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Zhu F, Wang P, Zhang Z, Yao C, Wang Y, Ye J, Wu J. Integrative genomic analysis reveals cancer-associated mutations in patients with ophthalmic tumors. J Int Med Res 2024; 52:3000605241258171. [PMID: 39053449 PMCID: PMC11283671 DOI: 10.1177/03000605241258171] [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: 09/12/2023] [Accepted: 05/04/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Apart from the role of the retinoblastoma gene, the genomic events associated with poor outcomes in patients with ophthalmic tumors are poorly understood. METHODS We retrospectively analyzed 48 patients with six types of ophthalmic tumors. We searched for high-frequency mutated genes and susceptibility genes in these patients using combined exome and transcriptome analysis. RESULTS We identified four clearly causative genes (TP53, PTCH1, SMO, BAP1). Susceptibility gene analysis identified hotspot genes, including RUNX1, APC, IDH2, and BRCA2, and high-frequency gene analysis identified several genes, including TP53, TTN, and MUC16. Transcriptome analysis identified 5868 differentially expressed genes, of which TOP2A and ZWINT were upregulated in all samples, while CFD, ELANE, HBA1, and HBB were downregulated. Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that the phosphoinositide 3-kinase (PI3K)-Akt and Transcriptional misregulation in cancer signaling pathways may be involved in ophthalmic tumorigenesis. CONCLUSIONS TP53 is clearly involved in ophthalmic tumorigenesis, especially in basal cell carcinoma, and the PI3K-Akt signaling pathway may be an essential pathway involved in ophthalmic tumorigenesis. RUNX1, SMO, TOP2A, and ZWINT are also highly likely to be involved in ophthalmic tumorigenesis, but further functional experiments are needed to verify the mechanisms of these genes in regulating tumorigenesis.
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Affiliation(s)
| | | | | | - Chunlei Yao
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yijie Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Wu
- MyGenostics Inc., Beijing, China
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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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3
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Novelli A, Romero-Kusabara IL, Frazão MAM. Update in ocular surface squamous neoplasia. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S124. [PMID: 38865544 PMCID: PMC11164286 DOI: 10.1590/1806-9282.2024s124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 06/14/2024]
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4
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Alamillo-Velazquez J, Ortiz-Morales G, Gonzalez-Gonzalez SE, Lopez-Altamirano DF, Rodríguez-Garcia A. Actinic conjunctivitis and its relationship with prurigo in an indigenous population from the Highlands of Chiapas, Mexico. Int Ophthalmol 2024; 44:4. [PMID: 38315255 DOI: 10.1007/s10792-024-02925-0] [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: 09/16/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis that affects high-risk populations. We analyzed the clinical manifestations and onset of actinic conjunctivitis (AC), and its relationship with prurigo (AP) in a susceptible population. METHODS This prospective observational cohort study was performed on Indigenous populations from the highlands of Chiapas, Mexico. Thorough dermatological and ophthalmological examinations were performed in patients attending a primary health care center. The clinical features, labor and environmental factors, onset timing, and clinical staging of AC and AP were analyzed. RESULTS Of the 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18 ± 18.52 years (6-70 years). The mean residential altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 h a day (0.5-12 h). A total of 90.7% reported exposure to biomass fuels during cooking, and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease. CONCLUSIONS AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Although solar exposure was not associated with late AC stages, a positive association was found with farm animal exposure. Evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC.
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Affiliation(s)
- Jimena Alamillo-Velazquez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
- Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Gustavo Ortiz-Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
- Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | | | - Daniel F Lopez-Altamirano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
- Clinical Pathology Department, Hospital San Jose Tec Salud, Monterrey, Mexico
| | - Alejandro Rodríguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico.
- Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion TecSalud. Av, Batallon de San Patricio No. 112, Col. Real de San Agustin, CP. 66270, San Pedro Grarza Garcia, Nuevo León, Mexico.
