PMC6668246_01
Slit lamp photographs of (A) patient 1 (masquerading as carcinoma in situ) and (B) patient 2 (masquerading as Terrien marginal degeneration), showing peripheral corneal opacities of the superior-nasal quadrant or the nasal quadrant, respectively.
IMCRJ-12-237-g0001.jpg
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F0001
Slit lamp biomicroscopy revealed symmetric slightly elevated, nodular, peripheral, subepithelial, and anterior stromal fibrosis in the nasal quadrant of both eyes with a non-nodular zone toward the limbus giving the false impression of thinning (Figure 1B).
(A) Anterior segment optical coherence tomography (AS-OCT) of the right eye horizontally and (B) vertically in patient 1, demonstrating mostly continuous, homogenous, well-demarcated hyperreflective subepithelial band respecting the Bowman layer (arrow) while rarely breaking through and expanding slightly into the anterior stroma (star) (C) oblique in vivo confocal microscopy (IVCM) of patient 1 demonstrating normal structured epithelium, underlying fibrotic structures, intact Bowman layer (arrowhead) and normal anterior stroma.
IMCRJ-12-237-g0002.jpg
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F0002
AS-OCT (Avanti-Optovue, Fermont, California, 70,000 scans/second, scan beam wavelength 840 nm) showed a mostly continuous, homogenous, well-demarcated hyperreflective (qualitatively, compared to surrounding structures as the epithelium or the stroma) subepithelial band respecting the Bowman layer while rarely breaking through and expanding slightly into the anterior stroma (Figure 2A and B). IVCM (Rostock Cornea Module for Heidelberg Retina Tomograph, Heidelberg Engineering Inc., Heidelberg, Germany, 670 nm diode laser, axial resolution of approximately 1 microm) showed normally structured epithelium with underlying hyperreflective, fibrotic appearing structures comprising of oval-shaped cells (Figure 2C).
PMC6668246_02
Slit lamp photographs of (A) patient 1 (masquerading as carcinoma in situ) and (B) patient 2 (masquerading as Terrien marginal degeneration), showing peripheral corneal opacities of the superior-nasal quadrant or the nasal quadrant, respectively.
IMCRJ-12-237-g0001.jpg
PMC6668246_02_IMCRJ-12-237-g0001.jpg
F0001
Slit lamp biomicroscopy revealed symmetric slightly elevated, nodular, peripheral, subepithelial, and anterior stromal fibrosis in the nasal quadrant of both eyes with a non-nodular zone toward the limbus giving the false impression of thinning (Figure 1B).
(A) anterior segment optical coherence tomography (AS-OCT) of the right eye in patient 2, demonstrating mostly continuous, slightly nodular, well-demarcated hyperreflective subepithelial band partially breaking through the Bowman layer (arrow) and expanding into the anterior stroma (star). (B) Slightly oblique in vivo confocal microscopy (IVCM) of patient 2 demonstrating normal structured epithelium, and adjacent fibrotic structures (C) tangential IVCM on the level of the fibrotic structures.
IMCRJ-12-237-g0003.jpg
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F0003
This band respects the Bowman layer central to the lesion, while showing an inhomogeneous structure breaking through the Bowman layer and expanding into the anterior stroma peripheral to the lesion (Figure 3A). IVCM showed normally structured epithelium with underlying hyperreflective, fibrous structures with rare cells (Figure 3B and C).