Diagnosis Of Ocular Surface Squamous Neoplasia Research Articles

Efficacy of topical 5-Fluorouracil in the management of ocular surface squamous neoplasia: a study of 101 eyes.

To study the efficacy and side-effect profile of topical 5-Fluorouracil (5-FU) in the treatment of ocular surface squamous neoplasia (OSSN). Retrospective study of 101 eyes of 100 patients treated with 5-FU with one week on and 3weeks off regimen. Of the 100 patients (101 eyes), the mean age at diagnosis of OSSN was 49 (median, 52years; range, 11-87years). History of prior intervention was noted in 6 (6%) eyes. Tumor epicenter included bulbar conjunctiva (n = 54; 53%), limbus (n = 27; 27%), and cornea (n = 20;20%). Mean number of cycles of topical 5-FU administered was 3 (median, 3; range, 1-8). Complete tumor regression was achieved with topical 5-FU in 89 (88%) eyes with a mean number of 2 cycles (median, 2; range, 1-6) of 5-FU. The remaining 12 (12%) lesions underwent additional treatment including excisional biopsy (n = 7), extended enucleation (n = 3), and topical Interferon alpha 2b (n = 2) for complete tumor control. Over a mean follow-up period of 6months (median, 5months; range, 1-36months) following treatment, tumor recurrence was noted in 2 (2%) patients, and side-effects were noted in 7 (7%) eyes including conjunctival hyperemia (n = 1), punctal stenosis (n = 1), sterile keratitis (n = 4), and limbal stem cell deficiency (n = 1). Topical 5-FU is an effective non-invasive therapy for OSSN with a minimal side-effect profile.

Study of Demographic Patterns and Treatment Approaches of Ocular Surface Squamous Neoplasia in a Tertiary Care Centre

Abstract Background: Ocular surface squamous neoplasia (OSSN) includes a wide spectrum of conjunctival and corneal intraepithelial neoplasia, which can manifest as mild, moderate, severe dysplasia, carcinoma-in-situ and invasive squamous cell carcinoma. OSSN can mimic many common indolent lesions like pterygium and have a potential for causing ocular and systemic morbidity and mortality. OSSN is more common in elderly males. ultraviolet-B light, human immune deficiency, and human papilloma virus have been proposed as major risk factors in aetiopathogenesis. Though diagnosis of OSSN is mainly based on clinical suspicion, definitive diagnosis needs histopathological evaluation. Anterior segment optical coherence tomography, ultrasonic bio microscopy, and impression cytology are nonsurgical tools used for diagnosis and management, of which anterior segment optical coherence tomography has brought about a paradigm shift in the diagnosis of OSSN. Aim: The aim of the study was to demonstrate the demographics, clinical profile, types of OSSN, management approaches, histopathology and the effectiveness of different approaches in patients with OSSN in a tertiary care centre in Tamil Nadu. Materials and Methods: It was a hospital-based prospective interventional study where 51 eyes of 50 patients with clinically suspicious OSSN were studied between July 2021 and January 2023 (over 18 months) with a minimum follow-up of 6 months. Results: The age group for the patients ranged between 30 and 79 years. Out of 50 patients, 26 were men and 24 were women with no sex predilection in our study. Unilateral involvement was seen in 49 patients and only one patient had bilateral involvement. Twenty-nine patients presented with gelatinous-like lesions, six with leukoplakic lesions, five with papilliform like lesion, nine with pigmented lesions and one with nodulo ulcerative type lesion. On histopathological examination, majority (21 patients) were severe dysplasia. Majority (78.4%) underwent surgical clearance with no recurrence. Adjunctive therapy to reduce recurrence included intraoperative cryotherapy and postoperative topical chemotherapy using mitomycin C. Conclusion: In our series, the most common morphological type of lesion was gelatinous, and surgical management using Shield’s technique was commonly used as the management option for unifocal lesions less than 5 mm with less than 4 clock hours involvement. The demographic profile was comparable with other studies on OSSN. Being a potentially malignant condition, a study on OSSN helps us in understanding the disease better and helps in early detection, leading to timely intervention and improved treatment outcomes. Furthermore, research on OSSN contributes to enhancing our knowledge on ocular oncology.