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Gurnani B, Kaur K. Molecular and epigenetic mechanisms governing ocular surface squamous neoplasia: opportunities for diagnostics. Expert Rev Mol Diagn 2023:1-15. [PMID: 38131180 DOI: 10.1080/14737159.2023.2298681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) is the most common ocular malignancy; the pathophysiology is influenced by molecular, genetic, and epigenetic mechanisms. The incidence of OSSN is associated with the anatomy and physiology of the ocular surface, limbal stem cell configuration, limbal vulnerability, cancer stem cells, dysplasia, neoplasia, angiogenesis, invasion, and metastasis. The key etiological factors involved are human papillomavirus (HPV), human immunodeficiency virus (HIV), immunosuppression, p53 tumor suppressor gene, hypovitaminosis A, and failure of Deoxyribonucleic acid (DNA) repair mechanisms. AREAS COVERED This special report is a focussed attempt to understand the molecular mechanism, genetic and epigenetic mechanism, and diagnostic modalities for OSSN. EXPERT OPINION While these mechanisms contribute to genome instability, promoter-specific hypermethylation might facilitate and promote tumor formation by silencing tumor suppressor genes. OSSN understanding has improved with increased literature available on various genetic, molecular, and epigenetic mechanisms, although the exact genetic and epigenetic mechanisms still need to be elucidated. It is important to note that the molecular mechanisms of OSSN can vary among individuals, and further research is required to elucidate the underlying processes fully. Understanding these mechanisms is crucial for the development of targeted therapies and improved management of OSSN.
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Affiliation(s)
- Bharat Gurnani
- Cataract, Cornea, Refractive Services, Trauma, External Diseases, Contact Lens and Ocular Surface, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Chitrakoot, India
| | - Kirandeep Kaur
- Children Eye Care Centre, Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya, Shri Sadguru Seva Sangh Trust, Janaki Kund, Chitrakoot, India
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García-Onrubia L, Pacheco-Callirgos GE, García-Álvarez C, Muñoz-Moreno MF, García-Lagarto E, Almaraz-Gómez A, Saornil-Álvarez MA. Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023:S2173-5794(23)00107-X. [PMID: 37369322 DOI: 10.1016/j.oftale.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/07/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE The present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. METHODS retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. RESULTS Of 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. CONCLUSION Most of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.
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Affiliation(s)
- L García-Onrubia
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Moorfields Eye Hospital NHS Foundation Trust, Londres, United Kingdom.
| | - G E Pacheco-Callirgos
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - C García-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M F Muñoz-Moreno
- Unidad de Tumores Oculares, Unidad de Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - E García-Lagarto
- Departamento de Patología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Almaraz-Gómez
- Departamento de Epidemiología y Medicina Preventiva, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - M A Saornil-Álvarez
- Unidad de Tumores Oculares, Departamento de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Lin Y, Liu X, Zhang Y, Xie Z, Fang X, Shi K, Zhong Y, Su S, Cai M, Wu H, Ou S. The clinicopathological analysis of ocular and orbit tumors in southeast of China. Front Oncol 2023; 13:1118862. [PMID: 37404770 PMCID: PMC10316389 DOI: 10.3389/fonc.2023.1118862] [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: 12/08/2022] [Accepted: 04/21/2023] [Indexed: 07/06/2023] Open
Abstract
Purpose The purpose of this study is to describe the clinicopathologic characteristics of ocular surface and orbit tumors in the Southeast of China and explore the method to differentiate the benign and malignant masses. Materials and methods 3468 patients undergoing mass resection from January 2015 to December 2020 were selected as observation subjects and were classified into benign and malignant masses according to postoperative pathology. The clinicopathologic characteristics were collected, including gender, age, pathological tissue signs, and pathological signs. Multivariate Logistic regression analysis of independent risk factors of malignant mass was applied to establish a diagnostic model and the efficacy was evaluated by the subject working characteristics (ROC) curve. Results Benign tumors accounted for 91.5% of all cases, and malignant tumors accounted for 8.5%. The most common ocular benign tumors were nevi (24.2%), granuloma (17.1%), and cysts (16.4%). The most common ocular malignant tumors were malignant lymphoma (32.1%) and Basal cell carcinoma (20.2%). As for the histologic origin, melanocytic origin was on the list with 819 (23.6%), mesenchymal 661 (19.1%), epithelial 568 (16.3%), cystic 521 (15.0%), skin adnexal 110 (3.1%), lymphoid 94 (2.8%), and Neural 25(0.8%). Based on the gender, age, tumor location, and the pathological tissue image feature (including differentiation, structural atypia, covering epithelial, keratosis, nest structure/distribution, nuclear atypia, cytoplasmic change and nuclear division), the diagnostic model had predictive value to differentiate the benign and malignant masses. Conclusion Most ocular surface and orbit tumors are benign. Tumor diagnosis is relative to the patient's age, gender, tumor location, and pathologic characteristics. We generated a satisfactory diagnostic model to differential diagnosis of benign and malignant masses.
