Factors affecting recurrence after surgical treatment in cases with ocular surface squamous neoplasia

AIM: To evaluate the risk factors leading to recurrence in patients with ocular surface squamous neoplasia(OSSN)METHODS: The records of 112 patients with OSSN who underwent treatment and follow-up between February 1999 and August 2018 were reviewed retrospectively.RESULTS: Totally 67 patients(59.8%) were male and 45 patients(40.2%) were female. The mean age at presentation was 63.7 y(range 22-87 y). Partial lamellar scleroconjunctivectomy(PLSC) was performed in 105(93.7%) cases and enucleation was performed in 7(6.3%) cases due to bulbus invasion as the first step treatment. Treatments used in addition to PLSC included cryotherapy in 78 eyes(74.3%), alcohol epitheliectomy in 57 eyes(54.3%) for presence of corneal involvement, and amniotic membrane transplantation in 17 eyes(16.2%) for ocular surface reconstruction. Topical mitomycin C was used in 10 patients(9.5%) and strontium-90(Str-90) treatment in 4(3.8%) patients because surgical margins were tumor positive at the histopathological examination. Postoperative histopathologic diagnoses were squamous cell carcinoma(52 cases), carcinoma in situ(44 cases), moderate conjunctival intraepithelial neoplasia(11 cases), and mild conjunctiva intraepithelial neoplasia(5 cases). At a mean follow-up of 20.1 mo, tumor recurrence was observed in 21(18.8%) cases. The rate of recurrence was found to be lower in cases that underwent supplemental cryotherapy compared to those that did not(P<0.001). There was no metastasis in any case. CONCLUSION: In our series, the recurrence rate is 18.8% and overall globe salvage rate is 90.2% for OSSN at relatively short-term follow-up.

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

To evaluate the outcome of amniotic membrane transplantation（AMT） after tumor excision followed by topical interferon alfa-2 b（IFNα2 b） drops for primary ocular surface squamous neoplasia（OSSN）. Twelve eyes of 12 patients with a mean age of 66±10 y were included. The average followup was 23±10 mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2 b drops restores a healthy ocular surface in OSSN without recurrence.

Update on pharmacotherapy for ocular surface squamous neoplasia

The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia(OSSN).Over the past two decades,the pharmacological management of OSSN has grown,with topical 5-fluorouracil,mitomycin,and interferon alpha 2b all being successfully used to treat this disease.Other agents,such as anti-vascular endothelial growth factor(VEGF),retinoic acid,cidofovir and Aloe vera,have less frequently been used in the treatment of OSSN.This review will discuss these pharmacologic agents,summarizing available data and presenting the approach to the treatment of these tumors.

Epidemiology of ocular surface squamous neoplasia in veterans: a retrospective casecontrol study

Background:A number of risk factors have been evaluated in ocular surface squamous neoplasia,but few studies have assessed risk factors specific to the armed forces veteran population.Methods:We conducted a retrospective case-control study on 55 patients and 55 age-matched controls with biopsy-proven ocular surface squamous neoplasia from the Miami Veterans Administration Hospital Eye Clinic to investigate potential risk factors encountered by veterans,including service-specific exposures.Veteran-specific risk factors included ionizing radiation exposure,Agent Orange exposure,deployment to Southwest Asia,and exposure to the series of biochemical warfare tests known as Project Shipboard Hazard and Defense.Data was analyzed with SPSS(SPSS Inc.,Chicago,IL)using t-tests,chi-squared,and logistic regression analysis,with a p-value of<0.05 considered statistically significant.Results:The strongest risk factor for ocular surface squamous neoplasia was lifetime sun exposure both directly assessed via historical quantification of exposure by dermatology practitioners(Odds Ratio(OR)5.4,95%Confidence Interval(CI)2.27–12.847,p<0.005),and using the surrogate markers of basal cell carcinoma(OR 3.157,95%CI 1.286–7.748,p=0.010)and pingueculae(OR 5.267,95%CI 2.104–13.186,p<0.005).Of the veteran-specific risk factors,Agent Orange exposure and Southwest Asia deployment were not associated with an increased risk of ocular surface squamous neoplasia.Exposure to ionizing radiation and involvement in Project Shipboard Hazard and Defense were not documented among any cases or controls.Conclusions:The results of our study are consistent with prior established risk factors,namely highlighting the important role of sun exposure in ocular surface squamous neoplasia among veterans.

Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

Background:To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia(OSSN)detected by high-resolution anterior segment tomography(HR-OCT)in patients with clinically unapparent disease following topical treatment.Methods:A retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted.Patients undergoing primary therapy with topical 5-fluorouracil 1%(5-FU)(4 times a day for 7 days with a 21-day break)or interferon-alpha-2b(IFN)(4 times a day)were reviewed.Patients were separated into two groups.Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT.Group 2(sub-clinical OSSN group)included individuals with clinical OSSN resolution but with features of persistent disease on HR-OCT.Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct.Results:A total of 95 patients(95 eyes)were reviewed.Sub-clinical OSSN was detected at a frequency of 17%in our study patients(n=16 patients,9 treated with 5-FU and 7 treated with IFN).In the 16 individuals,the mean time to clinical resolution was 3.6±1.0 cycles for 5-FU and 4.0±0.0 months for IFN.An additional 2.1±0.8 cycles for 5-FU and 1.2±0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN.Recurrence in Group 1 was noted in 10 patients(12%)while no recurrences occurred in Group 2,the cohort with subclinical disease that received the extended medical therapy.The mean follow-up was 24.0±17.9 months.Conclusion:We found that at least 17%of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT.This information can be used to optimize treatment and extend therapy past the point of clinical resolution.

A UV-related risk analysis in ophthalmic malignancies:Increased UV exposure may cause ocular malignancies

Purpose:To explore the role of ultraviolet radiation(UVR)in the occurrence and development of various ocular malignancies.Methods:In this article,we retrieved ocular malignancy data from the Global Cancer Observatory(GCO)and performed correlation analysis with the global UV index and sunshine duration.We searched for associated studies using the following databases:Embase,Pubmed,Cochrane Library,and Google Scholar.We conducted the literature by searching the Mesh terms denoting an exposure of interest("UV radiation","ultraviolet rays",and"ocular malignancies"),All studies included are published until December 30,2023 without language restrictions.Results:The mechanisms and epidemiological statistics of UVR on the onset and progression of eyelid malig-nancies are the most studied and clear.The role of UVR in conjunctival melanoma is similar to that in eyelid melanoma.The relationship between uveal melanoma and UVR is controversial,however,it may have at least a certain impact on its prognosis.UVR causes ocular surface squamous neoplasia by further activating HPV infection.Conclusions:UVR is a decisive risk factor for ocular malignancies,but the incidence of ultraviolet-induced tumors is also affected by many other factors.A correct and comprehensive understanding of the mechanisms of UVR in the pathogenesis of ocular malignant tumors can provide patients with more effective and selective immune regulation strategies.