Chronic inflammation as a proposed risk factor for ocular surface squamous neoplasia

Chronic inflammation is a predisposing factor for metaplastic changes and ultimately dysplasia. We describe cases of OSSN occurring in the setting of chronic ocular surface inflammation. Sixteen eyes from 14 individuals were included from one ocular oncology clinic between 2010 and 2023. Patients presented with ocular surface squamous neoplasia (OSSN) in the setting of chronic inflammation. The diagnosis of OSSN was made using anterior segment high-resolution optical coherence tomography (HR-OCT) and confirmed by histopathological analysis in all cases. Median age on presentation was 61 [IQR 47.5-69.2] years. Eleven (86%) individuals were male and five (36%) identified as White Hispanic. Ten eyes were referred with ocular surface diagnoses including pannus (n=4), scarring (n=3), pterygium (n=2), and herpetic keratitis (n=1). Only six eyes were referred as possible neoplasia. All individuals had a history of ocular surface inflammation. The most common inflammatory conditions were ocular rosacea (seven individuals) and atopic keratoconjunctivitis (AKC) (five individuals). Two individuals were found to have bilateral OSSN, one in the setting of ocular rosacea and the other in the setting of AKC. All 16 eyes from 14 individuals were suspected to have OSSN based on HR-OCT findings which guided the location of the incisional biopsies that subsequently confirmed histopathological diagnosis in all cases. OSSN may arise in the setting of chronic inflammation on the ocular surface. Identification of the tumor can be challenging in these cases, and HR-OCT can be a key diagnostic tool in detecting OSSN.

Impression Cytology in the Evaluation of Ocular Surface Squamous Neoplasia- A Retrospective Cohort Study

Introduction: Ocular Surface Squamous Neoplasia (OSSN) are a diverse group of lesions varying from Conjunctival Intraepithelial Neoplasia (CIN) to invasive Squamous Cell Carcinomas (SCC). Histopathological examination is the gold standard technique in diagnosing them. However, it is invasive and may not be suitable in recurrent cases. Numerous minimally invasive techniques are available to diagnose OSSN cytologically. This study employs Impression Cytology (IC) to diagnose ocular squamous neoplastic lesions and compare it with the histological diagnosis. Aim: To utilise IC in the diagnosis of OSSN and to compare its findings with histopathological diagnosis. Materials and Methods: This was a retrospective cohort study, conducted in a Tertiary Eye care Hospital, Hubli, Karnataka, India during January 2023. The data included was over a period of three years (from July 2016 to June 2019). A total of 44 eyes (34 patients), in which both biopsy and IC done, were included. The patients’ age, sex and ocular examination findings were recorded. The cytological and histopathological slides were retrieved from the archives and examined morphologically. The cytological findings were compared with histopathological diagnosis and the sensitivity and specificity of the IC technique were calculated. The data was analysed using Microsoft excel sheets. Results: A total of 34 patients were studied ranging from 19 to 85 years. The mean age was 49 years, 21 (61.76%) of them were males and 13 (38.24%) were females. In 24 patients, single eye was affected and in 10 patients bilateral eye involvement was seen. Histology revealed that there were 18 (40.90%) CIN I cases, 4 (9.09%) CIN II, 5 (11.36%) CIN III and 17 (38.65%) SCC. On cytology, 3 (6.82 %) were normal conjunctival epithelium, 30 (68.18 %) were dysplasia and 11 (25.00 %) were SCC. On cyto- histomorphological analysis, 35 (79.55 %) were concordant, out of 44 diagnosis. IC has a sensitivity of 88.89% and specificity of 64.71% to detect dysplasia. To diagnose SCC, it has sensitivity of 64.71% and 100% specificity. Conclusion: According to the present study observations, IC is an excellent preliminary tool to investigate suspected neoplastic lesions of ocular surface. It has a very good concordance with histopathological diagnosis. IC is highly sensitive to detect dysplasia (CIN) and is very specific to diagnose SCC.

