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Greenfield JA, Cohen AK, Galor A, Chodosh J, Stone D, Karp CL. Ocular Surface Squamous Neoplasia: Changes in the Standard of Care 2003 to 2022. Cornea 2024; 43:942-949. [PMID: 38236065 PMCID: PMC11216900 DOI: 10.1097/ico.0000000000003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The aim of this review was to elucidate treatment preferences for ocular surface squamous neoplasia and to examine the changes in treatment modalities over the past 2 decades. METHODS An electronic survey was distributed to members of The Cornea Society, Ocular Microbiology and Immunology Group, and 4 international corneal specialist listservs. Questions examined medical and surgical treatment preferences, and results were compared with surveys administered in 2003 and 2012. RESULTS A total of 285 individuals responded to the survey; 90% of respondents were self-classified as corneal specialists. Seventy-three percent reported using primary topical monotherapy to treat ocular surface squamous neoplasia as compared with 58% in 2012 ( P = 0.008). Compared with 2003, the percentage use of topical interferon significantly increased ( P < 0.0001) from 14% to 55%, 5-fluorouracil increased ( P < 0.0001) from 5% to 23%, and mitomycin C decreased ( P < 0.0001) from 76% to 19% as a primary monotherapy. The frequency of performing excision without the use of postoperative adjunctive medical therapy decreased significantly ( P < 0.0001), from 66% to 26% for lesions <2 mm, 64% to 12% for lesions between 2 and 8 mm, and 47% to 5% for lesions >8 mm from 2003 to 2022. More clinicians initiated topical immuno/chemotherapy without performing a biopsy as compared to 2003 (31% vs. 11%, P < 0.0001). CONCLUSIONS These results demonstrate a paradigm shift in the management of ocular surface squamous neoplasia. The use of primary medical therapy as a first approach has significantly increased, with a reduction in the frequency of performing surgical excision alone.
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Affiliation(s)
| | - Adam K. Cohen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL
| | - James Chodosh
- Department of Ophthalmology and Visual Sciences, The University of New Mexico, Albuquerque, NM
| | | | - Carol L. Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
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Sinha S, Ramesh PV, Nishant P, Morya AK, Prasad R. Novel automated non-invasive detection of ocular surface squamous neoplasia using artificial intelligence. World J Methodol 2024; 14:92267. [PMID: 38983656 PMCID: PMC11229874 DOI: 10.5662/wjm.v14.i2.92267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/19/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is a common eye surface tumour, characterized by the growth of abnormal cells on the ocular surface. OSSN includes invasive squamous cell carcinoma (SCC), in which tumour cells penetrate the basement membrane and infiltrate the stroma, as well as non-invasive conjunctival intraepithelial neoplasia, dysplasia, and SCC in-situ thereby presenting a challenge in early detection and diagnosis. Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments, such as topical medicines, whereas advanced invasive lesions may need orbital exenteration, which carries a risk of death. Artificial intelligence (AI) has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management. AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN, aiding ophthalmologists in early detection and diagnosis. AI can also track and monitor lesion progression over time, providing objective measurements to guide treatment decisions. Furthermore, AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response. This manuscript highlights the role of AI in OSSN, specifically focusing on its contributions in early detection and diagnosis, assessment of lesion progression, treatment planning, telemedicine and remote monitoring, and research and data analysis.
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Affiliation(s)
- Sony Sinha
- Department of Ophthalmology–Vitreo Retina, Neuro Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna 801507, India
| | | | - Prateek Nishant
- Department of Ophthalmology, ESIC Medical College, Patna 801113, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, India
| | - Ripunjay Prasad
- Department of Ophthalmology, RP Eye Institute, Delhi 110001, India
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Ucakhan OO. Optical Biopsy Using Anterior-Segment Optical Coherence Tomography in Ocular Surface Tumors: The Game Changer. Eye Contact Lens 2024; 50:241-242. [PMID: 38778464 DOI: 10.1097/icl.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Affiliation(s)
- Omur O Ucakhan
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
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4
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Messina M, Poddi M, De Santi N, Bianchi E, Cagini C. Combined superficial keratectomy, alcohol delamination and amniotic membrane patch with fibrin glue in Salzmann nodular degeneration. Eur J Ophthalmol 2024:11206721241251890. [PMID: 38676318 DOI: 10.1177/11206721241251890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
PURPOSE To describe the outcomes of five Salzmann's Nodular Degeneration (SND) cases treated with a combination of alcohol delamination, superficial keratectomy and amniotic membrane patch with fibrin glue. METHODS Five patients affected by SND with significant discomfort and decreased visual acuity were evaluated with refraction, best corrected visual acuity, Break-up time test, corneal topography, Anterior Segment of Optical Coherence Tomography and images of anterior segment with a full slit lamp examination. All the patients underwent alcohol delamination of the corneal epithelium followed by superficial keratectomy to remove the subepithelial nodules. A patch of amniotic membrane was applied to all of them with a ring shape and a banana shape in two patients due to the location of the disease. A bandage contact lens was inserted. The patch was kept in place for 14 days. Another bandage contact lens was inserted for 21 days until the corneal epithelium had completely healed. RESULTS The surgical procedure was successful in removing the nodules in all patients. Vision was restored in all cases with a significant regularization of the corneal surface and reduction of ocular discomfort. After a 12-month follow-up, none of the patients showed recurrence of the disease. CONCLUSIONS Combining alcohol delamination with superficial keratectomy and amniotic membrane patch with fibrin glue is an effective procedure for the management of SND to regularize the corneal surface and avoid the recurrence of subsequent nodules. This report is the first description of the outcomes of SND cases treated with a combination of the aforementioned techniques.
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Affiliation(s)
- Marco Messina
- Department of Medicine and Surgery, Ophthalmology Section, S. Maria della Misericordia Hospital, University of Perugia, Italy
| | - Maria Poddi
- Department of Medicine and Surgery, Ophthalmology Section, S. Maria della Misericordia Hospital, University of Perugia, Italy
| | - Nicola De Santi
- Department of Medicine and Surgery, Ophthalmology Section, S. Maria della Misericordia Hospital, University of Perugia, Italy
| | - Eduardo Bianchi
- Department of Medicine and Surgery, Ophthalmology Section, S. Maria della Misericordia Hospital, University of Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Ophthalmology Section, S. Maria della Misericordia Hospital, University of Perugia, Italy
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Hӧllhumer R, Michelow P, Williams S. Comparison of non-invasive diagnostic modalities for ocular surface squamous neoplasia at a tertiary hospital, South Africa. Eye (Lond) 2024; 38:1118-1124. [PMID: 37996734 PMCID: PMC11009401 DOI: 10.1038/s41433-023-02833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
AIMS The aim of the study is to assess non-invasive diagnostic modalities for ocular surface squamous neoplasia (OSSN) when compared to histology. METHODS A prospective case-control study was conducted of patients presenting with conjunctival masses at a tertiary eye hospital in Johannesburg, South Africa. Patients completed an interview and had three non-invasive diagnostic tests: optical coherence tomography, impression cytology and methylene blue stain. A biopsy with histology was performed as the gold standard to confirm the diagnosis. RESULTS One hundred and eighty-two conjunctival masses of 175 patients were evaluated. There were 135 lesions identified as OSSN on biopsy and 47 lesions were benign on histology. Optical coherence tomography had a sensitivity and specificity of 87.2% (95% CI: 80.0-92.5) and 75.6% (95% CI: 60.5-87.1), respectively, when an epithelial thickness cutoff of 140 um was used. Shadowing was found in 46% of cases due to leukoplakia or increased thickness of the mass. Cytology had a sensitivity of 72.4% (95% CI: 62.5-81.0) and a specificity of 74.3% (95% CI: 56.7-87.5). Twenty-seven per cent of cytology specimens were excluded from analysis due to inadequate cellularity. Methylene blue had a high sensitivity of 91.9% (95% CI: 85.9-95.9), but low specificity of 55.3% (95% CI: 40.1-69.8). CONCLUSION Optical coherence tomography had a high sensitivity and specificity as a non-invasive test and liquid-based cytology performed well but had a lower sensitivity and specificity than with optical coherence tomography. Methylene blue performed well as a screening test, with a high sensitivity but low specificity.
