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Despoina Theotoka, Sarah Wall, Asaf Friehmann, Anat Galor, Carol Karp; Ocular Surface Squamous Neoplasia Arising from Chronic Inflammation: A Case Series. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3274.
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Chronic inflammation has long been established as a predisposing factor to metaplastic changes as a cellular adaptation and ultimately to dysplasia. The ocular surface, with its presence of limbal stem cells, is susceptible to the same metaplastic and neoplastic changes and yet there is a paucity of literature on the development of ocular surface tumors in the setting of chronic inflammation. The purpose of this study is to identify and describe cases of ocular surface squamous neoplasia (OSSN) directly arising from chronic inflammatory states.
Four eyes from four patients were selected based on the presence of OSSN in the setting of chronic inflammation and availability of confirmatory histopathological analysis. All four eyes were initially referred with a presumptive diagnosis of benign corneal scarring. High resolution optical coherence tomography (HR-OCT) was performed in all cases. The presumptive clinical diagnosis was compared to diagnosis by HR-OCT findings and ultimately to definitive diagnosis by histopathology.
Mean age of the patient population was 50±23 years with two patients aged 30 years or younger and two patients aged 65 years or older. Three of the four patients were male and all four of the patients identified as Caucasian. All four patients were originally referred for corneal scarring in the setting of chronic inflammatory conditions and were ultimately diagnosed with OSSN by HR-OCT findings and definitive histopathological analysis. One patient developed OSSN in the setting of contact lens-related acanthamoeba keratitis, two patients in the setting of ocular rosacea, and the remaining patient in the setting of herpes simplex virus (HSV) keratitis and juvenile ocular rosacea.
OSSN may be misdiagnosed as benign corneal scarring. In the setting of chronic inflammatory conditions, HR-OCT can be a key diagnostic tool in detecting atypical presentations of OSSN. Clinical suspicion should be high for neoplastic transformation in any patient who presents with ocular surface changes amidst a chronic inflammatory process.
This is a 2020 ARVO Annual Meeting abstract.
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