A report on the outcome of topical mitomycin C as the primary treatment for ocular surface squamous neoplasia

Background: Although surgical excision is still the gold standard treatment for ocular surface squamous neoplasia (OSSN), interest in conservative medical approaches is steadily growing due to its advantages. The clinical outcome of topical mitomycin C (MMC) as the primary treatment for OSSN was reported. The primary outcome measure was clinical regression of the tumour. The secondary Outcome measures were duration of treatment, possible side effects and recurrences. Materials and methods: In this prospective study 11 patients with the diagnosis of OSSN were included. All were treated with mitomycin C eye drops 0.02% 4 times daily for 4 days a week. Results: Out of the 11 patients, complete tumour regression was achieved in 6 (54.5%) patients. The remaining 5 patients reported partial tumour regression. Mean duration of treatment was 6 weeks. The most common side effect noted was eye irritation. The side effect was transient and resolved with the cessation of treatment. No recurrence was observed during the follow up. Conclusion: Topical chemotherapy can be tried as primary treatment in all patients with OSSN as it can cause complete or partial tumour regression with negligible side effects. Keywords: ocular surface squamous neoplasia; mytomycin C; tumour regression

Diagnosis and staging of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour. The diagnosis of OSSN is based on clinical suspicion and confirmed by various diagnostic modalities, of which histology is the gold standard. With the move to less invasive management options such as topical chemo- or immunotherapy, less invasive diagnostic options have come to the fore.Aim: The purpose of this article was to review the current staging and diagnostic modalities for OSSN with a focus on less invasive modalities.Method: A literature review was performed for publications on ocular surface neoplasia and diagnostic modalities.Results: Histology is the gold standard for diagnosing OSSN. Cytology has been shown to be a simple, repeatable and minimally invasive diagnostic modality, which also allows for additional testing such as polymerase chain reaction. Anterior segment optical coherence tomography provides a non-contact method of evaluating the ocular surface, with OSSN showing a thickened hyper-reflective epithelium, abrupt transition zone and demarcation line. Vital dyes are used less commonly with high sensitivity, but lower specificity for OSSN. Finally, confocal microscopy provides en-face images of the ocular surface, with OSSN showing a classic ‘starry night’ appearance.Conclusion: Histology remains the gold standard for diagnosis; however, with the increasing use of topical therapy for OSSN, there has been an increase in the uptake of less invasive diagnostic modalities.

Role of mitomycin C in the management of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) in a broader terminology recently introduced in the field of ophthalmology that includes conjunctival malignancies which ranges from mild epithelial dysplasia to invasive squamous cell carcinoma. The routinely used topical chemotherapy for OSSN is mitomycin C (MMC), 5-fluorouracil, interferon-alpha, and cidofovir, and among these, MMC is usually preferred by most of the ophthalmologists because of its cost-effectiveness and lesser side effects. Aim: The aim of study was to evaluate the role of MMC as an adjuvant therapy intraoperatively and postoperatively in the management of OSSN. Methodology: Patients in the age group of 40 years and above with a diagnosis of OSSN were included as our study subjects. The diagnosis of OSSN was made based on the clinical presentation and the cytological picture. A total of 22 patients with OSSN were taken as our study subjects. The tumor was surgically removed in toto along with 3–4 mm of uninvolved conjunctiva. Further, 0.4 mg/ml of MMC was applied over the excised site. Postoperatively, two cycles of 0.04% MMC eye drops were given for 2 weeks with a dosage of 4 times/day. It is given in two cycles, each cycle lasting for a week with an interval of 1 week in between. Results: Postoperatively, only one patient (4.5%) had recurrence which had developed after 6 months. Patients aged more than 60 years and who had the initial size of the lesion as > 8 mm were more prone to recurrence. Other postoperative complications that had occurred were one patient had allergic conjunctivitis and the other patient had punctate erosion. Conclusion: The use of MMC eye drop in the concentration of 0.04% has shown good clinical results without any serious side effects and with a very less recurrence rate during the follow-up period of 1 year when used as alternate 7-day courses.