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Affiliation(s)
- Yuan Lin
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Xiaodong Liu
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Yujie Zhang
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Zhiwen Xie
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Xie Fang
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Ke Shi
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Yanlin Zhong
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Shengqi Su
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
- Xiamen Science and Technology Middle School, Xiamen, Fujian, China
| | - Minqing Cai
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Huping Wu
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
| | - Shangkun Ou
- Eye Institute of Xiamen University and affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, Fujian, China
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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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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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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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Solnik M, Paduszyńska N, Czarnecka AM, Synoradzki KJ, Yousef YA, Chorągiewicz T, Rejdak R, Toro MD, Zweifel S, Dyndor K, Fiedorowicz M. Imaging of Uveal Melanoma—Current Standard and Methods in Development. Cancers (Basel) 2022; 14:cancers14133147. [PMID: 35804919 PMCID: PMC9265106 DOI: 10.3390/cancers14133147] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Uveal melanoma is the most prevalent intraocular tumor in adults, derived from melanocytes; the liver is the most common site of its metastases. Due to troublesome tumor localization, different imaging techniques are utilized in diagnostics, i.e., fundus imaging (FI), ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), or fundus autofluorescence (FAF). Specialists eagerly use these techniques, but sometimes the precision and quality of the obtained images are imperfect, raising diagnostic doubts and prompting the search for new ones. In addition to analyzing the currently utilized methods, this review also introduces experimental techniques that may be adapted to clinical practice in the future. Moreover, we raise the topic and present a perspective for personalized medicine in uveal melanoma treatment. Abstract Uveal melanoma is the most common primary intraocular malignancy in adults, characterized by an insidious onset and poor prognosis strongly associated with tumor size and the presence of distant metastases, most commonly in the liver. Contrary to most tumor identification, a biopsy followed by a pathological exam is used only in certain cases. Therefore, an early and noninvasive diagnosis is essential to enhance patients’ chances for early treatment. We reviewed imaging modalities currently used in the diagnostics of uveal melanoma, including fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), as well as positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI). The principle of imaging techniques is briefly explained, along with their role in the diagnostic process and a summary of their advantages and limitations. Further, the experimental data and the advancements in imaging modalities are explained. We describe UM imaging innovations, show their current usage and development, and explain the possibilities of utilizing such modalities to diagnose uveal melanoma in the future.
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Affiliation(s)
- Małgorzata Solnik
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (N.P.)
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
| | - Natalia Paduszyńska
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (N.P.)
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
| | - Kamil J. Synoradzki
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland;
- Correspondence:
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman 11941, Jordan;
| | - Tomasz Chorągiewicz
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
| | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
- Eye Clinic, Public Health Department, Federico II University, via Pansini 5, 80131 Naples, Italy
| | - Sandrine Zweifel
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland;
| | - Katarzyna Dyndor
- Department of Radiography, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland;
| | - Michał Fiedorowicz
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland;
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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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Pterygium and Ocular Surface Squamous Neoplasia: Optical Biopsy Using a Novel Autofluorescence Multispectral Imaging Technique. Cancers (Basel) 2022; 14:cancers14061591. [PMID: 35326744 PMCID: PMC8946656 DOI: 10.3390/cancers14061591] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
In this study, differentiation of pterygium vs. ocular surface squamous neoplasia based on multispectral autofluorescence imaging technique was investigated. Fifty (N = 50) patients with histopathological diagnosis of pterygium (PTG) and/or ocular surface squamous neoplasia (OSSN) were recruited. Fixed unstained biopsy specimens were imaged by multispectral microscopy. Tissue autofluorescence images were obtained with a custom-built fluorescent microscope with 59 spectral channels, each with specific excitation and emission wavelength ranges, suitable for the most abundant tissue fluorophores such as elastin, flavins, porphyrin, and lipofuscin. Images were analyzed using a new classification framework called fused-classification, designed to minimize interpatient variability, as an established support vector machine learning method. Normal, PTG, and OSSN regions were automatically detected and delineated, with accuracy evaluated against expert assessment by a specialist in OSSN pathology. Signals from spectral channels yielding signals from elastin, flavins, porphyrin, and lipofuscin were significantly different between regions classified as normal, PTG, and OSSN (p < 0.01). Differential diagnosis of PTG/OSSN and normal tissue had accuracy, sensitivity, and specificity of 88 ± 6%, 84 ± 10% and 91 ± 6%, respectively. Our automated diagnostic method generated maps of the reasonably well circumscribed normal/PTG and OSSN interface. PTG and OSSN margins identified by our automated analysis were in close agreement with the margins found in the H&E sections. Such a map can be rapidly generated on a real time basis and potentially used for intraoperative assessment.
