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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.
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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.3- 8
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Corresponding Author: Nikolas N. Raufi, MD, Duke Eye Center, 2351 Erwin Rd, Durham, NC 27705 (firstname.lastname@example.org).
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.
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