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.

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.

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.

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.

眼表鳞状上皮瘤研究进展

眼表鳞状上皮瘤(OSSN)是临床上少见的眼表肿瘤,由于其发病率低,且易与翼状胬肉等混淆,给诊断造成困难。近年来,各种诊断技术的提高,以及干扰素(interferon,IFN)广泛应用于OSSN治疗,大幅度降低复发率,OSSN诊断治疗手段趋于多样化。了解当前OSSN发病原因以及治疗方式,可以更好地指导OSSN研究。

眼表鳞状细胞癌的临床表现

目的探讨眼表鳞状细胞癌(SCC)的临床表现。方法回顾性系列病例研究。收集2014年11月~2016年10月在本科治疗的眼表SCC患者22例,进行全面的眼科检查和全身检查。患者均在局部或全身麻醉下行眼表SCC切除手术。结果切除组织病理及免疫组织化学分析均证实为眼表SCC。肿瘤发生于颞侧14例(63.6%),发生于鼻侧5例(22.7%),环绕角膜生长2例(9.1%),位于角膜表面1例(4.5%)。其中累及角膜缘19例(86.4%),环绕角膜缘2例(9.1%),仅累及结膜2例(9.1%),累及半月皱襞1例(4.5%),累及巩膜13例(59.1%),侵犯至眼内2例(9.1%)。肿瘤的外观表现:结节状7例(31.8%)、菜花状5例(22.7%)、草莓状5例(22.7%)、乳头状4例(18.2%)、角结膜缘弥漫性增厚1例(4.5%)。多数肿瘤基底宽阔,厚度中等。伴有局部淋巴结肿大4例(18.2%)。4例患者(18.2%)手术后复发,再次手术,其中2例(9.1%)侵犯至眼内,行眼球摘除手术。结论睑裂部角膜缘是眼表SCC的好发部位,其中颞侧较为常见。临床表现多样,可侵犯眼内,少数患者伴有局部淋巴结增大。早期诊断和手术完整切除对于预后至关重要。

蠕形螨睑缘炎眼表改变的研究

目的:探讨蠕形螨睑缘炎的眼表改变,了解蠕形螨睑缘炎患者眼表的细胞学改变。方法:收集2013年9月-2015年9月在我院眼科门诊确诊为蠕形螨睑缘炎的患者60例作为实验组;对照组为体检中心眼科检查无眼部蠕形螨感染的体检人群40例。对每位患者进行蠕形螨镜检和眼表疾病指标问卷(OSDI)调查,记录实验组蠕形螨感染的数量和OSDI得分等参数;同时进行角膜荧光素钠染色(FL)、泪膜破裂时间测定(BUT)和泪液分泌试验(SIT)检查。运用结膜印迹细胞学联合苏木素-糖原(PAS)染色方法,分析实验对象结膜上皮鳞状化生程度。鳞状化生程度比较采用χ2检验。结果:(1)本研究60例蠕形螨睑缘炎患者(120只眼)中,31(25.83%)只眼为重度蠕形螨感染;48(40.00%)只眼为中度感染;41(34.17%)只眼为轻度感染;对照组40例(80眼),均无眼部蠕形螨感染。实验组BUT及SIT较对照组均降低,差异有统计学意义(P<0.05);OSDI问卷的得分比较,实验组较对照组明显升高,差异有统计学意义(P<0.05)。(2)结膜印迹细胞学检查中发现实验组结膜鳞状化生程度显著高于对照组,差异有统计学意义(P<0.05)。结论:(1)蠕形螨睑缘炎导致泪膜不稳定及泪液分泌减少同时伴发炎症。(2)蠕形螨睑缘炎引起结膜细胞学改变,导致患者结膜上皮鳞状化生级别升高。

眼球表面鳞状细胞性肿瘤临床和病理学特点

眼球表面鳞状细胞性肿瘤是比较常见的眼表肿瘤,包括鳞状细胞乳头状瘤、日光性角化病、结膜上皮内瘤变和鳞状细胞癌。深入了解这些病变的临床和病理学特点,有利于提高临床诊断的正确性。本文对眼球表面鳞状细胞性肿瘤的类型、临床表现和病理学特点进行阐述,以期对临床诊治提供参考。

手术切除眼表面鳞状细胞性肿物29例临床分析

目的 提高对眼表面鳞状细胞肿物的诊断和治疗水平。方法 对我院 1988年 5月～ 2 0 0 1年 10月手术切除的2 9例眼表面鳞状细胞肿物进行临床分析。结果 本组病例中男性多见 (69% ) ,病变好发于角膜缘部 (62 .1% ) ,可分为 :良性病变 (14例 ,48.3 % ) ,包括鳞状细胞良性增生、鳞状细胞乳头状瘤 ;交界性病变 (6例 ,2 0 .7% ) ,主要是非典型性增生 ;恶性病变(9例 ,3 1.0 % ,) ,包括原位癌、浸润性鳞状细胞癌 3大类。手术完整切除是治疗的主要手段。结论 对眼表鳞状细胞肿物早期的正确诊断。