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Affiliation(s)
- Roland Hӧllhumer
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Pamela Michelow
- Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Williams
- Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa
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Agarwal A, Kaliki S, Murthy SI. Corneal squamous neoplasia: masquerades and management outcomes at a rural eyecare centre. BMJ Case Rep 2023; 16:e254365. [PMID: 37130635 PMCID: PMC10163424 DOI: 10.1136/bcr-2022-254365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
The authors describe two cases of corneal ocular surface squamous neoplasia (OSSN), presenting at our rural eyecare centre, which were initially misdiagnosed as viral epithelial keratitis and corneal pannus with focal limbal stem cell deficiency. Both the cases were refractory to initial treatment and corneal OSSN was suspected. Anterior segment-optical coherence tomography (AS-OCT) revealed a thickened, hyper-reflective epithelium with abrupt transition and an underlying cleavage plane, features typical of OSSN. Topical 1% 5-fluorouracil (5-FU) therapy was initiated and in two cycles (first case) to three cycles (second case), complete resolution was noted both clinically and on AS-OCT, with no significant side effects. Both patients are currently free of tumour at the 2-month follow-up period. The authors report the rare, atypical presentations of corneal OSSN, discuss the masquerades and highlight the role of primary topical 5-FU in managing corneal OSSN in limited resource settings.
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Affiliation(s)
- Ayushi Agarwal
- Ocular Oncology Services, The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- Ocular Oncology Services, The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Gündüz AK, Mirzayev I, Okcu Heper A, Kuzu I, Gahramanli Z, Cansiz Ersöz C, Gündüz ÖÖ, Ataoğlu Ö. Anterior segment optical coherence tomography in ocular surface tumours and simulating lesions. Eye (Lond) 2023; 37:925-937. [PMID: 36513855 PMCID: PMC10050214 DOI: 10.1038/s41433-022-02339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
This study aims to systematically review the reported literature on the use of anterior segment optical coherence tomography (AS-OCT) in ocular surface tumours and simulating lesions. A systematic literature search was done using PubMed, Scopus, and Web of Science databases between January 2002 and December 2021. On AS-OCT, ocular surface squamous neoplasia typically demonstrate epithelial thickening, epithelial hyperreflectivity, and an abrupt transition between normal and abnormal epithelium. Conjunctival nevi usually show mildly hyperreflective epithelium of normal thickness, internal hyperreflectivity, and intralesional cysts which is the hallmark of this tumour. Primary acquired melanosis presents with normal thickness epithelium, basal epithelial hyperreflectivity, and absence of cysts. Conjunctival melanoma demonstrates hyperreflective normal/thickened epithelium, hyperreflective basal epithelium, internal hyperreflectivity, and absence of intralesional cysts. Conjunctival lymphoma shows homogenous, low-medium reflective subepithelial lesions with smooth borders, and dot-like infiltrates. Benign reactive lymphoid hyperplasia findings are similar to lymphoma but the infiltrates are more hyperreflective compared to lymphoma. Pterygium shows thickened conjunctival epithelium, epithelial hyperreflectivity, and subepithelial wedge-shaped hyperreflective tissue separated from the overlying epithelium by a cleavage plane. Pinguecula demonstrates mildly thickened epithelium and similar findings with pterygium but does not extend beyond the corneal limbus. This review shows that AS-OCT, as a noninvasive tool, has potential uses in the differential diagnosis of ocular surface tumours and simulating lesions. Major limitations of AS-OCT include limited visualization of the posterior border of thick, keratinized, and pigmented tumours and lack of assessment of large conjunctival tumours in a single cut.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
- Private Eye Clinic, Ankara, Turkey.
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Ophthalmology, Dünyagöz Hospital, Ankara, Turkey
| | - Aylin Okcu Heper
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Işınsu Kuzu
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ömür Özlenen Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömür Ataoğlu
- Private Mikro-Pat Pathology Laboratory, Ankara, Turkey
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Stevens SM, Reyes-Capo DP, Patel U, Choudhary A, Khzam RA, Tang V, Galor A, Karp CL, Dubovy S. Clinical and Optical Coherence Tomography Comparison Between Ocular Surface Squamous Neoplasia and Squamous Metaplasia. Cornea 2023; 42:429-434. [PMID: 35439777 PMCID: PMC9547982 DOI: 10.1097/ico.0000000000003039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the clinical characteristics and high-resolution optical coherence tomography (HR-OCT) findings between corneal squamous metaplasia and ocular surface squamous neoplasia (OSSN). METHODS A retrospective case-control study of 8 patients, 4 with histologically confirmed squamous metaplasia and 4 with histologically confirmed OSSN, who presented to the Miami Veterans Administration Medical Center and Bascom Palmer Eye Institute between 2016 and 2020 was performed. Clinical characteristics, HR-OCT findings, and pathology were evaluated and compared. RESULTS Four patients with squamous metaplasia and 4 with OSSN were evaluated. In the metaplasia group, 75% were male, 2 were White, and 2 were Black. In the OSSN group, all 4 were White males. All lesions were opalescent and occurred at the limbus; however, the borders were more smooth and rounded in the metaplastic lesions compared with OSSN. HR-OCT findings were indistinguishable between the 2 groups. CONCLUSIONS There is overlap in clinical characteristics and HR-OCT findings between corneal squamous metaplasia and OSSN, highlighting one limitation of HR-OCT. As such, if a corneal opacity has some but not all HR-OCT findings of OSSN, squamous metaplasia should also be considered. A biopsy may be indicated to further evaluate and guide treatment.
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Affiliation(s)
- Shanlee M. Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | | | - Umangi Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anjalee Choudhary
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Rayan Abou Khzam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Vincent Tang
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
- Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L. Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
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Monroy D, Serrano A, Galor A, Karp CL. Medical treatment for ocular surface squamous neoplasia. Eye (Lond) 2023; 37:885-893. [PMID: 36754986 PMCID: PMC10050251 DOI: 10.1038/s41433-023-02434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common non-melanocytic tumour of the ocular surface. Surgical excision with wide margins using the "no-touch" method was originally the most popular treatment for OSSN. However, in the past two decades, the use of topical medications for OSSN treatment has gained a reputation amongst ophthalmologists for being an effective alternative to surgical excision. Furthermore, technological advancements, such as those seen in high-resolution optical coherence tomography (HR-OCT) for the anterior segment, have facilitated the diagnosis and monitoring of OSSN. When selecting a topical agent, interferon alpha-2b (IFNα-2b) and 5-fluorouracil (5-FU) are two of the gentlest medications used for OSSN and are often considered first line therapies due to their high-resolution rates and mild side effect profiles. Mitomycin C (MMC), on the other hand, has a highly toxic profile; therefore, while effective, in our hands it is considered as a second-line treatment for OSSN if the other modalities fail. In addition, newer and less studied agents, such as immune checkpoint inhibitors, retinoic acid, aloe vera, and anti-vascular endothelial growth factor have anti-neoplastic properties and have shown potential for the treatment of OSSN. We enclose an updated literature review of medical treatments for OSSN.
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Grants
- R01 EY026174 NEI NIH HHS
- P30 EY014801 NEI NIH HHS
- I01 BX004893 BLRD VA
- R61 EY032468 NEI NIH HHS
- I01 CX002015 CSRD VA
- The Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (Dr. Galor) and Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (Dr. Galor), Department of Defense Gulf War Illness Research Program (GWIRP) W81XWH-20-1-0579 (Dr. Galor) and Vision Research Program (VRP) W81XWH-20-1-0820 (Dr. Galor), National Eye Institute R01EY026174 (Dr. Galor) and R61EY032468 (Dr. Galor), and Research to Prevent Blindness Unrestricted Grant (institutional).
- NIH Center Core Grant P30EY014801, RPB Unrestricted Award, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough Grant,The Robert Baer Family Grant, The Roberto and Antonia Menendez Grant, The Emilyn Page and Mark Feldberg Grant, The Calvin and Flavia Oak Support Fund, The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant, The Carol Soffer Grant, and the Richard Azar Family Grant(institutional grants).
