An Unusual Corneal Mass | Cornea | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

An Unusual Corneal Mass

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 74-year-old man was referred to the ocular oncology clinic for a right eye corneal mass. He had a history of herpetic keratitis and cataract surgery 2 years prior, both in the right eye, complicated by postoperative bullous keratopathy without treatment. The patient noted a corneal scar after the cataract surgery that gradually thickened over the ensuing 6 months. In our office, his examination in the right eye was notable for hand motion visual acuity and a pearly white, raised, 10 × 10-mm, gelatinous, corneal lesion with both intrinsic and feeder vessels (Figure 1A). There was no view of the anterior segment. Ultrasound biomicroscopy showed a hyperechoic opacity on the surface of the cornea, with maximal thickness of 1.5 mm. A cleft was noted between the lesion and the cornea (Figure 1B). There was no extension posteriorly into the anterior chamber, iris, or ciliary body.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

Corneal keloid

C. Excisional biopsy

Given the cleft seen on biomicroscopy (Figure 1B), a #57 ultrasharp blade was used to gently but completely excise the lesion. Pathology results were positive for corneal keloid (hyperplastic corneal pannus),1 a rare corneal lesion usually occurring during the first 3 decades of life.2 No link has been found with cutaneous keloids, nor is this lesion more common among African American or Asian individuals. While bilateral cases are typically associated with systemic disorders such as Lowe syndrome and Rubenstein-Taybi syndrome, isolated unilateral cases are usually secondary to corneal trauma, surgery, keratouveitis, or infection.38

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Nikolas N. Raufi, MD, Duke Eye Center, 2351 Erwin Rd, Durham, NC 27705 (nikolas.raufi@duke.edu).

Published Online: April 4, 2019. doi:10.1001/jamaophthalmol.2019.0519

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Jakobiec  FA, Stacy  RC, Mendoza  PR, Chodosh  J.  Hyperplastic corneal pannus: an immunohistochemical analysis and review.  Surv Ophthalmol. 2014;59(4):448-453. doi:10.1016/j.survophthal.2013.10.005PubMedGoogle ScholarCrossref
2.
Vanathi  M, Panda  A, Kai  S, Sen  S.  Corneal keloid.  Ocul Surf. 2008;6(4):186-197. doi:10.1016/S1542-0124(12)70179-9PubMedGoogle ScholarCrossref
3.
Esquenazi  S, Eustis  HS, Bazan  HE, Leon  A, He  J.  Corneal keloid in Lowe syndrome.  J Pediatr Ophthalmol Strabismus. 2005;42(5):308-310.PubMedGoogle Scholar
4.
Shoukrey  NM, Tabbara  KF.  Ultrastructural study of a corneal keloid.  Eye (Lond). 1993;7(pt 3):379-387. doi:10.1038/eye.1993.76PubMedGoogle ScholarCrossref
5.
Jung  JJ, Wojno  TH, Grossniklaus  HE.  Giant corneal keloid: case report and review of the literature.  Cornea. 2010;29(12):1455-1458. doi:10.1097/ICO.0b013e3181d83858PubMedGoogle ScholarCrossref
6.
Gupta  J, Gantyala  SP, Kashyap  S, Tandon  R.  Diagnosis, management, and histopathological characteristics of corneal keloid: a case series and literature review.  Asia Pac J Ophthalmol (Phila). 2016;5(5):354-359. doi:10.1097/APO.0000000000000154PubMedGoogle ScholarCrossref
7.
Lee  HK, Choi  HJ, Kim  MK, Wee  WR, Oh  JY.  Corneal keloid: four case reports of clinicopathological features and surgical outcome.  BMC Ophthalmol. 2016;16(1):198. doi:10.1186/s12886-016-0372-4PubMedGoogle ScholarCrossref
8.
Singh  A, Sen  S, Vanathi  M, Tandon  R.  Corneal keloid with cystoid cicatrix: post-small-incision cataract surgery.  Can J Ophthalmol. 2017;52(3):e93-e95. doi:10.1016/j.jcjo.2016.11.013PubMedGoogle ScholarCrossref
9.
Bukowiecki  A, Hos  D, Cursiefen  C, Eming  SA.  Wound-healing studies in cornea and skin: parallels, differences and opportunities.  Int J Mol Sci. 2017;18(6):1257. doi:10.3390/ijms18061257PubMedGoogle ScholarCrossref
10.
Mejía  LF, Acosta  C, Santamaría  JP.  Clinical, surgical, and histopathologic characteristics of corneal keloid.  Cornea. 2001;20(4):421-424. doi:10.1097/00003226-200105000-00017PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close