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A Man With a Cloudy Cornea

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

A 77-year-old man was referred to the cornea service for painless, progressive blurring of vision in his left eye. His best-corrected visual acuity was 20/40 OS, and the patient reported that his vision had waxed and waned over several months. His ocular history included cataract surgery in the left eye, followed by yttrium-aluminum-garnet capsulotomy 2 months before his referral. Of note, he had recently undergone Mohs surgery and subsequent reconstruction for squamous cell carcinoma in situ of the lateral canthus in the fellow eye; he also had a medical history of multiple skin malignant neoplasms.

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A 77-year-old man was referred to the cornea service for painless, progressive blurring of vision in his left eye. His best-corrected visual acuity was 20/40 OS, and the patient reported that his vision had waxed and waned over several months. His ocular history included cataract surgery in the left eye, followed by yttrium-aluminum-garnet capsulotomy 2 months before his referral. Of note, he had recently undergone Mohs surgery and subsequent reconstruction for squamous cell carcinoma in situ of the lateral canthus in the fellow eye; he also had a medical history of multiple skin malignant neoplasms.

Slitlamp examination findings were notable for a grayish cornea opacity that appeared to be lusterless, abutting the nasal limbus and extending into the visual axis (Figure 1A). There was no apparent conjunctival erythema or appreciable feeder vessels at the limbus. The rest of the examination findings, including the fundus, were unremarkable. Anterior segment optical coherence tomography (AS-OCT) indicated that the hyperreflective corneal lesion did not involve the cornea stroma (Figure 1B).

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Article Information

Corresponding Author: Christine Shieh, MD, Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37203 (christine.shieh@vumc.org).

Published Online: December 23, 2020. doi:10.1001/jamaophthalmol.2020.4646

Conflict of Interest Disclosures: None reported.

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

References
1.
Clinical approach to neoplastic disorders of the conjunctiva and cornea. In: Weisenthal RW, ed.  2019-2020 BCSC: Basic and Clinical Science Course: External Disease and Cornea. American Academy of Ophthalmology; 2019:327-350.
2.
Chin  EK , Cortés  DE , Lam  A , Mannis  MJ .  Anterior segment OCT and confocal microscopy findings in atypical corneal intraepithelial neoplasia.   Cornea. 2013;32(6):875-879. doi:10.1097/ICO.0b013e318285cab9 PubMedGoogle ScholarCrossref
3.
Alomar  TS , Nubile  M , Lowe  J , Dua  HS .  Corneal intraepithelial neoplasia: in vivo confocal microscopic study with histopathologic correlation.   Am J Ophthalmol. 2011;151(2):238-247. doi:10.1016/j.ajo.2010.08.035 PubMedGoogle ScholarCrossref
4.
Wessel  MM , Sarkar  JS , Jakobiec  FA ,  et al.  Treatment of Lisch corneal dystrophy with photorefractive keratectomy and mitomycin C.   Cornea. 2011;30(4):481-485. doi:10.1097/ICO.0b013e3181ec8e26 PubMedGoogle ScholarCrossref
5.
Barros  JN , Lowen  MS , Ballalai  PL , Mascaro  VLDM , Gomes  JAP , Martins  MC .  Predictive index to differentiate invasive squamous cell carcinoma from preinvasive ocular surface lesions by impression cytology.   Br J Ophthalmol. 2009;93(2):209-214. doi:10.1136/bjo.2008.147710 PubMedGoogle ScholarCrossref
6.
Carreira  H , Coutinho  F , Carrilho  C , Lunet  N .  HIV and HPV infections and ocular surface squamous neoplasia: systematic review and meta-analysis.   Br J Cancer. 2013;109(7):1981-1988. doi:10.1038/bjc.2013.539 PubMedGoogle ScholarCrossref
7.
Sayed-Ahmed  IO , Palioura  S , Galor  A , Karp  CL .  Diagnosis and medical management of ocular surface squamous neoplasia.   Expert Rev Ophthalmol. 2017;12(1):11-19. doi:10.1080/17469899.2017.1263567 PubMedGoogle ScholarCrossref
8.
Shields  CL , Kaliki  S , Kim  HJ ,  et al.  Interferon for ocular surface squamous neoplasia in 81 cases: outcomes based on the American Joint Committee on Cancer classification.   Cornea. 2013;32(3):248-256. doi:10.1097/ICO.0b013e3182523f61 PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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