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Affiliation(s)
- David Monroy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andres Serrano
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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10
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Sripawadkul W, Khzam RA, Tang V, Zein M, Dubovy SR, Galor A, Karp CL. Anterior segment optical coherence tomography characteristics of conjunctival papilloma as compared to papilliform ocular surface squamous neoplasia. Eye (Lond) 2023; 37:995-1001. [PMID: 36402855 PMCID: PMC10050070 DOI: 10.1038/s41433-022-02309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/24/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe the anterior segment optical coherence tomography (AS-OCT) appearance of conjunctival papilloma and identify differentiating features from papilliform ocular surface squamous neoplasia (OSSN). METHOD A retrospective chart review of individuals clinically diagnosed with conjunctival papilloma (n = 10) or papilliform OSSN (n = 10) based on slit lamp features. Data on demographics, tumour characteristics, and primary treatment were collected. AS-OCT features were assessed including epithelial thickness and reflectivity, a corrugated epithelial surface, presence of an overhanging edge, presence of intrinsic spaces and posterior shadowing. Histopathology was available in 5 papilloma and 3 OSSN specimens. RESULT Overall, the majority of individuals in both groups were white males. OSSN lesions were more likely to involve the limbus (80% vs.10%, p = 0.005) and the bulbar conjunctiva (100% vs. 20%, p < 0.001) compared to papillomas. On AS-OCT, maximum epithelial thickness was thicker in papilloma compared to OSSN (936 ± 533 vs. 637 ± 207 µm, p = 0.009). The feature that best differentiated papilloma from OSSN was an overhanging edge (100% vs. 0%, p < 0.001), where the epithelial lesion was seen on top of underlying normal epithelium. Other features more common in papilloma compared to OSSN included a corrugated epithelial surface (70% vs.10%, p = 0.02), the presence of intrinsic spaces (100% vs. 50%, p = 0.03), and posterior shadowing (100% vs. 40%, p = 0.01). CONCLUSION AS-OCT shows differentiating features between papilloma and OSSN with an overhanging edge as a distinctive AS-OCT feature of papilloma.
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Grants
- P30 EY014801 NEI NIH HHS
- Research to Prevent Blindness (RPB)
- NIH Center Core Grant P30EY014801, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough, The Robert Baer Family Grant, The Roberto and Antonia Menendez Grant, The Emilyn Page and Mark Feldberg Grant, The Calvin and Flavia Oak Support Fund, The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant, The Carol Soffer Grant, and the Richard Azar Family Grant(institutional grants).
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Affiliation(s)
- Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Vincent Tang
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Mike Zein
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Florida Lions Ocular Pathology Laboratory, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA.
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He LF, Mou P, Wei RL. Epidemiology and survival outcomes of patients with orbital region non-cutaneous squamous cell carcinoma: a population-based analysis. Front Oncol 2023; 13:1152337. [PMID: 37213302 PMCID: PMC10196690 DOI: 10.3389/fonc.2023.1152337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Non-cutaneous squamous cell carcinoma (ncSCC) of the orbital region is very rare. Thus, its epidemiological characteristics and prognosis are poorly understood. The aim of the study was to assess the epidemiological characteristics and survival outcomes of ncSCC of the orbital region. Methods Incidence and demographic data on ncSCC of the orbital region were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed. The chi-square test was used to calculate the differences between groups. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors for disease-specific survival (DSS) and overall survival (OS). Results The overall incidence of ncSCC in the orbital region from 1975 to 2019 was 0.68/1,000,000, and the incidence showed an increasing trend during this period. A total of 1,265 patients with ncSCC of the orbital region (mean age, 65.3 years) were identified in the SEER database. Of these, 65.1% were aged ≥60 years, 87.4% were White, and 73.5% were male. The conjunctiva (74.5%) was the most common primary site, followed by the orbit (12.1%), lacrimal apparatus (10.8%), and overlapping lesion of the eye and adnexa (2.7%). Multivariate Cox regression analysis revealed that age, primary site, SEER summary stage, and surgery were independent prognostic factors for DSS, whereas age, sex, marital status, primary site, SEER summary stage, and surgery were independent prognostic factors for OS. Conclusions The incidence of ncSCC in the orbital region has increased over the past 40 years. It usually affects White people, men, and people aged ≥60 years, and its most common site is the conjunctiva. Orbital SCC has worse survival outcomes than SCC of other sites in the orbital region. Surgery is the independent protective treatment for ncSCC of the orbital region.
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12
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Levy A, Georgeon C, Knoeri J, Tourabaly M, Leveziel L, Bouheraoua N, Borderie VM. Corneal Epithelial Thickness Mapping in the Diagnosis of Ocular Surface Disorders Involving the Corneal Epithelium: A Comparative Study. Cornea 2022; 41:1353-1361. [PMID: 35349542 PMCID: PMC9555759 DOI: 10.1097/ico.0000000000003012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/25/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to analyze the role of corneal epithelial thickness (ET) mapping provided by spectral domain optical coherence tomography in the diagnosis of ocular surface disorders (OSDs) involving the corneal epithelium. DESIGN This was a retrospective comparative study. METHODS Institutional settings are as follows. Study population includes 303 eyes with an OSD and 55 normal eyes (controls). Observation procedures include spectral domain optical coherence tomography with epithelial mapping in the central 6 mm. Main outcome measures include ET map classification (normal, doughnut, spoke-wheel, localized/diffuse, and thinning/thickening patterns) and ET data and statistics (minimum, maximum, and SD). A quantitative threshold was determined with receiver operating curves to distinguish pathological from normal corneas. Sensitivity and specificity of classification and quantitative data were calculated using all eyes to assess the ability to distinguish corneas with a given corneal disorder from other conditions. RESULTS Classification of full agreement between 3 readers was obtained in 75.4% to 99.4% of cases. Main OSD features were keratoconus (135 eyes), doughnut pattern (sensitivity/specificity = 56/94%), and max-min ET ≥ 13 μm (84/43%); limbal deficiency (56 eyes), spoke-wheel pattern (66/98%), and max-min ET ≥ 14 μm (91/59%); epithelial basement membrane dystrophy (55 eyes), inferior thickening pattern (55/92%), and central ET > 56 μm (53/81%); dry eye (21 eyes), superior thinning pattern (67/88%), and minimal ET ≤ 44 μm (86/48%); pterygium (10 eyes), nasal thickening pattern (100/86%), and nasal ET > 56 μm (80/71%); and in situ carcinoma (11 eyes), max ET > 60 μm (91/60%), and ET SD >5 μm (100/58%). CONCLUSIONS The epithelial map pattern recognition combined with quantitative analysis of ET is relevant for the diagnosis of OSDs and for distinguishing various OSDs from each other. Deep learning analysis of big data could lead to the fully automated diagnosis of these disorders.
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Affiliation(s)
- Arielle Levy
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Cristina Georgeon
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Juliette Knoeri
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Moïse Tourabaly
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Loïc Leveziel
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Nacim Bouheraoua
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Vincent M. Borderie
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
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13
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Watane A, Hansen ED, Vazquez LE, Karp CL. Ocular Surface Squamous Neoplasia Masquerading as Recalcitrant Epithelial Keratitis. Cornea 2022; 41:1185-1187. [PMID: 34907943 PMCID: PMC9192825 DOI: 10.1097/ico.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report a unique case of ocular surface squamous neoplasia that masqueraded as a nonresolving toxic epithelial keratitis. METHODS This was a case report and review of the literature. RESULTS A 79-year-old man presented with decreased vision, redness, and a foreign body sensation in his right eye that was refractory to treatment with lubrication and topical nonsteroidal antiinflammatory drops. Before presentation, the referring provider believed that he had medicamentosa-related keratitis and placed him on oral methazolamide. Slitlamp biomicroscopy of the right eye revealed diffuse epitheliopathy with punctate fluorescein staining and subtle underlying corneal epithelial opalescence. A mildly thickened and inflamed pinguecula was noted from 2 to 5 o'clock at the limbus of the right eye. An anterior segment high-resolution optical coherence tomography revealed thickened, hyperreflective epithelium with an abrupt transition. An incisional biopsy confirmed conjunctival and corneal intraepithelial neoplasia. The patient improved after 4 cycles of topical chemotherapy with 1% 5-fluorouracil eye drops with complete resolution of the corneal and conjunctival pathology. CONCLUSIONS Ocular surface squamous neoplasia can rarely masquerade as a recalcitrant medicamentosa and epithelial keratitis. In subtle cases or in cases with combined ocular surface morbidities, anterior segment high-resolution optical coherence tomography can be helpful to diagnose and direct therapy.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT
| | - Eric D Hansen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Luis E Vazquez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
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14
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Hossain RR, Oh JA, McLintock C, Murphy C, McKelvie J. Ocular Surface Squamous Neoplasia: A 12-Month Prospective Evaluation of Incidence in Waikato, New Zealand. Vision (Basel) 2022; 6:vision6030050. [PMID: 35997381 PMCID: PMC9397019 DOI: 10.3390/vision6030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Ocular surface squamous neoplasia (OSSN) has a high incidence in the southern hemisphere. This prospective study evaluated the incidence of OSSN in the Waikato region of New Zealand. All patients presenting with pterygium or conjunctival lesions in the Waikato region in 2020 were included. All surgeons in the region were asked to send all conjunctival and corneal specimens excised for histopathologic examination. The primary outcome measure was the incidence of OSSN. Eighty-eight percent of all excised specimens were sent for histopathologic examination. Of the 185 excised lesions sent for histopathological assessment, 18 (10%) were reported as OSSN. Patients were on average 69.4 years of age (standard deviation, SD = 6.9), predominantly male (78%), and of New Zealand-European ethnicity (89%). The OSSN annual incidence was 3.67/100,000/year. Histology grades included conjunctival intraepithelial neoplasia (CIN)-I (25%), CIN-II (25%), CIN-III (12.5%), carcinoma in situ (25%), and invasive squamous cell carcinoma (SCC) (12.5%). One patient with invasive SCC required exenteration. This study identified a high incidence rate of OSSN and is the first prospective study to analyze OSSN epidemiology in New Zealand.
