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Lily Zhang, Carolina Mercado, Anat Galor, Gaofeng Wang, Carol Karp; Atopy and Ocular Surface Squamous Neoplasia. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3940.
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© ARVO (1962-2015); The Authors (2016-present)
Few studies have described ocular surface squamous neoplasia (OSSN) and its association with atopic diseases and there is no consensus on the course of OSSN in atopic patients. We thereby report 3 patients with atopy and OSSN, focusing on presenting features and unique response to therapy.
Retrospective chart review from 2014 to 2016 of patients with clinical history of atopy who presented with OSSN to the Bascom Palmer Eye Institute.
Three male patients with mean age of 73 presented with OSSN and history of atopy with ocular manifestations. Their histories were significant for atopic dermatitis and keratoconjunctivitis. All patients had treatment courses complicated by multiple surgeries, recurrences, or advanced disease. One patient also had keratolimbal allograft transplantation to treat limbal stem cell deficiency. The patients initially received medical treatment with topical interferon-alpha-2b (IFNα2b). However, all patients had recurrences and eventual eradication with 5-fluorouracil (5-FU).
Three patients with history of atopy whose OSSN were associated with aggressive disease, frequent recurrences and required multiple treatment modalities. IFNα2b therapy was marked by partial response and recurrences. These cases suggest the immune hyperactivity of atopy affects both OSSN course and how medical therapy combats OSSN. More research is needed to elucidate how atopy affects OSSN presentation and treatment. Our study suggests topical 5-FU may be a better therapy compared to IFNα2b, and aggressive treatment and vigilance may be beneficial for patients with atopy and OSSN.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Biomicroscopy of case 1 illustrates (a) opalescent and gelatinous tumor at 3 to 10 o'clock with vascularity and rose bengal stain (white arrows); (b) HR-OCT with thickened hyper-reflective epithelium (white arrows), and abrupt epithelial transition (black arrow); (c) 2 months of 5-FU shows drastic improvement with mild subepithelial haze; (d) HR-OCT confirms normalized epithelium with mild residual hyper-reflectivity.
Biomicroscopy of case 2 illustrates (a) opalescent and gelatinous lesion at 2 to 4:30 o'clock limbus with 4mm extension onto cornea (white arrows) at edge of limbal autograft; (b) HR-OCT confirms recurrent OSSN with thickened, hyper-reflective epithelium (white arrow) and abrupt epithelial transition (black arrow). (c) Resolution after 4 rounds of 5-FU; note atopic eyelid scarring. (d) HR-OCT confirms thin, normalized epithelium.
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