Incidentally detected primary corneal squamous neoplasia in an elderly man presenting with cataract

Corneal squamous neoplasia: masquerades and management outcomes at a rural eyecare centre

The authors describe two cases of corneal ocular surface squamous neoplasia (OSSN), presenting at our rural eyecare centre, which were initially misdiagnosed as viral epithelial keratitis and corneal pannus with focal limbal stem cell deficiency. Both the cases were refractory to initial treatment and corneal OSSN was suspected. Anterior segment-optical coherence tomography (AS-OCT) revealed a thickened, hyper-reflective epithelium with abrupt transition and an underlying cleavage plane, features typical of OSSN. Topical 1% 5-fluorouracil (5-FU) therapy was initiated and in two cycles (first case) to three cycles (second case), complete resolution was noted both clinically and on AS-OCT, with no significant side effects. Both patients are currently free of tumour at the 2-month follow-up period. The authors report the rare, atypical presentations of corneal OSSN, discuss the masquerades and highlight the role of primary topical 5-FU in managing corneal OSSN in limited resource settings.

Isolated keratinising corneal ocular surface squamous neoplasia with multifocal recurrence

Corneal ocular surface squamous neoplasia usually begins at the limbus and presents as an avascular translucent sheet over the corneal surface. This case report describes a 67-year-old man with an unusual isolated, keratinous nodular corneal lesion. Slit-lamp examination showed an elevated, avascular, whitish plaque-like lesion at the central cornea surrounded by a normal corneal epithelium, with reduced visual acuity of 20/200 in the right eye. Anterior segment optical coherence tomography displayed a hyper-reflective, thickened epithelium with back shadowing. Histopathology showed keratinising hyperplastic stratified squamous epithelium with parakeratosis and moderate nuclear pleomorphism in lower second/third of epithelium suggestive of moderate dysplasia. His visual acuity returned to 20/20 after surgical excision but he developed multifocal corneal recurrences 6 weeks later, which were successfully managed with seven cycles of topical interferon immunotherapy. There are no recurrences observed at 6 months of follow-up.