人乳头瘤病毒与眼表鳞状上皮肿瘤关系的研究进展

人乳头瘤病毒(HPV)是一种与人类多种疾病尤其是宫颈癌相关的病毒,自HPV与宫颈癌的关系被确认以来,其致病机制及感染预防一直是研究的热点。近年的研究在眼表鳞状上皮肿瘤(OSSN)中检测出HPV,提示其可能参与OSSN的发生。了解其在OSSN中的作用有利于深入了解OSSN的发病机制,从而更好地预防和治疗该病。

眼表肿物50例临床分析

目的分析眼表肿物的临床特征、性质及其治疗方法。方法对连续2年经我院治疗的50例(53只眼)眼表肿物进行分析。记录肿物临床体征。根据形态、大小、位置确定手术方法,手术方法根据肿物大小及位置分为4种:①单纯肿物切除,②肿物切除联合冷冻术,③肿物切除联合冷冻术联合羊膜移植术,④肿物切除联合部分板层角膜移植术。肿物切除常规病理检查确定性质、分析病理结果,术后观察发随访复发情况。结果角结膜鳞状细胞癌形态呈菜花状且见松针样毛细血管扩张。角膜原位癌呈半透明或胶冻状白色,表面凹凸不平。色素痣扁平、黑色弥漫浸润,界限较清楚。结膜乳头状瘤呈桑葚或乳头状隆于表面。单纯肿物切除21例,肿物切除联合冷冻术17例,肿物切除联合冷冻术联合羊膜移植术10例,肿物切除联合部分板层角膜移植术2例。根据病理结果,恶性肿物共23例(46%),良性肿物27例(54%)。恶性肿瘤可见异型性明显,角结膜鳞状细胞癌鳞状上皮增生活跃,呈浸润性生长,突破基底膜。角膜原位癌、角结膜上皮内瘤变基底膜完整。良性肿物结膜乳头状瘤呈乳头状,可见纤维血管轴心。色素痣见痣细胞呈巢团状分布。随访时间1～10年(平均4. 8年),恶性肿物随访19例,其中4例复发。良性肿物随访20例,20例中均未复发。共失访11例,4例为恶性眼表肿物患者,7例为良性。结论眼表肿物中恶性发病比例较高,发现眼表肿物应尽早切除,并行病理检查明确肿物性质。

显性结膜鳞状细胞癌1例(英文)

患者,男,37岁,以"右眼肿块迅速增大,无痛感5mo"就诊于我科。行眼科常规检查,发现一发白带蒂肿块位于右眼睑裂区角膜缘颞侧。遂行肿块切除术,手术成功。对切除肿块进行病理组织学检查,显示为分化良好的鳞状细胞癌。通过对此例居住在热带地区的亚裔患者发生的结膜鳞状细胞癌的诊治,认为长期的阳光照射是导致鳞状细胞癌发生的一个主要危险因素,提示我们对于任何眼表面病变都必须进行仔细的评估,进而正确诊断和治疗。

眼球表面鳞状细胞癌临床病理分析

目的探讨眼球表面鳞状细胞癌的临床特征和病理表现。方法1975～2007年12月经我院病理检查确诊的眼球表面鳞状细胞癌患者16例,就其流行病学﹑临床病理特征﹑治疗及预后等进行分析。结果本文眼球表面鳞状细胞癌患者发病的平均年龄为55.8岁;以户外工作者多见;肿瘤部位以颞侧角膜缘最多。主要临床症状有疼痛,畏光和流泪,但视力均正常。病理特征:上皮鳞状细胞层次变厚,极性紊乱,胞浆红染,核分裂明显,多数出现角化,以高、中分化为主。治疗以手术切除加局部抗癌药物点眼效果较好。结论本病诊断并不困难且预后较好,但仍然强调早期诊断和早期治疗。

眼表鳞状细胞性肿瘤切除联合自体结膜移植及局部冷冻术治疗的应用价值

目的探讨眼表鳞状细胞性肿瘤接受肿瘤切除联合自体结膜移植及局部冷冻术治疗的应用价值。方法随机选取眼表鳞状细胞性肿瘤患者90例,随机分为肿瘤切除联合自体结膜移植及局部冷冻术治疗组(联合治疗组,n=45)和肿瘤切除单独治疗组(单独治疗组,n=45)两组,统计分析两组患者的痊愈、复发、死亡情况。结果联合治疗组患者的痊愈率93.3%(42/45)显著高于单独治疗组84.4%(38/45)(P<0.05),复发率4.4%(2/45)显著低于单独治疗组11.1%(5/45)(P<0.05),bcl-2阳性率[6.7%(3/45)]显著低于单独治疗组[31.1%(14/45)](P<0.05),但两组患者的死亡率[2.2%(1/45)、4.4%(2/45)]差异不显著(P>0.05)。结论眼表鳞状细胞性肿瘤接受肿瘤切除联合自体结膜移植及局部冷冻术治疗的应用价值较肿瘤切除单独治疗高。

