OBJECTIVE: Ocular surface squamous neoplasia (OSSN) are among the most frequent non-pigmented malignancies of the ocular surface. They have a wide range of histological characteristics - ranging from mild epithelial dysplasia to invasive carcinoma of the squamous cells of the cornea. They may be restricted to the conjunctiva or also involve the cornea. As there are no leading symptoms in the early stages, diagnosis may be very delayed in patients who do not receive regular ophthalmological treatment. The present case series describes clinical and histological data on OSSN and includes clinical and histological data on OSSN, including possible clinical presentations, important risk factors, special histological and cytological features and therapeutic options.
METHODS: Retrospective case series of patients with histologically confirmed severe epithelial dysplasia of the conjunctiva and cornea consistent with OSSN who presented to the Department of Ophthalmology in Basel University Hospital. The analysis covered demographic data, symptoms, diagnostic testing (photo documentation, brush biopsy), treatment and cytological and/or histological material and findings.
RESULTS: We report on five patients aged between 41 and 92 years at the time of diagnosis. The histological findings in all patients included severe epithelial dysplasia, but with a heterogenous clinical presentation. In all cases, the lesion started in the conjunctiva, but traversed the limbus and extended to the cornea. The primary treatment was always surgical removal. In one patient, this had to be repeated several times due to recurrent metaplasia and was complemented by subsequent mitomycin C therapy. The clinical outcome ranged between total restitution of the original state to inevitable enucleation.
CONCLUSIONS: The clinical presentation of OSSN is highly heterogenous, so that the initial diagnosis is difficult. There are no official guidelines for treatment, so that the treatment of choice varied between clinics. Regular ophthalmological follow-ups are recommended, even after complete surgical excision. Possible relevant concomitant diseases and risk factors must be identified before therapy.
UNASSIGNED: Die Gruppe der Ocular Surface Squamous Neoplasia (OSSN) zählt zu den häufigsten nicht pigmentierten Malignomen der Augenoberfläche. Histologisch zeigt sich dabei eine große Spanne von einer milden epithelialen Dysplasie bis hin zum invasiven Plattenepithelkarzinom. Weiterhin lässt sich zudem zwischen einer reinen Bindehaut- und zusätzlichen Hornhautbeteiligung unterscheiden. Bei Patienten, die sich nicht in regelmäßiger augenärztlicher Behandlung befinden, wird die Diagnose aufgrund von fehlenden Leitsymptomen in Frühstadien meist sehr spät gestellt. Die vorliegende Fallserie mit klinischen und histologischen Daten zum OSSN soll auf mögliche klinische Erscheinungsbilder, relevante Risikofaktoren, histologische und zytologische Besonderheiten sowie Therapieoptionen aufmerksam machen.
METHODS: Retrospektive Fallserie von Patienten mit histologisch gesicherter schwerer epithelialer Dysplasie der Bindehaut und Hornhaut im Sinne einer OSSN (Ocular Surface Squamous Neoplasia) an der Augenklinik des Universitätsspitals Basel. Demografische Daten, Symptome, Diagnostik (Fotodokumentationen, Bürstenbiopsie), Behandlung sowie zytologisches und/oder histologisches Material und Befunde wurden analysiert.
UNASSIGNED: Wir berichten über 5 Patienten im Alter zwischen 41 und 92 Jahren zum Zeitpunkt der Diagnosestellung. Bei allen Patienten stellt sich im histologischen Befund eine schwere epitheliale Dysplasie dar, die sich in einem heterogenen klinischen Bild präsentiert. Es zeigt sich in allen Fällen eine von der Konjunktiva ausgehende Läsion, jeweils mit Limbusüberschreitung und einhergehender Hornhautbeteiligung. Die jeweilige primäre Behandlung umfasste eine operative Exzision. In einem Fall wurde diese aufgrund von rezidivierenden Metaplasien mehrfach notwendig und durch eine anschließende Mitomycin-C-Therapie ergänzt. Im klinischen Outcome ergaben sich große Unterschiede von einer vollständige Restitutio ad integrum bis hin zur Notwendigkeit einer Enukleation.
UNASSIGNED: Das klinische Bild der OSSN präsentiert sich als sehr heterogen, was die initiale Diagnosestellung erschwert. Offizielle Behandlungsleitlinien bestehen dabei nicht, sodass sich die Therapie der Wahl zwischen den einzelnen Kliniken unterscheidet. Regelmäßige ophthalmologische Nachkontrollen sind auch nach vollständiger chirurgischer Exzision empfohlen. Mögliche relevante Begleiterkrankungen und Risikofaktoren sollten im Vorfeld der Therapie erfasst werden.

