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Advancing wavelike epitheliopathy after conjunctival intraepithelial neoplasia. Atipical case report
Epiteliopatía progresiva en ondas tras neoplasia intraepitelial conjutival. Caso clínico atípico
B. Moratal Peiro
, R. Calvo Garcia, I. Soler Sanchis, L. Mata Moret, E. Cervera Taulet
Corresponding author
Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Atipical case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "339" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B. Moratal Peiro, R. Calvo Garcia, I. Soler Sanchis, L. Mata Moret, E. Cervera Taulet" "autores" => array:5 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Moratal Peiro" "email" => array:1 [ 0 => "Balto8@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Calvo Garcia" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Soler Sanchis" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Mata Moret" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Cervera Taulet" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epiteliopatía progresiva en ondas tras neoplasia intraepitelial conjutival. Caso clínico atípico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 601 "Ancho" => 905 "Tamanyo" => 58169 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Progressive wave epitheliopathy with upper limbar focus, during the final weeks of the condition.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Advancing wave-like epitheliopathy (AWE) was first described by D'Aversa et al. in 1997.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">AWE is a corneal disorder described in the literature as chronic and recurring that presents as well defined, thickened waves of corneal epithelium, progressing from the corneal limbus towards the visual axis, in the absence of limbal stem cell deficits. It manifests with ocular irritation and pain, plus visual deficit if it involves the visual axis. AWA has usually been described as starting from the upper limbus, although there are reported cases of progression from any part of the corneal limbus.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> It has been associated with chronic lesions on the corneal limbus such as the use of benzalkonium chloride eye drops, fluorouracil, topical acyclovir, contact lens use or blepharitis, among others.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although its pathophysiology remains unclear and appears to be multifactorial, a modification of epithelial cell production by limbal stem cells is suspected, which under limbal niche conditions with an inflammatory microenvironment turns into parakeratotic epithelium and leads to thickened and opacified migratory waves of epithelial turnover.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case</span><p id="par0020" class="elsevierStylePara elsevierViewall">This communication describes the presentation of the entity after topical treatment with the antimitotic mitomycin eye drops (0.2 mg/mL) in combination with interferon (α2β1 MUI/mL) in the case of conjunctival intraepithelial neoplasia.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 64-year-old woman with no ophthalmic history of interest was referred for evaluation of a corneal lesion in the left eye. She presented with invasion 360° of apparent conjunctival intraepithelial neoplasia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which was subsequently confirmed by the pathological anatomy of the biopsy obtained at the first visit.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment was started with mitomycin eye drops, followed by interferon α2β eye drops, both every 6 h, every other week, for a total of 4 weeks. At the end of the scheduled treatment, complete remission of the conjunctival intraepithelial neoplasia was observed and the patient was kept under observation, with no recurrence being observed at the 6th and 8th week visits.</p><p id="par0035" class="elsevierStylePara elsevierViewall">At week 12 the patient reported a decrease in visual acuity. The appearance of the characteristic waves of thickened epithelium originating in the corneal limbus was observed at 4−6 h (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In the different images obtained at follow-up, the pattern varied depending on the limbal site of predominant aberrant epithelial proliferation at that time. Initially the waves were of inferior origin and changed to the classic wedge pattern from upper limbus, with lower sector in resolution, during the final weeks of the presentation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), passing through a phase of presentation, during the central weeks of the picture, in a pseudodendritic pattern.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The literature describes treatment with cryotherapy with liquid nitrogen as being successful.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> In our experience, steroid treatment is effective in the vast majority of cases. Treatment is scheduled with fluorometholone eye drops (1 mg/mL) FML® (Allergan), every 8 h, together with preservative-free artificial tears every 2 h, until complete resolution at 12 weeks. No recurrence seen on follow-up to date (over 5 years). Diagnosis and follow-up of AWE based exclusively on slit-lamp examination findings, with the diagnostic limitation that confocal microscopy is not available.