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14
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Machado CF, Sousa IMOD, Araripe LDA, Guedes MDS, Barbosa JDP, Marçal E, Ribeiro JC. Development and usability of a photograph-based smartphone app for ocular surface tumor screening. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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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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Bontzos G, Douglas VP, Douglas KAA, Kapsala Z, Drakonaki EE, Detorakis ET. Ultrasound Elastography in Ocular and Periocular Tissues: A Review. Curr Med Imaging 2021; 17:1041-1053. [PMID: 33319691 DOI: 10.2174/1573405616666201214123117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
Ultrasound elastography has become available in everyday practice, allowing direct measurement of tissue elasticity with important and expanding clinical applications. Several studies that have evaluated pathological and non-pathological tissues have demonstrated that ultrasound elastography can actually improve the diagnostic accuracy of the underlying disease process by detecting differences in their elasticity. Ocular and periocular tissues can also be characterized by their elastic properties. In this context, a comprehensive review of literature on ultrasound elastography as well as its current applications in Ophthalmology is presented.
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Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
| | | | | | - Zoi Kapsala
- Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
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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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18
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Abstract
PURPOSE OF REVIEW This review will discuss the utility of high-resolution anterior segment optical coherence tomography (HR-OCT), in-vivo confocal microscopy (IVCM) and ultrasound biomicroscopy (UBM) in characterizing and diagnosing various ocular surface tumors, namely ocular surface squamous neoplasia (OSSN), conjunctival lymphoma and conjunctival melanoma. The strengths and limitations of each imaging modality will be discussed along with the characteristics findings of each lesion on each imaging platform. RECENT FINDINGS HR-OCT can consistently be utilized in the clinic setting to distinguish between epithelial ocular surface tumors such as OSSN as compared with subepithelial tumors such as conjunctival lymphoma and conjunctival melanoma given their distinctive findings. IVCM can be used as an adjunct to HR-OCT to obtain cellular and surface characteristics, whereas UBM can be used to assess tumor depth and thickness for larger and highly pigmented lesions as well as to detect intraocular invasion. SUMMARY HR-OCT, IVCM and UBM are all helpful imaging modalities to diagnose and characterize various ocular surface tumors and can serve as valuable adjuncts to monitor treatment response and assess for recurrence ocular surface tumors.
