PMC6472153_01
Giant OSSN before treatment. (a, b) Slit-lamp picture of giant OSSN shows
elevated flesh-like, keratinized mass of salmon color, involving 360  of
limbus, three quarters of the cornea, and three quadrants of conjunctiva.
(c, d) HR-OCT of giant OSSN shows thickened hyper-reflective epithelium,
abrupt transition from normal epithelium, and marked separation between the
lesion and the underlying tissue.
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On slit-lamp examination, we found bilateral cataracts and left eye showed diffuse moderate hyperemia, tortuous vessels, and an elevated flesh-like, keratinized mass of salmon color, involving 360  of limbus, three quarters of the cornea, and three quadrants of conjunctiva (Figure 1(a) and (b)). OSSN. On high-resolution optical coherence tomography (HR-OCT), we observed the typical characteristics of OSSN, with thickened hyper-reflective epithelial layer, abrupt transition from normal epithelium, and marked separation between the lesion and the underlying tissue (Figure 1(c) and (d)).
Ocular surface toxicity after 4 weeks of topical 5-FU. (a) Slit-lamp picture
shows ocular surface toxicity to 5-FU with generalized hyperemia, chemosis,
central corneal thinning, and fluorescein-staining subtotal corneal
epithelial defect. (b) Slit-lamp picture after total resolution of surface
toxicity with healed corneal epithelium, a stable corneal thinning, and
further reduction in the size of the OSSN.
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The observed local signs of toxicity were subtotal corneal epithelial defect, generalized hyperemia, chemosis and central corneal thinning of about 50% measured subjectively with slit-lamp by the evaluator (Figure 2(a)). After 4 weeks of treating the ocular surface toxicity for 5-FU, we observed total resolution of the corneal epithelial defect, a stable corneal thinning of 50%, further reduction of the OSSN, and improvement of systemic symptoms (Figure 2(b)).
Six-month follow-up after topical 5-FU treatment of giant OSSN. (a) Clear
central cornea with mild peripheral haze, symmetrical residual corneal
thinning, and total resolution of the OSSN. (b) HR-OCT confirms the absence
of OSSN and shows normal thickness epithelium and normal cornea-conjunctiva
epithelial transition.
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Confirmation of clinical resolution was observed on HR-OCT images that showed a normal thickness epithelium and a normal transition between corneal and conjunctival epithelium at 6 months after the beginning of 5-FU (Figure 3(a) and (b)).