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The acute onset of the entity under discussion after a 4-week topical treatment with antimitotics and antineoplastic agents has not been described in the literature. AWE with no apparent single delimited limbar focus, migrant in its limbar time zone. Recurrence is described from places other than the original, but not simultaneously from several foci. The fact that this entity can present from different limbal foci at the same time at the beginning can be added to our knowledge of its range of presentations. The presentation of the condition after this acute ocular surface aggression and resolution with steroid treatment reinforces the pathophysiological orientation of the entity, in which it is presumed that the presence of the inflammatory environment in the limbal stem cells during cell replication of the corneal epithelium leads to a variation in the cellular characteristics of the epithelium that alters its phenotype to a firmer and more resistant one, giving rise to said acute parakeratosis and the consequent loss of transparency of the corneal layer. After cessation of the inflammatory environment, the phenotype becomes transparent again.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">No conflicts of interests were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1726721" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1524940" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1726722" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1524941" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-10" "fechaAceptado" => "2021-04-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1524940" "palabras" => array:3 [ 0 => "Advancing wavelike epitheliopathy" 1 => "Conjunctival intraepithelial neoplasia" 2 => "Limbal inflamation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1524941" "palabras" => array:3 [ 0 => "Epiteliopatía progresiva en ondas" 1 => "Neoplasia intraepitelial conjuntival" 2 => "Inflamación limbar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">An atypical Advancing Wavelike Epitheliopathy case, consecutive to topical treatment for a 360º Conjunctival Intraepithelial Neoplasia, is presented. Mitomycin (0.2 mg/mL) and interferon (1 MUI/mL) drops were used. An atypical presentation, with migrating limbal focus, non clearly delimited in its hourly site through its evolution. Treated with flurometholone drops plus artificial tears, working to complete resolution.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso atípico de Epiteliopatía Progresiva en Ondas consecutiva a tratamiento tópico de una Neoplasia Intraepitelial Conjuntival en 360º. Se usaron colirios de mitomicina (0.2 mg/mL) e interferón (1 MUI/mL). Presentación atípica con foco limbar principal migratorio, y no claramente delimitado en su sitio horario a través de su evolución. Tratado con flurometolona y lágrimas artificiales, con resultado de resolución completa.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moratal Peiro B, Calvo Garcia R, Soler Sanchis I, Mata Moret L, Cervera Taulet E. Epiteliopatía progresiva en ondas tras neoplasia intraepitelial conjutival. Caso clínico atípico. Arch Soc Esp Oftalmol. 2022;97:337–339.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 905 "Tamanyo" => 66625 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conjunctival intraepithelial neoplasia at 360° initial presentation.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 601 "Ancho" => 905 "Tamanyo" => 52607 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Progressive wave epitheliopathy with lower limbar focus, at the onset of the condition.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 601 "Ancho" => 905 "Tamanyo" => 58169 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Progressive wave epitheliopathy with upper limbar focus, during the final weeks of the condition.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advancing wave-like epitheliopathy. Clinical features and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. D’Aversa" 1 => "J.L. Luchs" 2 => "M.J. Fox" 3 => "P.S. Rosenbaum" 4 => "I.J. Udell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(97)30199-7" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology." "fecha" => "1997" "volumen" => "104" "paginaInicial" => "962" "paginaFinal" => "969" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9186437" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent advancing wavelike epitheliopathy from the opposite side of the initial presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.H. Huang" 1 => "H.S. Chu" 2 => "F.R. Hu" 3 => "I.J. Wang" 4 => "Y.C. Hou" 5 => "W.L. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e318156d572" "Revista" => array:6 [ "tituloSerie" => "Cornea." "fecha" => "2008" "volumen" => "27" "paginaInicial" => "111" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18245978" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medically reversible limbal stem cell disease: clinical features and management strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.Y. Kim" 1 => "K.M. Riaz" 2 => "P. Bakhtiari" 3 => "C.C. Chan" 4 => "J.D. Welder" 5 => "E.J. Holland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2014.04.025" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology." "fecha" => "2014" "volumen" => "121" "paginaInicial" => "2053" "paginaFinal" => "2058" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24908203" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liquid nitrogen cryotherapy of advancing wavelike epitheliopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.W. Fraunfelder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cornea." "fecha" => "2006" "volumen" => "25" "paginaInicial" => "196" "paginaFinal" => "198" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009700000006/v1_202206060559/S2173579422000354/v1_202206060559/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009700000006/v1_202206060559/S2173579422000354/v1_202206060559/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422000354?idApp=UINPBA00004N" ]
