DILEMMAS IN MANAGEMENT OF OCULAR SURFACE SQUAMOUS NEOPLASIA (OSSN) – A RETROSPECTIVE INTERVENTIONAL CASE REPORT

Abstract

A 70 years old male with history of being diagnosed as carcinoma-in-situ in left eye (OS) at nasal limbus was operated for mass excision with bare sclera 3 months back – histopathologically – squamous cell carcinoma (SCC) was diagnosed and patient was on topical steroids. Then, patient developed scleral melt and was referred. On presentation, there was a scleral perforation at nasal limbus and uveal prolapse, shallow anterior chamber and decentered posterior chamber intraocular lens (PCIOL) with nasal choroidal detachment on ultrasound (USG). Rheumat work up was done to rule out autoimmune etiology for scleral melt but it was within normal limits. Patient was operated for OS granuloma excision with cryopexy on free margins with scleral patch graft and conjunctival autograft. Histopathology revealed it to be moderately differentiated SCC with scleral invasion with free margins. Patient was given 2 cycles of interferon α eye drops. But, conjunctival autograft retracted after 3 days, so resuturing was done. Then there was sterile scleral melt with corneal edema and drop in vision to light perception 1 month later. Patient was started on oral steroids but melt persisted and again patient developed scleral perforation. So, we have: 

Dilemma 1 – Was scleral melt due to autoimmune condition / recurrence / interferon toxicity?

Dilemma 2 – Management – Re-sclero-corneal lamellar patch graft / enucleation / lid sparing exenteration?