CORNEAL CANCER

Squamous cell carcinoma can sometimes masquerade as pterygium, but timely removal of the tumour followed by lamellar keratoplasty can prevent further damage to the eye and restore excellent vision to the patient, said Rossella Spena MD, Forlí, Italy, who presented a case report at a Cornea Day session at the 18th ESCRS Winter Meeting in Ljubljana.

The patient was a 60-year-old male with a two-year history of a slowly developing corneal lesion that had originally been diagnosed as pterygium. At the time the patient was referred to Dr Spena and her associates, the patient had a solid mass that extended into the optical zone and infiltrated the cornea and underlying sclera with abnormal vascularisation.

Dr Spena and her associates decided on a surgical treatment using a two-step approach. The first step was the removal of the cancerous mass, including the infiltrated underlying sclera and cornea, associated with cryotherapy of the residual corneo-scleral bed. A biopsy confirmed that the lesion was a squamous cell carcinoma, which is of conjunctival origin and only in very rare cases infiltrates the cornea beyond Bowman’s layer.

Microscopic examination of the excised tissue showed the infiltrated corneal and scleral tissue as well as the clear margins. The eye was fully healed without complications at one month’s follow-up and Dr Spena and her team then proceeded with the lamellar keratoplasty.

The second step was to restore the patient’s vision in that eye with a large lamellar keratoplasty. At the beginning of the graft procedure a superficial portion of the cornea, 9.0mm diameter and about 250 microns in depth, was dissected and removed. As the initial dissection was not deep enough to remove the entire corneal opacity, the surgeon continued with a pneumatic dissection of the residual stroma from the underlying Descemet in the central optical zone and the removal of the central 6.0mm of the deepest stroma. Finally, a donor lamella with a thickness of about 350 microns, was prepared by means of the microkeratome, punched to a diameter of 9.0mm and sutured into place with a double running 10-0 nylon suture.

At six months’ follow-up the best corrected visual acuity was 0.8 and there was no recurrence of the neoplastic lesion, Dr Spena said, adding: “Removal of the squamous cell carcinoma was helpful in curing the lesion and at the same time lamellar keratoplasty was instrumental in restoring vision.”

Rossella Spena: mbusin@yahoo.com