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Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
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El-Hadad C, Rubin ML, Nagarajan P, Ford JR, Xu S, Ning J, Esmaeli B. Prognostic Factors for Orbital Exenteration, Local Recurrence, Metastasis, and Death From Disease in Conjunctival Squamous Cell Carcinoma. Ophthalmic Plast Reconstr Surg 2021; 37:262-268. [PMID: 33009325 PMCID: PMC7865015 DOI: 10.1097/iop.0000000000001798] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Information regarding risk of metastasis and disease-related death (DD) from conjunctival squamous cell carcinoma (SCC) is relatively scarce. We explored prognostic factors for orbital exenteration, local recurrence, nodal metastasis, and DD in patients with conjunctival SCC. DESIGN Retrospective cross-sectional study. METHODS All consecutive patients with conjunctival SCC treated by the senior author at MD Anderson Cancer Center during1999-2018 were included. Survival curves were estimated using the Kaplan-Meier method, and survival differences were assessed using 2-sided log-rank tests. RESULTS The study included 44 patients (24 men, 20 women); median age was 64 years (range, 40-90). T categories at presentation were as follows: Tis, 20 patients; T2, 8; T3, 9; and T4, 7. Eighteen patients (41%) had tumors exclusively in the bulbar conjunctiva; 26(59%) had nonbulbar conjunctival involvement. The median follow-up time was 29.2 months (95% CI: 21.8-44.3). Orbital exenteration was performed in 10 cases (23%) and was associated with T3 or more advanced disease at presentation (p < 0.001). Seven patients developed local recurrence during follow up. History of organ transplant correlated with local recurrence and orbital exenteration (p < 0.01). Nodal metastasis was present in 1 patient at presentation and occurred in 3 patients during follow up, for an overall nodal metastasis rate of 9% (4/44). By end of follow up, 2 patients had died of disease, 4 had died of other causes, and 38 were alive with no evidence of disease. The results suggest that both orbital exenteration and nodal metastasis are independent variables associated with DD. CONCLUSIONS In patients with conjunctival SCC, orbital exenteration and nodal metastasis are associated with DD and organ transplantation is associated with orbital exenteration.
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Affiliation(s)
- Christian El-Hadad
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Priya Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua Richard Ford
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shiqiong Xu
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Brodie F, Repka M, Burns SA, Prakalapakorn SG, Morse C, Schuman JS, Duenas MR, Afshari N, Pollack JS, Thorne JE, Vitale A, Sen HN, Myung D, Blumenkranz MS, Tu E, Hammer DX, Tarver M, Cunningham B, Kagemann L, Sadda S, Sarraf D, Jaffe GJ, Eydelman M. Development, Validation, and Innovation in Ophthalmic Laser-Based Imaging: Report From a US Food and Drug Administration-Cosponsored Forum. JAMA Ophthalmol 2021; 139:113-118. [PMID: 33211074 DOI: 10.1001/jamaophthalmol.2020.4994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In April 2019, the US Food and Drug Administration, in conjunction with 11 professional ophthalmic, vision science, and optometric societies, convened a forum on laser-based imaging. The forum brought together the Food and Drug Administration, clinicians, researchers, industry members, and other stakeholders to stimulate innovation and ensure that patients in the US are the first in the world to have access to high-quality, safe, and effective medical devices. This conference focused on the technology, clinical applications, regulatory issues, and reimbursement issues surrounding innovative ocular imaging modalities. Furthermore, the emerging role of artificial intelligence in ophthalmic imaging was reviewed. This article summarizes the presentations, discussion, and future directions.
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Affiliation(s)
- Frank Brodie
- Byers Eye Institute, Stanford University, Stanford, California.,Now with Vitreoretinal Surgery Fellowship Program, Duke Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Michael Repka
- American Academy of Ophthalmology, San Francisco, California
| | | | - S Grace Prakalapakorn
- American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California
| | - Christie Morse
- American Association for Pediatric Ophthalmology and Strabismus, San Francisco, California
| | | | | | - Natalie Afshari
- American Society of Cataract and Refractive Surgeons, Fairfax, Virginia
| | - John S Pollack
- American Society of Retinal Specialists, Chicago, Illinois
| | | | | | - H Nida Sen
- American Uveitis Society, Birmingham, Alabama
| | - David Myung
- Byers Eye Institute, Stanford University, Stanford, California
| | | | - Elmer Tu
- Cornea Society, Fairfax, Virginia
| | - Daniel X Hammer
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Michelle Tarver
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Bradley Cunningham
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
| | - Larry Kagemann
- Center for Devices and Radiological Health Food and Drug Administration, Silver Spring, Maryland
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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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22
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Laver NMV. Ocular cytology: Diagnostic features and ongoing practices. Cancer Cytopathol 2020; 129:419-431. [PMID: 33136340 DOI: 10.1002/cncy.22384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/28/2022]
Abstract
Ocular cytology specimens are small, with limited options for a repeat biopsy. Appropriate handling of these specimens and triaging for ancillary testing can be taxing. In this article, the author reviews a selection of potentially challenging diagnoses and current common practices and methods used in diagnosing ocular diseases by cytology. The majority of cytology specimens submitted for evaluation of ocular diseases can be divided into 3 major categories: surface epithelial corneal and conjunctival cytology samples, intraocular fluids from the anterior (aqueous fluid) or posterior (vitreous fluid) chambers of the eye, and intraocular fine-needle aspiration specimens. The clinical findings, testing, and cytologic features of ocular surface epithelial infections, inflammations and neoplasia are discussed; and challenges in processing and diagnosing intraocular infections, chronic uveitis, and vitreoretinal lymphoma are reviewed. Novel molecular testing in the cytologic diagnosis and classification of uveal melanoma also is explored. Cytology evaluation of corneal epithelial and stromal cells, anterior chamber and vitreous samples, and fine-needle aspiration biopsies can provide detailed diagnostic findings to aid in the treatment and follow-up of patients with ocular diseases.
