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A curious case of an intraocular anterior segment membrane: approach to diagnosis and management

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First Author: A.Gkiala GREECE

Co Author(s):    A. Gkiala   D. Laura   S. Palioura              

Abstract Details

Purpose:

To describe a case of intraocular extension of ocular surface squamous neoplasia (OSSN) through a prior cataract wound and to provide a literature review of intraocular invasion of surface malignancies.

Setting:

Tertiary Referral Ophthalmology Clinic

Methods:

An 87-year-old woman presented with pain, redness, and a membranous structure in the anterior chamber (AC) of her right eye (OD). Past ocular history was notable for excisional biopsy with conjunctival autograft of a conjunctival lesion OD 10 days prior to presentation. Per report, the lesion was adjacent to an old cataract wound. Histopathology report disclosed poorly differentiated OSSN with inability to assess margins. On exam, visual acuity was 20/320 OD, the membranous film was seen covering the inferior half of an ACIOL and it appeared connected to the old cataract wound.

Results:

The membrane was biopsied and revealed dysplastic squamous epithelial cells of conjunctival origin. Ten days later vision declined to light perception, and the tumor expanded to cover the entirety of the ACIOL and iris surface. A modified enucleation was performed using a no touch technique with wide margins and cryotherapy. Histopathology report disclosed invasive squamous cell carcinoma extending deep to the ciliary body and laterally into the AC, with negative conjunctival margins. Literature review revealed 6 reports of invasive OSSN specifically resulting from extension through a prior cataract wound. Of those, 4 required a modified enucleation.

Conclusions:

In our patient, malignant cells extended into the AC through a prior surgical incision. Invasive OSSN may occur in patients with conjunctival malignancy that previously underwent cataract extraction.

Financial Disclosure:

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