光相干断层扫描技术在眼表鳞状上皮瘤诊疗中的应用及展望

眼前节光相干断层扫描技术(AS-OCT)作为一种无创性检查手段,具有检测肿瘤性上皮病变的巨大潜力。依据AS-OCT上的特征性表现,可在多种眼表疾病中检测出眼表鳞状上皮瘤(OSSN)的存在,其诊断效果堪比病理组织活检。随着技术的发展,AS-OCT成像模式已从时域OCT发展到具有更高外显率和分辨率的频域OCT,其呈现的高质量图像有助于精细辨别OSSN的良恶性,提高OSSN的检出率,完善眼表肿瘤的鉴别诊断,从而提高OSSN的诊断效率。此外,在监测OSSN复发及化疗评估等临床管理阶段,AS-OCT可辅助优化治疗方案,有效监测疾病的转归。本文就OSSN的形态学表现、OSSN各种辅助检查的优劣性、AS-OCT的发展、OSSN在AS-OCT上的特异表现、AS-OCT在非典型OSSN中的应用、AS-OCT在OSSN诊疗中的应用及局限性进行综述。

长链非编码RNA BANCR在眼表鳞状细胞癌中的表达及意义

目的探讨长链非编码RNA(LncRNAs)BANCR在眼表鳞状细胞癌中的表达及意义。方法取82例眼表鳞状细胞癌患者的病灶组织标本(观察组)与癌旁组织标本(对照组),检测LncRNA BANCR表达水平,调查与随访患者的病理特征、预后并进行相关性分析。结果观察组的LncRNA BANCR表达阳性率为54.9%,显著高于对照组的2.4%(P<0.05)。在82例患者中,不同组织学分化、临床分期、远处转移、吸烟患者的LncRNA BANCR表达阳性率对比差异有统计学意义(P<0.05)。直线相关分析显示患者的LncRNA BANCR表达与组织学分化、临床分期、远处转移、吸烟存在显著相关性(P<0.05)。随访到2020年2月1日,平均随访时间(31.72±2.28)个月,82例患者中死亡30例,死亡率为36.6%。COX回归分析显示LncRNA BANCR、组织学分化、临床分期、远处转移、吸烟都为影响患者预后死亡的主要因素(P<0.05)。结论LncRNA BANCR在眼表鳞状细胞癌中呈现高表达状况,与患者的病理特征与预后显著相关,可作为眼表鳞状细胞癌病情与预后评估的潜在生物标志靶点。

优化脉冲光辅助治疗蠕形螨相关鳞屑性睑缘炎的疗效及对眼表状态的影响

目的探究优化脉冲光辅助治疗蠕形螨相关鳞屑性睑缘炎的疗效及对眼表状态的影响。方法选取60例(120眼)蠕形螨相关鳞屑性睑缘炎患者作为研究对象,按照随机数字表法按1∶1比例分为观察组、对照组,各30例(60眼)。对照组采用妥布霉素地塞米松眼膏、茶树油眼睑湿巾治疗,观察组在对照组基础上加用优化脉冲光辅助治疗。比较两组疗效、治疗前后症状评分、体征评分、蠕形螨计数、眼表功能[泪膜破裂时间(tear film rupture time,TBUT)、结膜充血程度、角膜荧光染色(fluorescence staining,FL)、泪河高度(tear river height,TMH)]及安全性。结果观察组总有效率91.67%较对照组78.33%高(P=0.041);治疗后观察组症状评分、体征评分、蠕形螨计数较对照组低(P均<0.001);治疗后观察组TBUT较对照组高,结膜充血程度、FL、TMH较对照组低(P=0.012,P<0.001,P<0.001,P<0.001);两组患者均未发生明显并发症。结论优化脉冲光辅助治疗蠕形螨相关鳞屑性睑缘炎效果显著,可有效促使症状改善、降低蠕形螨数量、提高眼表功能、缓解角膜损伤、安全性高。

共聚焦显微镜在活体角膜上皮肿瘤鉴别诊断中的应用

目的通过活体共聚焦显微镜在角膜上皮肿瘤诊断中的应用，分析、鉴别角膜上皮肿瘤性质。方法7例角膜上皮肿瘤患者术前均行常规眼部裂隙灯检查、眼前节OCT和活体共聚焦显微镜检查。所有患者均实施角膜肿瘤切除术，术后行肿瘤组织病理学检查，与术前共聚焦显微镜结果比较。结果7例角膜上皮肿瘤均侵犯透明角膜、角膜缘和球结膜，突起于眼球表面，形状似桑葚，血管丰富。在眼前节OCT检查中5例角膜肿瘤显示密度均匀，与角膜组织之间界限清晰，浅层基质中未见肿瘤密度影；另外2例角膜肿瘤显示，密度不均，与角膜组织界限不清，而且侵犯前弹力层和浅层角膜基质。在活体共聚焦显微镜中7例均显示角膜上皮细胞非典型增生，其中2例非典型增生明显，侵犯前弹力层，在角膜上皮层和浅基质层内形成“癌巢”，5例诊断为角、结膜乳头状瘤，2例诊断为角膜鳞状上皮细胞癌，与术后组织病理学诊断结果一致。结论活体共聚焦显微镜检查对角膜上皮肿瘤术前诊断肿瘤性质提供重要依据。