Trauma’S Mirage: Exposing Corneal Intraepithelial Neoplasia Hidden In Plain Sight

This case report discusses the atypical presentation of corneal intraepithelial neoplasia, which can resemble a post-traumatic condition. The patient was initially diagnosed with an ectatic cicatrix following penetrating ocular trauma but was later found to have ocular surface squamous neoplasia (OSSN). The purpose of this report is to underscore the importance of clinical suspicion, the role of microscope integrated optical coherence tomography (OCT) in surgical planning, and the potential for visual rehabilitation even in the presence of an aggressive neoplastic condition.

Tertiary care centre in Western India

A 73-year-old male presented with gradual vision loss and a progressive corneal mass following a history of ocular trauma. Initially, his condition was misdiagnosed as long-standing post-traumatic ectatic cicatrix. However, upon further evaluation and clinical evaluation , the mass appeared to be arising from the centre of cornea with circumferential feeder vessels raising the suspicion of ocular surface squamous neoplasia. Patient was taken up for microscope-integrated OCT-guided surgical excision. Donor corneal tissue was kept in reserve to cater for intraoperative tectonic penetrating keratoplasty. On intraoperative excision, the mass was removed in toto.Excision biopsy was done and tissue was sent for histopathological analysis which confirmed a diagnosis of Grade III corneal intraepithelial neoplasia (CIN-III). The margins were treated by cryotherapy and amniotic membrane transplantation was done. This treatment led to partial visual recovery, achieving a vision of 20/200 at six months post-surgery, with no signs of recurrence.

Corneal intraepithelial neoplasia may present similarly to post-traumatic changes, which can result in delayed or misdiagnosed cases.

Optical Coherence Tomography (OCT)-guided excision is crucial for differentiating neoplastic conditions from non-neoplastic corneal opacities, thus averting unnecessary keratoplasty.

Histopathology continues to be the gold standard for diagnosing ocular surface squamous neoplasia (OSSN) and should be performed on any suspicious corneal lesions.

Prompt intervention, precise surgical techniques, and the application of adjuvant therapies can effectively reduce the risk of recurrence and facilitate functional visual rehabilitation.