Penetrating sclerokeratoplasty in massive recurrent invasive squamous cell carcinoma

A 35-year-old man presented with a recurrent temporal conjunctival mass (25 × 12 mm) involving about 6 clock hours of the limbus in the left eye. The mass encroached onto the temporal half of the cornea and showed surface keratin, intrinsic vasculature, and large feeder vessels. There was deep stromal infiltration. There were no cells in the anterior chamber. Ultrasound biomicroscopy confirmed infiltration of deep corneal stroma without intraocular extension. Surgery involved excision of the conjunctival component with a 4-mm margin, lamellar sclerectomy, and a penetrating sclerokeratoplasty with 3 mm of healthy corneal margin. Cryotherapy (double freeze-thaw) was done to the conjunctival margins. Histopathology showed it to be invasive squamous cell carcinoma. A thin layer of deep corneal stroma and all conjunctival margins were uninvolved. Twelve months after treatment, there was no recurrence, and the left eye recorded a visual acuity allowing finger counting at a 1-meter distance.