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Affiliation(s)
- Ruhella R Hossain
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Department of Ophthalmology, Hawkes Bay District Health Board, Hastings 4120, New Zealand
| | - Jee Ah Oh
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Cameron McLintock
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Chris Murphy
- Department of Ophthalmology, Waikato District Health Board, Hamilton 3204, New Zealand
| | - James McKelvie
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand
- Department of Ophthalmology, Waikato District Health Board, Hamilton 3204, New Zealand
- Correspondence:
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15
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Theotoka D, Wall S, Galor A, Sripawadkul W, Khzam RA, Tang V, Sander DL, Karp CL. The use of high resolution optical coherence tomography (HR-OCT) in the diagnosis of ocular surface masqueraders. Ocul Surf 2022; 24:74-82. [PMID: 35231640 PMCID: PMC9058205 DOI: 10.1016/j.jtos.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Ocular surface masqueraders encompass any ocular surface lesion masquerading as another ocular surface lesion. High resolution optical coherence tomography (HR-OCT) has emerged as an adjunctive tool to clinical acumen. This study's purpose is to evaluate the utility of HR-OCT images in guiding the diagnosis and management of those lesions. MATERIAL AND METHODS 22 individuals with a clinically ambiguous ocular surface lesion with slit lamp photographs (SLP), HR-OCT images, and histopathological examination were included in the study. The presumptive clinical diagnosis based on SLP was compared to the diagnosis suggested by HR-OCT findings and to definitive diagnosis by histopathology. The main outcome of this study was the frequency in which HR-OCT findings guided the clinician to the correct diagnosis. RESULTS 7 lesions were epithelial, 3 had an epithelial and a subepithelial component, and 12 were subepithelial. HR-OCT was most effective in discerning lesion location, successfully identifying the location in 100% of cases. Classic HR-OCT findings were detected in 68.2% of cases while suggestive features were detected in 31.8% of cases. The epithelial lesions' mean epithelial thickness was 265.4 ± 140.6 μm, the subepithelial lesions' mean was 58.0 ± 25.0 μm, and the combined lesions' mean was 140.0 ± 70.0 μm. The epithelium was significantly thicker in epithelial lesions compared to subepithelial and combined lesions. By ROC analysis we identified that using a cut off of 156 μm, the sensitivity was 86% and the specificity was 93%. DISCUSSION HR-OCT can be a valuable diagnostic tool, assisting in the differentiation of ambiguous ocular surface pathologies by providing a cross-sectional, morphological image of the lesion.
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Affiliation(s)
- Despoina Theotoka
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Sarah Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vincent Tang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dubovy L Sander
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Florida Lions Ocular Pathology Laboratory, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
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16
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Modabber M, Lent-Schochet D, Li JY, Kim E. Histopathological Rate of Ocular Surface Squamous Neoplasia in Clinically Suspected Pterygium Specimens: 10-Year Results. Cornea 2022; 41:149-154. [PMID: 34690264 DOI: 10.1097/ico.0000000000002780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prevalence of histopathologically confirmed ocular surface squamous neoplasia (OSSN) in clinically diagnosed pterygium samples at a tertiary center in Northern California, over a 10-year period (2009-2019). METHODS A retrospective chart review of patients older than 18 years with clinically diagnosed benign pterygium requiring excision was conducted. Clinically suspected pterygia were excised using standard techniques and routinely submitted to the University of California Davis for pathologic evaluation. Demographic, clinical, surgical, and pathological information were recorded and analyzed. The prevalence rate of OSSN was calculated. RESULTS A total of 348 consecutive specimens were evaluated. The mean (±SD) age of the patients was 58 ± 12 years, with a near equal sex representation. A total of 57 (16%) pterygia were recurrent at initial presentation. Histopathologic results demonstrated a single case of OSSN. This patient did not have a documented history of carcinoma in other organs or any history of herpes virus, human papilloma virus, or human immunodeficiency virus infection. CONCLUSIONS The prevalence of histopathological OSSN in clinically suspected pterygia within our sample was approximately 0.3%. Because of shared clinical characteristics of pterygia and OSSN, a high index of suspicion and judicious use of anterior segment optical coherence tomography enable for effective preoperative diagnosis of OSSN. However, in the absence of clinical expertise or high-resolution optical coherence tomography, routine tissue pathologic examination may be warranted.
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Affiliation(s)
- Milad Modabber
- UC Davis Eye Center, University of California, Davis, Sacramento, CA; and
| | | | - Jennifer Y Li
- UC Davis Eye Center, University of California, Davis, Sacramento, CA; and
| | - Esther Kim
- UC Davis Eye Center, University of California, Davis, Sacramento, CA; and
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17
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An Unexpected Incidence of Ocular Surface Neoplasia on Pterygium Surgery. A Retrospective Clinical and Histopathological Report. Cornea 2022; 41:e7. [PMID: 35044969 PMCID: PMC9590408 DOI: 10.1097/ico.0000000000002936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Abstract
Purpose of review To review and update the latest findings in diagnosis and management of ocular surface squamous neoplasia (OSSN). Recent findings OSSN is the most common anterior segment neoplastic disease process. Several ocular surface imaging techniques have been developed for the early diagnosis and management of clinical and subclinical ocular surface squamous neoplasia, including high-resolution optical coherence tomography (HR-OCT), in vivo confocal microscopy, and ultrasound biomicroscopy. Treatment modalities include both surgical and medical management, with a recent trend towards primary and adjunctive pharmacotherapy. Summary There is increasing use of HR-OCT for the diagnosis and monitoring of clinical and subclinical OSSN lesions. Topical pharmacotherapy agents, including interferon α-2b, 5-fluorouracil, and mitomycin C, have demonstrable efficacy in the treatment of OSSN and their use may be dictated based upon tumor factors, patient factors, cost, and side effect profile. Both surgical excision and adjunctive topical medications have excellent success, with the favored treatment method trending towards topical pharmacotherapy as primary therapy.
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19
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Aboumourad RJ, Galor A, Karp CL. Case Series: High-resolution Optical Coherence Tomography as an Optical Biopsy in Ocular Surface Squamous Neoplasia. Optom Vis Sci 2021; 98:450-455. [PMID: 33967253 DOI: 10.1097/opx.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Ocular surface squamous neoplasias are superficial tumors of the cornea and conjunctiva that can be sight threatening if neglected. Therefore, accurate noninvasive diagnostic modalities are needed. PURPOSE The purpose of this case series was to describe the hallmark features of ocular surface squamous neoplasia on high-resolution optical coherence tomography (HR-OCT) imaging and its use in the evaluation and management of superficial ocular tumors. CASE SERIES Five eyes of four patients with ocular surface squamous neoplasia are described. Whereas two eyes displayed the classic clinical features of ocular surface squamous neoplasia, three of the five eyes had more subtle atypical features. However, all shared features on HR-OCT of epithelial thickening and hyperreflectivity with abrupt transitions between normal and abnormal tissue, classic features of ocular surface squamous neoplasia. All lesions ultimately underwent incisional or excisional biopsy and were confirmed to be ocular surface squamous neoplasia on histopathology. CONCLUSIONS Ocular surface squamous neoplasia may present as a classic tumor but can also have subtle features or masquerade. Accurate methods to diagnose and manage patients with ocular surface squamous neoplasia are necessary. With recent advancements in technology, HR-OCT has been demonstrated to accurately identify ocular surface squamous neoplasia with the repeatable optical findings of (1) epithelial thickening, (2) epithelial hyperreflectivity, and (3) abrupt transition zone between normal and abnormal tissue. This case series demonstrates how HR-OCT can help provide an optical biopsy to guide appropriate diagnosis and management of this neoplastic lesion.
