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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.
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Corneal intraepithelial neoplasia
A. Discuss superficial keratectomy to confirm the diagnosis by histopathologic examination
Calcium chelation with EDTA therapy (choice B) is not recommended because the appearance and location of the lesion are atypical for band keratopathy. Performing a penetrating keratoplasty (choice C) would not be indicated because the lesion is superficial and does not affect the deeper cornea stromal layers. Finally, observation (choice D) would not be preferred because the patient is experiencing visual issues due to the lesion, and other conditions, such as a malignant neoplasm, should be excluded.
Corneal intraepithelial neoplasia (CIN), also known as corneal epithelial dysplasia, is usually grouped with conjunctival intraepithelial neoplasia under the broader classification of ocular surface squamous neoplasia (OSSN). Ocular surface squamous neoplasia is one of the most common ocular tumors in the US and is generally found in males of advanced age.1 Risk factors include prolonged exposure to UV light, infection with human papillomavirus or human immunodeficiency virus, smoking, and immunosuppression.2 Patients customarily present with nonspecific progressive symptoms of painless vision loss, which may be associated with ocular foreign body sensation or redness.3 Corneal intraepithelial neoplasia onset is typically in the limbal area, with a gradual extension toward the central visual axis. Lesions may or may not be accompanied by neovascularization.
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Corresponding Author: Christine Shieh, MD, Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37203 (email@example.com).
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.
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