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Affiliation(s)
- Nora M V Laver
- Departments of Ophthalmology, Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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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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Gallo B, Thaung C, Hay G, Arora AK, Cohen VM, Damato B, Sagoo MS. Invasive conjunctival melanoma mimicking ocular surface squamous neoplasia: a case series. Br J Ophthalmol 2020; 105:775-778. [PMID: 32675060 DOI: 10.1136/bjophthalmol-2019-315393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Conjunctival melanoma is the second most common conjunctival malignant tumour after squamous cell carcinoma, usually arising from primary acquired melanosis and less commonly from a conjunctival naevus or de novo. We report four cases of conjunctival melanoma masquerading as ocular surface squamous neoplasia. METHODS Four patients (2 females and 2 males; mean age 60.7 years; range 41-72 years) were referred for suspicious conjunctival lesions. In all cases, the lesions had a perilimbal location, were non-pigmented (cases 1 and 3) or mildly pigmented (cases 2 and 4), had a fleshy (cases 1, 2 and 4) or papillomatous (case 3) appearance and involved the corneal surface. In each case, our main clinical differential diagnosis included conjunctival intraepithelial neoplasia and squamous cell carcinoma. All four patients underwent an excisional biopsy with double freeze-thaw cryotherapy and alcohol keratoepitheliectomy. RESULTS In all four cases, the histopathological diagnosis was of invasive conjunctival melanoma with extension to the deep surgical margins. Adjuvant therapy consisting of strontium-90 β radiotherapy (all 4 patients) and topical Mitomicyn C (patient 2) was administered. CONCLUSION Conjunctival melanoma can clinically resemble ocular surface squamous neoplasia. Clinical impressions therefore need to be confirmed histopathologically.
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Affiliation(s)
- Beatrice Gallo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Thaung
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Gordon Hay
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Amit K Arora
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Victoria Ml Cohen
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Bertil Damato
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK.,Institute of Ophthalmology, University College London, London, UK
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25
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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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26
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Das J, Basak SK, Das N. Conjunctival stromal tumour (COST): anterior-segment OCT findings. BMJ Case Rep 2019; 12:12/11/e230348. [PMID: 31753821 DOI: 10.1136/bcr-2019-230348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Conjunctival stromal tumour (COST) is a recently described rare conjunctival tumour of mesenchymal origin with only four publications describing a handful of cases thus far. In this report, we describe the anterior-segment optical coherence tomography (AS-OCT) characteristics in a case of COST for the first time, in addition to the clinical and histopathological characteristics. The AS-OCT showed an elevated, dome-shaped hyporeflective homogenous lesion in the conjunctival stroma lined by hyperreflective outer layer with mild posterior shadowing, consistent with histological description of a paucicellular tumour with large myxoid collagenous material inside. Immunohistochemistry showed positive CD34 and vimentin but negative S100 and smooth muscle actin, thereby differentiating it from conjunctival myxoma.