Role of high resolution optical coherence tomography in diagnosing ocular surface squamous neoplasia with coexisting ocular surface diseases

PurposeCoexistence of an ocular surface disease can mask the typical features of ocular surface squamous neoplasia (OSSN). The purpose of this study was to evaluate high resolution optical coherence tomography (HR-OCT) as an adjunct in the detection and differentiation of OSSN within coexisting ocular surface pathologies. MethodsRetrospective study of 16 patients with ocular surface disease and lesions suspicious for OSSN that were evaluated with HR-OCT. HR-OCT images of the lesions were taken to look for evidence of OSSN. Biopsies were performed in all cases, and the HR-OCT findings were compared to the histological results. ResultsOf the 16 patients with OSSN and a coexisting ocular surface disease, 12 were found to have OSSN by HR-OCT and all were subsequently confirmed by biopsy. Two patients had OSSN with rosacea, one with pingueculum, two within pterygia, one with Salzmann’ nodular degeneration, six with limbal stem cell deficiency (LSCD)/scarring. In all 12 cases HR-OCT images revealed classical findings of hyper-reflective, thickened epithelium and an abrupt transition from normal to abnormal epithelium. OSSN was ruled out by HR-OCT in four cases (2 Salzmann's, 1 mucous membrane pemphigoid, and 1 LSCD). Negative findings were confirmed by biopsy. HR-OCT was used to follow resolution of the OSSN in positive cases, and it detected recurrence in 1 case. ConclusionsWhile histopathology is the gold standard in the diagnosis of OSSN, HR-OCT can be used to noninvasively detect the presence of OSSN in patients with coexisting ocular conditions.

Correlation of impression cytology with histopathology in the diagnosis of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) includes a wide spectrum of conjunctival and corneal intraepithelial neoplasia which can manifest as dysplasia, carcinoma in situ, and invasive squamous cell carcinoma. OSSN can be diagnosed by certain noninvasive techniques as well as invasive histopathological examination. One of such noninvasive techniques is impression cytology which refers to the histological study of superficial layers of ocular surface epithelium. Aim: The aim of this study was to assess the accuracy of impression cytology in the diagnosis of OSSN using cellulose acetate paper by correlating with histopathology. Materials and Methods: This is a prospective observational and interventional study conducted at a tertiary referral center in Chennai. This study was conducted from January 2016 to July 2017 and included 43 eyes of 42 patients presenting with conjunctival mass at the limbus or over the conjunctiva. Hospital ethics committee approval was obtained. Results: A total of 43 excision biopsies of 42 patients suspected for OSSN were performed. There was correlation in 36 eyes (83.72%), and in 7 eyes, there was no correlation (16.27%). The cases having hyperkeratotic lesions were missed by the impression cytology. Conclusion: Impression cytology can be used as a screening tool in the diagnosis of OSSN and in the follow-up of patients with recurrence. However, histopathology always remains the gold standard in diagnosing OSSN.

Conjunctival Seborrheic Keratosis Mimicking Ocular Surface Squamous Neoplasia

Seborrheic keratosis is a benign epithelial neoplasia that commonly occurs on the face and eyelids of middle-aged individuals. Its occurrence on the conjunctiva is rare. We report a case of conjunctival seborrheic keratosis that clinically resembled an ocular surface squamous neoplasia (OSSN). A 77-year old male was referred with a right temporal juxta-limbal conjunctival mass. Based on its appearance, a clinical diagnosis of OSSN was made and a wide excisional biopsy, cryotherapy and amniotic membrane graft was performed. A diagnosis of seborrheic keratosis was confirmed by histopathology. Our case highlights the fact that conjunctival seborrheic keratosis, though rare, can mimic malignant lesions such as OSSN and should be considered in the differential diagnosis of conjunctival tumours.

