Case of Progressive Keratoconus With Newly Diagnosed Pellucid Marginal Degeneration After Corneal Cross-Linking.

PURPOSE: The purpose of this study was to document, to our knowledge, the first reported case of keratoconus progression accompanied with newly diagnosed pellucid marginal degeneration after corneal cross-linking (CXL). METHODS: A novel case of further keratoconus progression plus development of pellucid marginal degeneration in the same eye after CXL was documented with supporting evidence from Scheimpflug and optical coherence tomography imaging. RESULTS: A male patient was diagnosed with progressive keratoconus in the left eye and treated with CXL when aged 25 years. Although strongly cautioned not to rub his eyes, he admitted that he continued eye rubbing in association with atopic disease. At a follow-up examination 3.5 years after CXL, progressive keratoconus was detected and pellucid marginal degeneration was newly diagnosed in the left eye. The eye was retreated with CXL. CONCLUSIONS: This case illustrates that progressive keratoconus and pellucid marginal degeneration can occur in the same eye after CXL and demonstrates the deleterious effects that can develop with continued eye rubbing.

Isolated primary sebaceous gland carcinoma of the bulbar conjunctiva.

Purpose: To report a rare case of primary sebaceous gland carcinoma of the bulbar conjunctiva without palpebral involvement. Observation: A 76-year-old male was referred to the cornea service for a suspicious lesion on the limbal conjunctiva and cornea of his left eye. On exam, there was a large fibrovascular growth with conjunctivalization of the cornea from 2:00 to 10:00 extending 6mm onto the cornea. Patient underwent treatment with 5-fluouracil, followed by excisional biopsy with cryotherapy. Histopathologic examination demonstrated poorly differentiated sebaceous gland carcinoma. Subsequent map biopsies of the palpebral and bulbar conjunctiva of the left eye were performed and ruled out pagetoid spread. Conclusions and Importance: Primary sebaceous gland carcinoma of the bulbar conjunctiva without eyelid involvement is a rare phenomenon. Our patient joins a few case reports in the literature. Of these cases, we are the second case to utilize 5-flurouracil preoperatively. We recommend clinicians consider sebaceous carcinoma on their differential when ocular surface neoplasms diagnosed as other conditions do not respond to conventional therapies.