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Affiliation(s)
- Rami J Aboumourad
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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20
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Vempuluru VS, Jakati S, Godbole A, Mishra DK, Mohamed A, Kaliki S. Spectrum of AS-OCT features of ocular surface tumors and correlation of clinico-tomographic features with histopathology: a study of 70 lesions. Int Ophthalmol 2021; 41:3571-3586. [PMID: 34241759 DOI: 10.1007/s10792-021-01939-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the correlation between clinical and anterior segment optical coherence tomographic (AS-OCT) details and histopathological changes in various ocular surface lesions. METHODS Prospective case series of 70 lesions in 65 patients. RESULTS AS-OCT revealed epithelial changes in OSSN (n = 19; 44%), squamous papilloma (n = 3; 60%), nevus (n = 1; 33%), epithelial hyperplasia (n = 1; 33%), granular dystrophy (n = 1; 100%) and granulation tissue (n = 1; 100%); subepithelial changes in chronic inflammation (n = 4, 100%), lymphoma (n = 3; 100%) and arteriovenous malformation (n = 1; 100%); combined epithelial and subepithelial changes in OSSN (n = 24; 56%), squamous papilloma (n = 2; 40%), PEH (n = 3; 100%), nevus (n = 2; 67%), epithelial hyperplasia (n = 2; 67%), solar elastosis (n = 1; 100%), lobular capillary hemangioma (n = 1; 100%) and sebaceous carcinoma (n = 1; 100%). Epithelial involvement on AS-OCT paralleled the histopathological findings in 98% (n = 69) and subepithelial involvement in 83% (n = 58). The correlation of clinico-tomographic diagnosis with histopathology diagnosis was seen in 77% (n = 54) lesions. Sensitivity and specificity of AS-OCT as a diagnostic tool for detection of epithelial involvement were 100% and 92% and for subepithelial involvement was 98% and 100%, respectively. CONCLUSION The correlation between AS-OCT and histopathology features determining epithelial and subepithelial involvement is excellent. It is a useful adjunctive tool for the diagnosis of ocular surface lesions.
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Affiliation(s)
- Vijitha S Vempuluru
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Anushri Godbole
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory, LV Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, 500034, India.
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Kounatidou NE, Palioura S. An update in the management of ocular surface squamous neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1932465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Ocular surface squamous neoplasia: management and outcomes. Eye (Lond) 2021; 35:1562-1573. [PMID: 33564137 PMCID: PMC8169825 DOI: 10.1038/s41433-021-01422-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour with an incidence ranging from 0.03 to 1.9 per 100,000 persons/year. The diagnosis is made on clinical suspicion and confirmed with anterior-segment optical coherence tomography (AS-OCT), cytology, or histology. The purpose of this review is to provide an overview of the management options available for OSSN and review their success and recurrence rates. Surgery is the gold standard for the management of small OSSN lesions. With the increased use of less invasive diagnostic modalities such as AS-OCT and cytology, there has been a move to use topical therapies for the management of OSSN. The most commonly used agents are interferon-α2b (IFN), mitomycin-C (MMC) and 5-fluorouracil (5FU). They have been shown to have similar resolution and recurrence rates but differ in cost and side effect profile. IFN has the lowest side effect profile, but is also the most expensive, whereas MMC has the greatest surface toxicity and is priced midway between the three. 5FU is the cheapest of the three topical agents with less surface toxicity than MMC. Radiotherapy is mostly employed as adjuvant therapy. Newer novel therapies are available but have not been widely adopted as mainstream therapy due to cost and lack of clinical evidence. OSSN has the benefit of many management options. No single modality has been shown to superior and some patients will need the use of combination therapy to achieve an optimal clinical outcome.
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Histopathological Variability and Concomitant Lesions in Pterygium in a Large Case Series. J Ophthalmol 2021; 2021:6623794. [PMID: 33828861 PMCID: PMC8004360 DOI: 10.1155/2021/6623794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 01/02/2023] Open
Abstract
Pterygium is a common lesion consisting of fleshy conjunctival growth extending towards the cornea. There is no documented risk of malignant transformation; however, concomitant disease is not rare, and its link to sunlight exposure indicates a risk of other malignancies. The purpose of our study is to describe histopathological features of resected pterygiums and to recognize patients at risk of other conjunctival diseases. One hundred and forty-nine formalin-fixed and paraffin-embedded pterygium samples were subjected to histopathological analysis. Histological H&E sections were obtained and digitalized using a Zeiss Axio Scan.Z1 slide scanner. Thirteen predefined morphological features were used to record histopathological changes in the epithelium and substantia propria. Neovascularization was observed in 54% of the samples. Sun damage, comprising solar elastosis and stromal plaque, was present in 81% of the samples. Variation in epithelial thickness was the most common change, with acanthosis and atrophy being observed in 62% and 26% of the samples, respectively. In our series, 21% (31/149) of pterygiums showed mild to moderate dysplasia, a finding that may be associated to ocular surface squamous neoplasia (OSSN). Moreover, 32% (47/149) of the cases showed melanocytic hyperplasia, which could represent primary acquired melanosis (PAM). There is a positive correlation between dysplasia and chronic inflammation (p=0.012) and an inverse correlation with epithelial atrophy (p=0.001) and neovascularization (p=0.05). Similarly, a positive correlation is observed between goblet cell hyperplasia and melanocytic hyperplasia (p=0.02). Our findings show that pterygiums harbour histological features that may be suggestive of OSSN or PAM in 53% of our patients. Whilst being on the benign side of the spectrum, these two entities are known for their potential progression to malignancy. A recommendation is made for all surgically excised pterygiums to be sent for histopathological diagnosis, and clear guidelines for reporting of these lesions should be established. Associated histopathological findings suggestive of other concomitant diseases should be identified to insure adequate follow-up of these patients.
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Non-malignant conjunctival epithelial masses with ocular surface squamous neoplasia-like optical coherence tomography features. Int Ophthalmol 2021; 41:1827-1834. [PMID: 33694094 PMCID: PMC8087600 DOI: 10.1007/s10792-021-01743-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/06/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To observe and describe the anterior segment optical coherence tomography features of limbally localised non-malignant epithelial mass lesions METHODS: Thirteen patients (age: 66.9 ± 16.3 years) with conjunctival mass suggesting ocular surface squamous neoplasia with biomicroscopic examination were imaged using anterior segment ocular coherence tomography (anterior segment optical coherence tomography)/Cirrus HD-OCT, Model 4000, Carl Zeiss Meditec, Inc., Dublin, CA, and Spectralis HRA + OCT system, Heidelberg Engineering, Vista, CA/. Cases with ocular surface squamous neoplasia-like anterior segment optical coherence tomography (hyperreflective, thickened epithelium and an abrupt transition from normal to abnormal) were included in the study. Maximal thickness of the epithelium was measured. Histological diagnosis was gained from an excisional or incisional biopsy or impression cytology specimens. RESULTS In six patients (age: 68.5 ± 15.4 years) with ocular surface squamous neoplasia-like anterior segment optical coherence tomography features, the histological diagnosis was other than ocular surface squamous neoplasia (papilloma, parakeratosis and a keratotic plaque with mild dysplasia), and ocular surface squamous neoplasia in seven cases (age: 65.6 ± 18.0 years). The maximal epithelial thickness was between 250 and 859 µm in non-ocular surface squamous neoplasia cases and between 252 and 596 µm in ocular surface squamous neoplasia cases. CONCLUSION Non-malignant epithelial lesions can mimic ocular surface squamous neoplasia on anterior segment optical coherence tomography.
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Ocular surface squamous neoplasia: outcomes following primary excision with 2 mm margin and cryotherapy. Eye (Lond) 2021; 35:3102-3109. [PMID: 33469127 DOI: 10.1038/s41433-020-01353-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess margins and the rate of local recurrence of ocular surface squamous neoplasia after excision with a 2 mm margin and cryotherapy at a single ophthalmic oncology center. OUTCOME MEASURES (1) Conjunctival margin were assessed as positive, negative, or indeterminate margins. (2) Feasibility of repair without a graft. (3) Local recurrence. METHODS Retrospective chart review of histologically proven conjunctival intraepithelial neoplasia and invasive squamous cell carcinoma cases that underwent excision with a 2 mm margin and cryotherapy. RESULTS Eighty cases met inclusion criteria for the quantitative analysis. The margin was positive in six cases (7.5%), four of which were treated with post-op topical immunotherapy/chemotherapy. Of the six positive margin cases, there was one recurrence which occurred in the patient who did not receive post-op topical adjuvant therapy, however resolved after starting topical treatment. Conjunctival repair without use of a graft was feasible in 74 (93%) cases with a mean basal diameter of 6.4 mm. Total number of local recurrence was seen in three cases (4%), which were successfully treated with adjuvant topical treatment (one positive margin case, one indeterminate margin case) or repeat resection followed by episcleral plaque brachytherapy (one negative margin case). CONCLUSION Excision with 2 mm margin of OSSN is not associated with high rates of positive surgical margins. Even those with positive margins, when treated with adjuvant topical therapy did not develop recurrence. While achieving low rates of local recurrence, the conjunctiva is conserved, thereby minimizing the need for amniotic membrane or free conjunctival grafts for conjunctival repair.