Topical Interferon α-2b as a Single Therapy for Primary Ocular Surface Squamous Neoplasia.

The aim of this study was to evaluate the efficacy and safety of topical interferon α-2b (IFNα2b) as a single therapy for primary ocular surface squamous neoplasia (OSSN). Medical records of 24 eyes of 24 patients with primary OSSN were reviewed retrospectively. The diagnosis of OSSN was primarily based on the slit-lamp examination. All cases were treated with topical IFNα2b (1 million IU/mL) 4 times daily. The duration of treatment, tumor response, adverse effects, and number of vials of topical IFNα2b were noted. Complete response was defined as total disappearance of lesions. The complete remission of the tumor was observed in 22 patients (91.6%). Two patients (8.3%) did not respond to the treatment. The mean age was 62.44 ± 13.65 years (range, 50-92 years). The mean follow-up period was 18.81 ± 3.81 months (range, 14-22 months). The median greatest linear dimension was 6 mm (range, 5.2-12 mm). In all successful remissions, the median time to lesion resolution was 3.25 months. Adverse effects of topical IFNα2b included spontaneous intratumoral bleeding after 3 weeks of topical therapy in 1 patient. No long-term complication or recurrence was found at the end of the follow-up period. Topical IFNα2b is effective and safe as a single therapy in the management of primary OSSN with minimal self-limited adverse effects. It may provide the least invasive way of treating OSSN.

Ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) represents a rare spectrum of disease ranging from mild dysplasia to carcinoma in situ to invasive squamous cell carcinoma of the ocular surface. OSSN is more common in elderly males, in countries closer to equator and countries where exposure to excessive sunlight is more common. Diagnosis of OSSN is mainly based on clinical suspicion. Definitive diagnosis needs histopathological evaluation. In this article, we report a case of OSSN in a 28 year old male presented with limbal nodule of right eye. Excisional biopsy was done. Histopathological examination revealed a well differentiated squamous cell carcinoma.

Ocular surface squamous neoplasia in patients with HIV infection in sub-Saharan Africa

Ocular surface squamous neoplasia (OSSN) in sub-Saharan countries is an aggressive tumor that affects younger patients and appears to be increasing in incidence. There are data to suggest the association of this disease with solar radiation exposure, HIV, and human papilloma virus (HPV). This trend possibly reflects the association of the high incidence of HIV, concomitant high incidence of exposure to HPV, and the solar radiation exposure that people in this region of the world receive. We undertook a PubMed search with the terms 'ocular surface squamous neoplasia', 'conjunctival carcinoma', 'HIV' and 'HPV', and 'sub-Saharan/Africa' to ascertain the scope of the problem and to review the available data, with an emphasis on publications of 2009 and the first quarter of 2010. There is increasing evidence of a significant association between HIV seropositivity and OSSN. The role of HPV as contributing to the cause of OSSN is being investigated. Patients with conjunctival cancer in sub-Saharan Africa are typically younger and more than 50% have underlying HIV infection. Initial presentation can be asymptomatic; however, many of these patients have advanced disease before they seek medical help and OSSN appears to have a more aggressive clinical course in sub-Saharan Africa. Treatment in Africa is primarily surgical. Chemotherapy and antiviral agents have been used. A diagnosis of OSSN in younger patients in sub-Saharan Africa should prompt HIV serotesting.