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Affiliation(s)
- Joyeeta Das
- Oculoplasty, Disha Eye Hospitals, Kolkata, West Bengal, India
| | - Samar K Basak
- Cornea and External Disease, Disha Eye Hospital, Kolkata, West Bengal, India
| | - Nibedita Das
- Cornea and External Disease, Disha Eye Hospital, Kolkata, West Bengal, India
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27
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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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28
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Tanenbaum RE, Galor A, Dubovy SR, Karp CL. Classification, diagnosis, and management of conjunctival lymphoma. EYE AND VISION 2019; 6:22. [PMID: 31372366 PMCID: PMC6660942 DOI: 10.1186/s40662-019-0146-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/15/2019] [Indexed: 02/06/2023]
Abstract
Lymphoma is a malignant lymphoproliferative tumor that can involve the conjunctiva. Approximately 5-15% of all extranodal lymphomas are found in the ocular adnexal region, with approximately 25% of those involving the conjunctiva. Ninety-eight percent of conjunctival lymphomas arise from B-lymphocytes. The most common subtype of conjunctival lymphoma is extranodal marginal zone lymphoma (80%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%) and mantle cell lymphoma (3%). Natural killer and T cells (NK/T) are rare causes of lymphoma. While most conjunctival lymphomas are localized to the ocular adnexa at the time of presentation, systemic examination and management are of key importance in the long-term care of the patient. This review outlines the classification, etiology, presentation, diagnosis, and management of conjunctival lymphoma. The novel use of high resolution optical coherence tomography, both as a diagnostic tool and as a means for ongoing evaluation during treatment, is illustrated. Treatment options discussed include external beam radiation, chemotherapy, immunotherapy, antibiotic therapy, and combination regimens. Future investigation of the etiology and pathogenesis of conjunctival lymphoma is expected to reveal opportunities for innovative and individualized therapeutic agents. Collaboration between multiple disciplines is key in the advancement of the field.
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Affiliation(s)
- Rebecca E Tanenbaum
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, 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, Miami, FL 33136 USA
| | - Sander R Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St., Miami, 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, Miami, FL 33136 USA
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29
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Santoni A, Thariat J, Maschi C, Herault J, Baillif S, Lassalle S, Peyrichon ML, Salleron J, Caujolle JP. Management of Invasive Squamous Cell Carcinomas of the Conjunctiva. Am J Ophthalmol 2019; 200:1-9. [PMID: 30552889 DOI: 10.1016/j.ajo.2018.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Ocular surface squamous neoplasia includes a spectrum of diseases from dysplasia to invasive squamous cell carcinoma (SCC) of the conjunctiva. Whether the degree of invasion influences outcomes is debated. We evaluated the outcomes and management of conjunctival carcinomas defined as ≤0.2 mm invasion of the chorion (microinvasive; miSCC) or over (SCC). DESIGN Retrospective case series. METHODS Clinical, tumor, and therapeutic characteristics and outcomes were collected for consecutive patients with histology-proven invasive conjunctival miSCC/SCC treated between 2002 and 2017. RESULTS Patients were 70% men, ≥70 years old (56%), with carcinomas of the bulbar conjunctiva (83.0%). Limbal, corneal, and/or scleral involvement were present in 70.4%, 42.6%, and 27.8%, respectively. Patient characteristics, tumor characteristics, and no-touch surgery rates were similar between the 39 SCC and 15 miSCC. However, mitomycin was performed in 93.3% and 20.5% of miSCC and SCC, respectively (P < .001). Proton therapy was performed in 0% and 92.0% of miSCC and SCC, respectively (P < .001). SCC received mitomycin in case of tumoral resection margins, respectively (P = .018). The 24-month incidence of local relapse was 14.8%, including 20% and 12% for miSCC and SCC, respectively (P = .079). Irradiation was the only prognostic factor associated with a lower risk for local relapse (hazard ratio [0.25]; P = .045). There were 2 cancer-related deaths (2%). Mild/moderate anterior segment complications occurred in one third of the patients. CONCLUSIONS miSCC had slightly worse relapse rates compared with SCC. Postoperative proton therapy, performed in SCC only, was associated with a lower risk for relapse.
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Affiliation(s)
- Alexandra Santoni
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer ARCHADE Center, Normandie Universite-Unicaen, Caen, France.
| | - Célia Maschi
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Joel Herault
- Department of Radiation Oncology, Antoine-Lacassagne Cancer Center, Nice, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Sandra Lassalle
- Department of Biopathology, Pasteur 2 Teaching Hospital, Nice, France
| | | | - Julia Salleron
- Department of Biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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