis made.

46 year old patient with long standing herpetic eye disease suddenly develped a mass over the superotemptal aspect of the limbus which quickly spread inferiornly and eventually nasally. Lesion was pale and non pigmented and looked vernal clinically.

Lesion was excised with margins where possible but was infiltrating into limbus.

Wide conjunctival peritomy done with corneal epithalial debridement.

Large freeze dried amnion membrane from Amniomatrix used to drape over the cornea and resected areas sealed with Tisseel glue.

Graft left in siut for two weeks whilst histology confirmed high grade MM. 

After discussion with Ocular oncolgist, o.o4% topicl MCC was initiaited cyclically QID for 5 weeks with a punctum plug inserted.

Patient was reviewd at 6 weeks with a completely quiet eye, no sign of clinical recurrence. Lesson learnt is that although this was a malignant lesion, we treated conservatively with graft anf then MMC but it can still have a potent effect for remaining neoplastic cells to be erradicated, thereby saving the eye!

The patient is comfortable and can see. We pan metastatic routine follow ups along with clinical evaluation and potentially trans-epithelial topography guided laser to regularize the anterior stroma.