Conjunctival Lichen Planus Simulating Ocular Surface Squamous Neoplasia

To describe the history and clinical presentation of a case of conjunctival lichen planus simulating ocular surface squamous neoplasia (OSSN). A 32-year-old Hispanic man presented with a 6-month history of worsening foreign body sensation, localized conjunctival hyperemia, and a progressively enlarging "bump" located in the temporal aspect of his right eye. The patient denied any prior ocular trauma or surgery to the affected eye. Evaluation consisted of slit lamp examination and surgical excision of the mass with histopathologic studies. Slit lamp examination revealed the presence of a 6 x 5 x 1 mm elevated conjunctival fleshy mass that extended into the corneal limbus in the right eye. The lesion exhibited intrinsic pigmentation and vascularization as well as the presence of a dilated feeder vessel. Based on clinical findings, a diagnosis of OSSN was suspected. An excisional biopsy was performed with cryotherapy application to the surgical margins. Histopathologic study of the lesion revealed hyperkeratosis, parakeratosis, irregular acanthosis, and a band-like infiltrate of predominantly lymphocytes hugging the epithelium, consistent with the diagnosis of lichen planus. Ocular lichen can present as a focal conjunctival lesion. Excisional biopsy allowed us to make the diagnosis of this rare entity, which presented as a simulating lesion with clinical features consistent with ocular surface squamous neoplasia.

Ocular Surface Squamous Neoplasia After Corneal Graft

To describe the clinical features and management of ocular surface squamous neoplasia (OSSN) after corneal graft. Retrospective case series of 4 patients. Four eyes of 4 patients treated for OSSN after corneal graft in an institutional setting were included. All 4 patients were treated with topical chemotherapy and additionally 1 patient each was treated with excisional biopsy and photodynamic therapy. The main outcome measure was the recurrence of OSSN and the clarity of corneal graft after treatment. The mean time interval between corneal graft and diagnosis of OSSN was 36 months (range, 2 to 73 months). All 4 eyes were on chronic treatment with topical steroids for a minimum duration of 2 months and 2 eyes had previous herpes keratitis. Misdiagnosis of graft rejection was found in 2 cases. The mean tumor basal diameter was 18 mm (range, 14- to 25-mm) and the tumor involved a mean of 76% of the corneal surface (range, 15% to 90%). Management was successful in all cases using topical mitomycin C (n = 1), topical interferon alpha2b (n = 4), and photodynamic therapy (n = 1). At mean follow-up of 20 months, tumor control was achieved in all cases and all 4 eyes showed chronic graft opacification with vascularization but no intraocular tumor. Corneal OSSN should be considered in patients using chronic topical steroids for corneal graft. Nonsurgical management with topical chemotherapy or photodynamic therapy can achieve tumor control.

Structural and cellular diagnosis of ocular surface squamous neoplasia using in‐vivo confocal microscopy

Abstract Purpose Aim of this study was to analyze in‐vivo structural and cellular features of ocular surface squamous (OSS) neoplasia using clinical confocal microscopy (CM). Methods Ten consecutive cases of OSS neoplasia were investigated using in‐vivo corneo‐conjunctival CM (ConfoScan4, Nidek, Gamagori, Japan) with a 40X surface‐ noncontact objective. Data obtained using CM were also compared to standard histopathology or cytologic samples obtained by scraping technique. Results CM analysis of OSS neoplasia showed good agreement with correspondent tumor cytology or histopathology, revealing some structural and cellular features of the lesions, including: loss of the normal epithelium structure in 10 cases (100%), high‐reflective areas in 10 cases (100%), inhomogeneous cell density in 8 cases (80%), cells debris in 8 cases (80%), abrupt demarcation at the lateral edge of the lesion in 7 cases (70%), nodular zone of cell proliferation in 6 cases (70%), fibrovascular structures in 3 cases (30%), keratin pearls in 1 case (10%) and pre‐Bowman space involvement in 1 case (10%). No anterior stroma involvement was documented. Cells anisocytosis, pleocytosis and anisonucleosis were also documented in 9 of 10 tumors (90%). Conclusion In‐vivo CM seems a reliable, non‐invasive method useful for in‐vivo diagnosis of OSS neoplasia.