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Venkateswaran N, Mercado C, Wall SC, Galor A, Wang J, Karp CL. High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 16:81-95. [DOI: 10.1080/17469899.2021.1851598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Mercado
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Grupo de Investigacion Escuela Barraquer, Escuela Superior de Oftalmologia del Instituto Barraquer de America, Bogota, Colombia
| | - Sarah C. Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
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Sun Y, Hua R. Long-Term Efficacy and Safety of Subconjunctival/Perilesional 5-Fluorouracil Injections for Ocular Surface Squamous Neoplasia. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:5659-5665. [PMID: 33376309 PMCID: PMC7765748 DOI: 10.2147/dddt.s285752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/07/2020] [Indexed: 02/02/2023]
Abstract
Purpose To investigate the effectiveness and safety of subconjunctival/perilesional 5-fluorouracil injections on ocular surface squamous neoplasia (OSSN) during a 3-year follow-up period. Patients and Methods We followed up six patients with intraepithelial OSSN (in one eye each) that had regressed after subconjunctival/perilesional 5-fluorouracil injections. Conjunctival fluorescein angiography (FA) and indocyanine green angiography (ICGA), as well as anterior segment optical coherence tomography (AS-OCT), were performed to evaluate the OSSN status 3 years after initiation of treatment. Results The mean age of patients (five males, one female) at baseline was 62.3±11.6 years. The mean number of 5-fluorouracil injections was 17.0±8.6, with a mean treatment duration of 13.0±7.4 weeks. At the final visit, both intratumoral and conjunctival feeding vessels had disappeared on ICGA and FA, with no neovascularization-related leakage, in accordance with the results of AS-OCT. The period from complete tumor regression to final visit according to AS-OCT was 32.5±4.2 months, which was longer than that according to ICGA (31.3±3.2 months, p=0.034). The final best-corrected visual acuity was similar to that at baseline (p=0.128). No side effects were observed in any of the eyes. Conclusion Subconjunctival/perilesional 5-fluorouracil injections are an effective and safe treatment for OSSN. Future studies with a larger sample size are warranted for confirmation of our findings, as well as investigation into the reasons for residual areas of non-perfusion in the conjunctiva.
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Affiliation(s)
- Yuzhao Sun
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China
| | - Rui Hua
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, People's Republic of China
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Höllhumer R, Michelow P, Williams S. Diagnosis and staging of ocular surface squamous neoplasia. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
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.
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Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa. PLoS One 2020; 15:e0237453. [PMID: 32780766 PMCID: PMC7418961 DOI: 10.1371/journal.pone.0237453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests. METHODS This observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy. DISCUSSION There is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.
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Liang Q, Le Q, Cordova DW, Tseng CH, Deng SX. Corneal Epithelial Thickness Measured Using Anterior Segment Optical Coherence Tomography as a Diagnostic Parameter for Limbal Stem Cell Deficiency. Am J Ophthalmol 2020; 216:132-139. [PMID: 32283095 DOI: 10.1016/j.ajo.2020.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Using anterior segment optical coherence tomography (AS-OCT), we investigated the epithelial thickness (ET) of the central cornea and limbal regions in patients with limbal stem cell deficiency (LSCD) as a diagnostic and staging parameter. DESIGN Prospective, cross-sectional study. METHODS The central corneal epithelium thickness (CET) and maximum limbal epithelium thickness (mLET) were measured in the superior, inferior, nasal, and temporal limbus on AS-OCT images of the normal and eyes with LSCD. CET was obtained by 1-point (OCT-CET1) and 3-point measurement (OCT-CET3). The values of OCT-CET1 and OCT-CET3 were compared to the CET obtained with in vivo confocal microscopy (IVCM-CET). RESULTS Sixty-eight eyes of 50 patients with LSCD and 52 eyes of 34 normal subjects were included. The mean (±standard deviation) OCT-CET3 was 55.0 ± 3.0 μm (range, 50.6-62.0 μm) in the control group and 41.6 ± 10.8 μm (range, 0-56.3 μm) in the LSCD group (P < .001). OCT-CET3 had a better correlation with IVCM-CET (r = 0.91) than did OCT-CET1 (r = 0.87, P = .001). The degree of reduction in OCT-CET3 increased in more advanced clinical stages of LSCD (all P < .001). The OCT-CET3 cutoff value that suggests LSCD was 46.6 μm. Compared with the control group, the LSCD group had decreases in mLET in all 4 limbal regions (all P < .001). The sensitivity and specificity of OCT-CET3 is the highest among all mLET in detecting LSCD. CONCLUSIONS Both CET and mLET were thinner in patients with LSCD than in normal subjects. OCT-CET3 appears to be a reliable parameter to confirm LSCD when there is clinical suspicion.
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Hollhumer R, Williams S, Michelow P. Ocular surface squamous neoplasia: Population demographics, pathogenesis and risk factors. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Ocular surface squamous neoplasia (OSSN) is a unifying term used to describe conjunctival intra-epithelial neoplasia, squamous cell carcinoma in situ and invasive squamous cell carcinoma.Aim: The aim of this article was to describe the demographics, clinical features, pathogenesis and risk factors of OSSN.Method: A literature search was conducted using the search criteria ‘ocular surface squamous neoplasia’, ‘diagnosis’, ‘epidemiology’, ‘pathogenesis’ and ‘risk factors’.Results: Ocular surface squamous neoplasia is the most common ocular tumour, with incidence rates ranging from 0.01 to 3.4 per 100 000 persons/year. There are two main patterns of disease presentation: older white males in temperate climates where human immunodeficiency virus (HIV) and human papilloma virus (HPV) are not associated; and a younger patient population in tropical climates where HIV and HPV are more prevalent. The pathogenesis primarily revolves around ultraviolet B exposure and HPV infection that cause genetic mutations and uncontrolled cellular proliferation, whilst HIV infection and vitamin A impair tumour surveillance mechanisms. Ocular surface squamous neoplasia is first suspected clinically before formal confirmation of the diagnosis. Morphologically, it can be divided into three groups: placoid, nodular and diffuse. Placoid lesions can further be sub-divided into gelatinous, leukoplakic and papilliform lesions. Nodular lesions have the poorest prognosis, with the highest risk of metastasis and recurrence.Conclusion: Ocular surface squamous neoplasia is a common ocular tumour associated with ultraviolet radiation, HPV and HIV infection. The pathogenesis revolves around acquired genetic mutations, unregulated cellular proliferation and impaired tumour surveillance mechanisms.
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Atalay E, Yu DJ, Nongpiur ME. When to use anterior segment optical coherence tomography. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1767596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eray Atalay
- Department of Ophthalmology, Eskisehir Osmangazi University Faculty of Medicine, Turkey
| | - Daryle Jason Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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B A, Rao S, Pandya HJ. Engineering approaches for characterizing soft tissue mechanical properties: A review. Clin Biomech (Bristol, Avon) 2019; 69:127-140. [PMID: 31344655 DOI: 10.1016/j.clinbiomech.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/14/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
From cancer diagnosis to detailed characterization of arterial wall biomechanics, the elastic property of tissues is widely studied as an early sign of disease onset. The fibrous structural features of tissues are a direct measure of its health and functionality. Alterations in the structural features of tissues are often manifested as local stiffening and are early signs for diagnosing a disease. These elastic properties are measured ex vivo in conventional mechanical testing regimes, however, the heterogeneous microstructure of tissues can be accurately resolved over relatively smaller length scales with enhanced spatial resolution using techniques such as micro-indentation, microelectromechanical (MEMS) based cantilever sensors and optical catheters which also facilitate in vivo assessment of mechanical properties. In this review, we describe several probing strategies (qualitative and quantitative) based on the spatial scale of mechanical assessment and also discuss the potential use of machine learning techniques to compute the mechanical properties of soft tissues. This work details state of the art advancement in probing strategies, associated challenges toward quantitative characterization of tissue biomechanics both from an engineering and clinical standpoint.
