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Ophthalmic Images
August 11, 2016

Regression of Squamous Cell Carcinoma With Corneal Invasion Following Local Resection and Plaque Radiotherapy

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(8):e161009. doi:10.1001/jamaophthalmol.2016.1009

A white man in his late 70s noticed a white mass on his right eye that grew larger over 5 months. At presentation, his visual acuity was 20/25 OD, and an examination revealed a pink-white limbal mass temporally with dilated feeder vessels, minimal leukoplakia, and extensive corneal stromal infiltration with feathery margins (Figure, A). Ultrasound biomicroscopy demonstrated increased corneal thickness with hyperechogenicity and posterior bulging into the anterior chamber, suggesting solid tumor invasion. Based on the presumptive diagnosis of corneal-invasive squamous cell carcinoma of the conjunctiva, the management strategy included alcohol superficial keratectomy, wide surgical resection of conjunctival component using a “no touch” technique, and cryotherapy to conjunctival margins with conjunctival reconstruction.1 The corneal-infiltrative stromal component was managed with iodine 125 plaque radiotherapy directly over the affected corneal surface and adjacent sclera, designed to irradiate for a 3-mm depth.2,3 On follow-up, complete regression of both conjunctival and corneal-invasive malignancy was observed (Figure, B). Visual acuity remained 20/25 OD.

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