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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 792-793

Epithelial hypertrophy or intraepithelial neoplasia – A rare case report of corneal squamous neoplasia in concomitant malpositioned lens with early corneal decompensation


Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India

Date of Submission01-Feb-2021
Date of Acceptance10-May-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Amar Agarwal
Chairman, Dr Agarwal's Eye Hospital and Eye Research Centre, 222, TTK Road, Chennai - 600 018, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_243_21

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  Abstract 


Keywords: Corneal squamous neoplasia, OSSN mimics epithelial hypertrophy, pseudophakic bullous keratopathy


How to cite this article:
Kumar DA, Agarwal A, Baskar N. Epithelial hypertrophy or intraepithelial neoplasia – A rare case report of corneal squamous neoplasia in concomitant malpositioned lens with early corneal decompensation. Indian J Ophthalmol Case Rep 2021;1:792-3

How to cite this URL:
Kumar DA, Agarwal A, Baskar N. Epithelial hypertrophy or intraepithelial neoplasia – A rare case report of corneal squamous neoplasia in concomitant malpositioned lens with early corneal decompensation. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:792-3. Available from: https://www.ijoreports.in/text.asp?2021/1/4/792/327727



Malpositioned posterior chamber intraocular lens (PC IOL) is a known cause for pseudophakic bullous keratopathy (PBK).[1],[2] Epithelial hypertrophy, bullae, and opacification can occur in chronic PBK. However, an ocular surface tumor in a preexisting PBK is rare.

A 72-year-old female presented with early morning blurred vision in the left eye for 3 months. Her past history revealed cataract surgery performed elsewhere 2 years earlier. On examination, there was a corneal edema with bullae in the periphery with a thick epithelium with PC IOL in the anterior chamber with haptic edges in the angles in the left eye [Figure 1]. The right eye was pseudophakic and had clear cornea. Her distant vision was 20/20 (OD) and 20/120 (OS). The specular count and polymegathism [Figure 2] were 1,172 cells/mm2, 37% (OD); and 2,363 cells/mm2, 2% (OS), respectively. A probable clinical diagnosis of early endothelial decompensation was made, and the patient was started on topical hyperosmotic agents by her general ophthalmologist. At 2 weeks, the thickened epithelium persisted without corneal edema. The anterior segment optical coherence tomography measured a 3 × 4.1 mm and 277 microns thick epithelial lesion [Figure 3]. The corneal epithelial excision biopsy (3 mm clearance) was performed. The histopathology showed acanthosis of stratified squamous epithelium with loss of polarity with moderate pleomorphism up to the middle third of epithelium, enlarged nuclei, coarse chromatin, moderate eosinophilic cytoplasm suggestive of intraepithelial neoplasia [Figure 4]. No evidence of deep invasion was noted. The postoperative period was uneventful with vision 20/30 [Figure 5] and topical mitomycin C 0.02% three times a day (week-on-week-off therapy for 1 month) was planned in follow-up.
Figure 1: Clinical (a) and Slit-lamp (b) picture of left eye at presentation to us after using topical hyperosmotic agents

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Figure 2: Corneal endothelial cells as imaged by the specular analyzer of right (a) and left eye (b). Note the polymegathism in the left eye

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Figure 3: Anterior segment optical coherence tomography showing thickened local epithelium on the cornea with an abrupt change

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Figure 4: Histopathology photomicrograph (100× magnification), hematoxylin and eosin stain showing acanthosis of stratified squamous epithelium with loss of polarity with moderate pleomorphism

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Figure 5: Postoperative clinical picture (a) and the corresponding anterior segment optical coherence (b)

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  Discussion Top


Epithelial cell proliferation, epithelial hyperplasia, and bullae formation due to endothelial dysfunction can happen by an increase in the Ki67 activity in proliferating cells.[3] We would like to report this case to forewarn the anterior segment surgeons of such camouflage.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Irvine AR, Kratz RP, O'Donnell JJ. Endothelial damage with phacoemulsification and intraocular lens implantation. Arch Ophthalmol 1978;96:1023-6.  Back to cited text no. 1
    
2.
Ravalico G, Botteri E, Baccara F. Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery. J Cataract Refract Surg 2003;29:1918-23.  Back to cited text no. 2
    
3.
Glasgow BJ, Gasymov OK, Casey RC. Exfoliative epitheliopathy of bullous keratopathy with breaches in the MUC16 Glycocalyx. Invest Ophthalmol Vis Sci 2009;50:4060-4.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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