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Affiliation(s)
- Alekya B
- Biomedical and Electronic (10(-6)-10(-9)) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore 12, India
| | - Sanjay Rao
- Department of Pediatric Surgery, Mazumdar Shaw Multispecialty Hospital, Narayana Health, Bangalore 99, India
| | - Hardik J Pandya
- Biomedical and Electronic (10(-6)-10(-9)) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore 12, India.
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Abstract
Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically “invisible” tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.
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Affiliation(s)
- Jose R Davila
- Ophthalmology, Stanford Byers Eye Institute, Palo Alto, CA, 94303, USA
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Karp CL, Mercado C, Venkateswaran N, Ruggeri M, Galor A, Garcia A, Sivaraman KR, Fernandez MP, Bermudez A, Dubovy SR. Use of High-Resolution Optical Coherence Tomography in the Surgical Management of Ocular Surface Squamous Neoplasia: A Pilot Study. Am J Ophthalmol 2019; 206:17-31. [PMID: 31163136 DOI: 10.1016/j.ajo.2019.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/07/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate whether high-resolution optical coherence tomography (HR-OCT) can detect histologic tumor margins of ocular surface squamous neoplasia (OSSN). METHODS Eight eyes of 8 patients with OSSN undergoing excision were studied prospectively. Immediately before surgery, the tumor was imaged using commercially available HR-OCT to identify the conjunctival margins of the neoplastic lesion. The tumor borders of the lesion determined by HR-OCT were mapped in relation to an anatomic reference point and transferred intraoperatively. The tumor was excised with 4-mm margins from the visible edge of the lesion with a "no-touch" technique. The specimens were sent for pathologic analysis and the histologic tumor margin was compared to the HR-OCT predicted tumor border. RESULTS Mean age of the 8 patients was 67 ± 9.9 years. Seven were male, 7 were white, and, ethnically, 3 were Hispanic. All 8 tumors were bulbar and in the exposure zone. Seven tumors were limbal. Corneal extension was present in 5. Mean tumor area was 17.5 ± 11.1 mm2. Clinically, 2 of the tumors were leukoplakic, 1 papillomatous, and 3 gelatinous. A conjunctival tumor margin identified with the HR-OCT coincided with the pathologically confirmed margin mark in all eyes. CONCLUSIONS HR-OCT has the potential to predict histologic tumor margins in OSSN. Optical identification of tumor margins could potentially decrease the incidence of residual positive margins and minimize healthy tissue removal. Advances in HR-OCT technology and integration into a microscope for "real-time" imaging are needed to further improve this technique. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Carolina Mercado
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nandini Venkateswaran
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marco Ruggeri
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Miami Veteran Affairs Medical Center, Miami, Florida, USA
| | - Armando Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kavitha R Sivaraman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria Paula Fernandez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Antonio Bermudez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Florida Lions Ocular Pathology Laboratory, Miami, Florida, USA
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Tran AQ, Venkateswaran N, Galor A, Karp CL. Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia. EYE AND VISION 2019; 6:27. [PMID: 31463333 PMCID: PMC6710864 DOI: 10.1186/s40662-019-0152-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Ann Q Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
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Gunzinger JM, Voulgari N, Petrovic A, Hashemi K, Kymionis G. Peripheral hypertrophic subepithelial corneal degeneration: clinical aspects related to in vivo confocal microscopy and optical coherence tomography. Int Med Case Rep J 2019; 12:237-241. [PMID: 31440105 PMCID: PMC6668246 DOI: 10.2147/imcrj.s208297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To report the findings of anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) in two patients with peripheral hypertrophic subepithelial corneal degeneration (PHSD). Methods Case series by restrospective chart review and imaging analysis of AS-OCT and IVCM. Results Slit lamp examination of the two patients revealed a bilateral subepithelial-elevated fibrous tissue of the superior-nasal quadrant, as well as inferior-nasal in one of the patients. Best corrected visual acuity ranged from 20/25 to 20/15. AS-OCT showed continuous, homogenous, well-demarked hyperreflective subepithelial band associated with hyperreflectivity in the anterior stroma. IVCM demonstrated normal epithelial cell morphology and arrangement and a fibrous structure subepithelial and in the anterior stroma. Conclusion AS-OCT and IVCM can facilitate the diagnosis of PHSD and differentiate it from other corneal entities that present peripheral opacifications.
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Affiliation(s)
- Jeanne Martine Gunzinger
- Lausanne University, Cornea and Refractive Surgery Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Nafsika Voulgari
- Lausanne University, Cornea and Refractive Surgery Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Aleksandra Petrovic
- Lausanne University, Cornea and Refractive Surgery Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Kattayoon Hashemi
- Lausanne University, Cornea and Refractive Surgery Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Georgios Kymionis
- Lausanne University, Cornea and Refractive Surgery Department, Jules-Gonin Eye Hospital, Lausanne, Switzerland
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Al Bayyat G, Arreaza-Kaufman D, Venkateswaran N, Galor A, Karp CL. Update on pharmacotherapy for ocular surface squamous neoplasia. EYE AND VISION 2019; 6:24. [PMID: 31417938 PMCID: PMC6689886 DOI: 10.1186/s40662-019-0150-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- Ghada Al Bayyat
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Dan Arreaza-Kaufman
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA.,Miami Veterans Hospital, Miami, FL 33125 USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
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Paranjpe V, Galor A, Monsalve P, Dubovy SR, Karp CL. Salzmann nodular degeneration: prevalence, impact, and management strategies. Clin Ophthalmol 2019; 13:1305-1314. [PMID: 31413538 PMCID: PMC6663077 DOI: 10.2147/opth.s166280] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose This review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases. Method PubMed review of 44 articles published between 1976 and 2018. Results SND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman’s layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithelial–stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules – primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokeratectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0–31%). Conclusion The pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.
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Affiliation(s)
- Vikram Paranjpe
- Department of Ophthalmology, University of Miami Miller School of Medicine , Miami, FL 33136, USA
| | - Anat Galor
- Department of Ophthalmology, University of Miami Miller School of Medicine , Miami, FL 33136, USA.,Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL 33125, USA
| | - Pedro Monsalve
- Department of Ophthalmology, University of Miami Miller School of Medicine , Miami, FL 33136, USA
| | - Sander R Dubovy
- Department of Ophthalmology, University of Miami Miller School of Medicine , Miami, FL 33136, USA
| | - Carol L Karp
- Department of Ophthalmology, University of Miami Miller School of Medicine , Miami, FL 33136, USA
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Venkateswaran N, Mercado C, Tran AQ, Garcia A, Diaz PFM, Dubovy SR, Galor A, Karp CL. The use of high resolution anterior segment optical coherence tomography for the characterization of conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia. EYE AND VISION 2019; 6:17. [PMID: 31236423 PMCID: PMC6580598 DOI: 10.1186/s40662-019-0143-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
Background Conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia (BRLH) are conditions that often have a similar appearance on the ocular surface. The use of high resolution anterior segment optical coherence tomography (HR-OCT) enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions. In this study, we characterize the morphological differences seen in conjunctival lymphoma, conjunctival amyloidosis and BRLH on HR-OCT imaging. Methods A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma, conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute. Patients were excluded if HR-OCT imaging was not performed on initial presentation. Results Thirty-four total eyes of 27 patients were identified. Twenty eyes had conjunctival lymphoma (16 patients), 8 eyes had conjunctival amyloidosis (6 patients) and 6 eyes had BRLH (5 patients). All conditions appeared clinically as pink, red or yellow subepithelial lesions but had different features on HR-OCT. In lymphoma, HR-OCT images typically showed homogenous, dark subepithelial lesions with smooth borders, containing monomorphic dot-like infiltrates. HR-OCT images of amyloidosis typically showed heterogeneous, dark lesions with irregular borders, often containing hyperreflective linear infiltrates. HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue, at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective, subepithelial tissue. Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions. Conclusions Distinctive features on HR-OCT of conjunctival lymphoma, conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination. Future studies can further validate this technology’s use with more subtle and challenging lesions.