BACKGROUND: Ophthalmologists mainly treat epithelial ingrowth by lifting the flap and scraping the ingrowth or using scraping combined with phototherapeutic keratectomy, mitomycin C, and so on. The potential usefulness of nonsteroidal anti-inflammatory drugs in such circumstances has not been reported before.
METHODS: A 32-year-old man and a 25-year-old man underwent lifting and scraping of the flap and phototherapeutic keratectomy to remove the epithelial ingrowths. Unfortunately, the ingrowths recurred and continued to develop.
METHODS: The patients were diagnosed with corneal epithelial ingrowth.
METHODS: The administration of bromfenac sodium and fluorometholone eye drops.
RESULTS: Epithelial ingrowths in both patients disappeared after 6 and 1 month of treatment, respectively. There were no adverse reactions to the eye drops.
CONCLUSIONS: Nonsteroidal anti-inflammatory drugs may be broadly applied in the treatment of epithelial ingrowth after laser in situ keratomileusis.

Epithelial basement membrane corneal dystrophy is a rare entity, characterized by recurrent corneal erosions secondary to a disorder in the attachment of the corneal epithelium to the basement membrane. To date, mainly the ophthalmological aspect of cases has been reported, with little emphasis on the pathology of this lesion. Here we aim to describe the microscopy and discuss the clinical and therapeutic aspects of a case.

BACKGROUND: High-dose systemic cytarabine chemotherapy may cause fine corneal opacities and refractile microcysts, which are densely distributed in the center of the cornea. Most previous case reports on microcysts have been those following complaints of subjective symptoms, and the findings at the initial stage of development and time-course changes are still unknown. This report aims to clarify the time-course changes of microcysts using slit-lamp photomicrographs.
METHODS: A 35-year-old woman who was treated with high-dose systemic cytarabine therapy (3 courses of 2 g/m2 every 12 h for 5 days) for acute myeloid leukemia and presented with subjective symptoms, such as bilateral conjunctival injection, photophobia, and blurred vision, on the 7th day of treatment in both the first two courses. Anterior segment findings by slit-lamp microscopy revealed microcysts densely distributed in the central region of the corneal epithelium. In both courses, microcysts disappeared within 2-3 weeks upon prophylactic steroid instillation. In the 3rd course, daily ophthalmic examinations were conducted from the start of the treatment, and on the 5th day without subjective symptoms, the microcysts in the corneal epithelium appeared evenly and sparsely distributed throughout the cornea except for the corneal limbus. Thereafter, the microcysts accumulated towards the center of the cornea and disappeared gradually. The change from low-dose to full-strength steroid instillation immediately following the occurrence of microcysts in the 3rd course resulted in the peak finding being the mildest compared to that in the past two courses.
CONCLUSIONS: Our case report revealed that microcysts appeared scattered throughout the cornea before the appearance of subjective symptoms and then accumulated in the center and disappeared. A detailed examination is necessary to detect early changes in microcyst development resulting in prompt and appropriate treatment.

OBJECTIVE: The purpose of this study was to introduce a new method of limbal stem cell transplantation using autologous platelet-rich plasma (E-PRP) eye drops for unilateral total limbal stem cell deficiency.
METHODS: Patients with total unilateral limbal stem cell deficiency due to chemical burn underwent mini-conjunctival limbal autograft using autologous E-PRP drops. One small limbal block, measuring 2 × 2 mm, was harvested from the patients\' contralateral healthy eye and transplanted to the diseased eye. All patients received E-PRP drops until achieving complete corneal epithelialization. Subsequent corneal transplantation was performed in eyes with significant stromal opacification. Corneal buttons obtained during corneal transplantation underwent immunohistochemistry for the evaluation of limbal stem cell markers (ABCG2 and P63). Visual acuity, epithelial healing, corneal clarity, and regression of corneal conjunctivalization/vascularization were evaluated after surgery.
RESULTS: Ten patients with acid (n = 7) or alkali (n = 3) burn were included. The mean follow-up period was 21.7 ± 5.8 months (range, 12-32 months). Corneas were completely reepithelialized within 14.9 ± 3.5 days (range, 11-21 days). Corneal conjunctivalization/vascularization dramatically regressed 1 to 2 months after surgery in all cases, and corneal clarity considerably improved in 7 patients. In the 3 eyes with significant stromal opacification, subsequent optical penetrating keratoplasty was performed. The ocular surface was stable throughout the follow-up period in all eyes. BSCVA improved to 0.60 ± 0.0.32 and 0.46 ± 0.0.25 logMAR in eyes with and without corneal transplantation, respectively, at the final follow-up visit. ABCG2 and P63 markers were detected on corneal buttons after keratoplasty.
CONCLUSIONS: Based on our clinical and laboratory findings, mini-conjunctival limbal autograft using E-PRP can be considered as a promising alternative to ocular surface reconstruction.