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Affiliation(s)
- Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Carolina Mercado
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Ann Q Tran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Armando Garcia
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Pedro Francisco Monsalve Diaz
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Sander R Dubovy
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA.,2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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Mohamed-Noriega K, Treviño-Herrera AB, Olvera-Barrios A, Morales-Wong F, Mohamed-Hamsho J. Resolution of giant ocular surface squamous neoplasia with topical 5-fuorouracil 1. SAGE Open Med Case Rep 2019; 7:2050313X19843392. [PMID: 31024731 PMCID: PMC6472153 DOI: 10.1177/2050313x19843392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
Abstract
An 82-year-old man presented with a left eye elevated single ocular surface
squamous neoplasia. The tumor involved 360° of limbus, three quadrants of cornea
and conjunctiva; this was compatible with the diagnosis of giant ocular surface
squamous neoplasia. Topical 5-fluorouracil 1% was planned four times daily for
1 week followed by 3 weeks off-treatment. Patient inadvertently continued
5-fluorouracil, four times daily for 4 weeks, presenting with clinical
resolution of the ocular surface squamous neoplasia and subtotal corneal
epithelial defect associated with 5-fluorouracil toxicity. One month later, we
observed a transparent cornea and no signs of toxicity. Total tumor resolution
was observed for at least 6 months of follow-up.
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Affiliation(s)
- Karim Mohamed-Noriega
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Alan Baltazar Treviño-Herrera
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Abraham Olvera-Barrios
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Fernando Morales-Wong
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Jesus Mohamed-Hamsho
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
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Deng SX, Borderie V, Chan CC, Dana R, Figueiredo FC, Gomes JAP, Pellegrini G, Shimmura S, Kruse FE. Global Consensus on Definition, Classification, Diagnosis, and Staging of Limbal Stem Cell Deficiency. Cornea 2019; 38:364-375. [PMID: 30614902 PMCID: PMC6363877 DOI: 10.1097/ico.0000000000001820] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite extensive knowledge gained over the last 3 decades regarding limbal stem cell deficiency (LSCD), the disease is not clearly defined, and there is lack of agreement on the diagnostic criteria, staging, and classification system among treating physicians and research scientists working on this field. There is therefore an unmet need to obtain global consensus on the definition, classification, diagnosis, and staging of LSCD. METHODS A Limbal Stem Cell Working Group was first established by The Cornea Society in 2012. The Working Group was divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to obtain agreement on a strategic plan and methodology from all participants after a comprehensive literature search, and final agreement was reached on the definition, classification, diagnosis, and staging of LSCD. A writing group was formed to draft the current manuscript, which has been extensively revised to reflect the consensus of the Working Group. RESULTS A consensus was reached on the definition, classification, diagnosis, and staging of LSCD. The clinical presentation and diagnostic criteria of LSCD were clarified, and a staging system of LSCD based on clinical presentation was established. CONCLUSIONS This global consensus provides a comprehensive framework for the definition, classification, diagnosis, and staging of LSCD. The newly established criteria will aid in the correct diagnosis and formulation of an appropriate treatment for different stages of LSCD, which will facilitate a better understanding of the condition and help with clinical management, research, and clinical trials in this area.
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Affiliation(s)
- Sophie X. Deng
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Vincent Borderie
- Quinze-Vingts National Eye Hospital, Faculté de Médecine Sorbonne Université, Paris, France
| | - Clara C. Chan
- University of Toronto Department of Ophthalmology & Vision Sciences Toronto, Ontario
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary, Harvard Medical School
| | - Francisco C. Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary and Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - José A. P. Gomes
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Brazil
| | - Graziella Pellegrini
- Centre for Regenerative Medicine, University of Modena and Reggio Emilia; Holostem Terapie Avanzate, Modena, Italy
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Friedrich E. Kruse
- Department of Ophthalmology, University Hospital Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Germany
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A prospective study of the incidence, associations and outcomes of ocular surface squamous neoplasia in the United Kingdom. Eye (Lond) 2018; 33:283-294. [PMID: 30593587 DOI: 10.1038/s41433-018-0217-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/17/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe the incidence, associations and outcomes of ocular surface squamous neoplasia (OSSN) in the United Kingdom. METHODS Prospective, observational study of every new case of OSSN reported via the British Ophthalmological Surveillance Unit reporting scheme over a 12-month period. Cases were followed up for 12 months. RESULTS The reported incidence of OSSN was 0.53 cases/million/year (conjunctival intraepithelial neoplasia: 0.43 cases/million/year; squamous cell carcinoma: 0.08 cases/million/year). Eighty-five per cent of affected patients were male, 97% were Caucasian, and the mean age at presentation was 67.9 (±12.8) years. Information on potential underlying risk factors was frequently unknown. The most commonly affected sites were the limbus and the nasal and temporal bulbar conjunctivae. Most patients presented with a visual acuity of 6/9 or better, without symptoms of pain or visual loss. Excision (with or without additional treatment) was the most common first-line treatment and interferon (with or without additional treatment) was the most common second-line treatment, although management varied widely. Complications of treatment were rare but occasionally severe. Recurrence within 12 months of follow-up occurred in at least 6% of patients. CONCLUSION Although subject to reporting bias, these data suggest that there has not been a significant change in the incidence of OSSN in the United Kingdom, or its demographic profile, since 1996. The broad range of management approaches identified in this study reflect a lack of consensus as to the optimal referral and treatment pathways.
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Neupane R, Gaudana R, Boddu SHS. Imaging Techniques in the Diagnosis and Management of Ocular Tumors: Prospects and Challenges. AAPS JOURNAL 2018; 20:97. [PMID: 30187172 DOI: 10.1208/s12248-018-0259-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 12/23/2022]
Abstract
Different types of imaging modalities are used in the diagnosis of ocular cancer. Selection of an imaging modality is based on the features of a tumor as well as the inherent characteristics of the imaging technique. It is vital to select an appropriate imaging modality in diagnosis of ocular tumor with confidence. This review focuses on five most commonly used imaging modalities, i.e., positron emission tomography-computed tomography (PET/CT), single photon emission computed tomography (SPECT), optical coherence tomography (OCT), ultrasound (US), and magnetic resonance imaging (MRI). The principal of imaging modalities is briefly explained, along with their role in the diagnosis and management of the most common ocular tumors such as retinoblastoma and uveal melanoma. Further, the diagnostic features of ocular tumors corresponding to each imaging modality and possibilities of utilizing imaging techniques in the process of ocular drug development are included in this review.
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Affiliation(s)
- Rabin Neupane
- College of Pharmacy and Pharmaceutical Sciences, The University of Toledo Health Science Campus, Toledo, OH, 43614, USA
| | - Ripal Gaudana
- Principal Scientist, Par Pharmaceuticals, 1 Ram Ridge Rd, Spring Valley, New York, 10977, USA
| | - Sai H S Boddu
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, P.O. Box 346, Ajman, United Arab Emirates.
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Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical Management of Ocular Surface Squamous Neoplasia: A Review of the Current Evidence. Ophthalmol Ther 2018; 7:247-262. [PMID: 30030703 PMCID: PMC6258579 DOI: 10.1007/s40123-018-0140-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/24/2022] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented malignancy of the ocular surface and is represented in a wide range of histologic diagnoses, ranging from mild epithelial dysplasia to invasive squamous carcinoma. Although surgical excision is still the gold standard for OSSN treatment, interest in conservative medical approaches is steadily growing. We have reviewed all of the literature on OSSN published in English in the MEDLINE database up to May 2018, using the keywords “ocular surface squamous neoplasia,” “squamous conjunctival carcinoma,” and “conjunctival carcinoma in situ,” with the aim to provide a comprehensive review of the most recent evidence on this distinct clinical entity.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Alessandro Marchese
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Modorati
- Oncology Unit, Department of Ophthalmology, University Vita-Salute-IRCCS Ospedale San Raffaele, Milan, Italy
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Cinotti E, Singer A, Labeille B, Grivet D, Rubegni P, Douchet C, Cambazard F, Thuret G, Gain P, Perrot JL. Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors. JAMA Ophthalmol 2017; 135:845-851. [PMID: 28654937 DOI: 10.1001/jamaophthalmol.2017.2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. Objective To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. Design A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. Main Outcomes and Measures Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. Results In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. Conclusions and Relevance Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Aurélie Singer
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bruno Labeille
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Damien Grivet
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Pietro Rubegni
- Department of Medical, Surgical, and Neurological Science, Dermatology Section, University of Siena, S Maria alle Scotte Hospital, Siena, Italy
| | - Catherine Douchet
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Cambazard
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Gilles Thuret
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France.,French University Institute, Paris, France
| | - Philippe Gain
- Department of Ophthalmology, University Hospital of Saint-Etienne, Saint-Etienne, France.,Biology, Engineering and Imaging of Corneal Graft Laboratory, EA2521, Jean Monnet University, Saint-Etienne, France
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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