OBJECTIVE: The aim of this study was to evaluate the anterior segment swept source optical coherence tomography (SS-OCT) and in vivo confocal microscopy (IVCM) features in a patient with bleb-like epithelial basement membrane dystrophy (EBMD).
METHODS: A 67-year-old man was referred to the hospital for recurrent attacks of severe ocular pain, tearing, and photophobia, typically upon awakening in the right eye. Biomicroscopic examination revealed pebbled glass-like appearance in the corneal epithelium which was remarkable with retroillumination and the patient was suspected to have bleb-like EBMD. The cornea was further evaluated using SS-OCT DRI Triton (Topcon, Tokyo, Japan) and IVCM (Heidelberg Retina Tomograph 3, Rostock Cornea Module).
RESULTS: Using anterior segment SS-OCT, multiple, hyporeflective, round-oval structures within the size range of 30 to 90 μm were observed at the basal epithelial level. IVCM showed circular or oval hyporeflective areas with a diameter ranging from 30 to 140 μm at the level of the basal epithelium in a depth of 35 to 40 μm from the corneal surface and hyperreflective linear structures extending into the corneal epithelium. The corneal stroma was normal, while a few round hyperreflective deposits and guttae were noted at the endothelial cell layer.
CONCLUSIONS: Anterior segment SS-OCT and IVCM can be used in the diagnosis of bleb-like EBMD and are very helpful in differentiating from other epithelial/subepithelial corneal dystrophies and cystic disorders of the corneal epithelium.

UNASSIGNED: The question of whether the epithelium should be removed in corneal cross-linking (CXL) in the treatment of keratoconus and other corneal ectatic disorders remains controversial. The motivation for epithelium-on CXL methods, which are not yet FDA approved and vary greatly in methodology, is to reduce the risk of vision-threatening complications related to debridement. However, as discussed in this counterpoint piece, most high-level evidence suggests that removal of the epithelium facilitates greater crosslinking effectiveness as measured by primary clinical outcome metrics such as topographic flattening and stabilization of disease. Furthermore, quality evidence is still lacking for a significant reduction in rates of infectious keratitis or loss of vision that can be attributed to debridement-related complications. In the absence of comparative effectiveness trials or long-term follow-up studies that show otherwise, the FDA-approved epi-off protocol is still the standard-bearer for safe and effective stabilization of corneal ectatic disease.

To describe the clinical outcomes of manual scraping of epithelial ingrowth followed by compressed heating air flow after laser in situ keratomileusis (LASIK).
We underwent a retrospective, noncomparative, and interventional case series. Twenty eyes of 17 patients were included in this study. Each patient with a history of LASIK underwent epithelial removal with mechanical debridement followed by compressed heating air flow. Our primary outcome was the recurrence of epithelial ingrowth after 3 months of follow-up, while our secondary outcomes were uncorrected distance visual acuity, corrected distance visual acuity, and complications after surgery.
Ten patients (58.8%) were male, and eight eyes of seven (41.2%) patients underwent primary LASIK surgery, while12 eyes of 10 patients had flap-lift retreatment LASIK; sixteen eyes (80.0%) underwent mechanical microkeratome LASIK and four (20.0%) underwent femtosecond laser-assisted LASIK. Mean age at surgical removal of epithelial ingrowth was 37.0 years ± 9.3 years (range 24 to 55 years). There was recurrence of ingrowth in two eyes (10%) after 3 months of follow-up. The mean corrected distance visual acuity of patients before surgery was 0.07 ± 0.09 logMAR, and after the last follow-up was 0.02 ± 0.04 logMAR (p=0.06). The odds ratio of presenting with epithelial ingrowth after LASIK enhancement compared to primary LASIK was 29.41.
Manual scraping followed by compressed heating air flow is a safe and effective treatment of clinically significant epithelial ingrowth after LASIK. At the last follow-up, no eye lost any line in corrected distance visual acuity.

UNASSIGNED: The Rho kinase inhibitor netarsudil is a recently approved therapeutic option for the management of increased intraocular pressure in the United States. Although phase 3 clinical trials noted corneal changes related to the medication-namely, nonvisually-significant corneal verticillata-descriptions of a unique form of cystic epithelial edema began to surface as netarsudil (and its sister drug ripasudil, approved in Japan) gained widespread use. This series adds 3 new cases and reviews the current literature on this unique side effect.

BACKGROUND: Alcohol-based hand sanitizers (ABHS) are widely used for hand hygiene due to the coronavirus disease pandemic. However, risk awareness regarding its adverse effects is lacking. We aim to report a case of ocular chemical burn that showed severe clinical presentation associated with ABHS.
METHODS: A 5-year-old girl presented with severe left eye pain after 62% gel-type ABHS splashed into her eye.
METHODS: On slit lamp examination, a near total corneal and conjunctival epithelial defect with limbal pale on the lower half of the cornea was noted. Severe ocular burn by ABHS was prominent with suspected limbal stem cell damage.
METHODS: She was hospitalized and was prescribed topical medications including antibiotics, steroid eye drops with preservative-free artificial tears, and oral nonsteroidal anti-inflammatory drugs.
RESULTS: Despite intensive medical treatments, the corneal and conjunctival epithelial defects showed no improvement up to the 4th hospital day. After additional instillation of autoserum eye drops to promote epithelial healing, the corneal epithelium barely recovered from the temporal limbus. On the third week of admission, the epithelial defect was completely resolved without corneal opacity, although with minimal symblepharon in the lower fornix.
CONCLUSIONS: Gel-type ABHS can cause severe form of ocular chemical burn such as delayed ocular surface healing. In clinical setting, immediate and thorough rinsing of alcohol-based gel and early intensive treatment are crucial.