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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Suleiman DE, Liman AA, Waziri GD, Iliyasu Y, Ahmed SA. Clinicopathological characteristics of ocular surface squamous neoplasia: a 10-year review form a referral tertiary centre in Nigeria. Int Ophthalmol 2022; 42:3905-3911. [PMID: 35802299 DOI: 10.1007/s10792-022-02411-5] [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: 12/14/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is a heterogeneous group of proliferative squamous lesions on the ocular surface with varying biologic behaviours. This study aims to report the clinical profile and pathological characteristics of cases of OSSN seen at a tertiary referral centre in North West Nigeria. METHODS A retrospective review of all cases of OSSN diagnosed over a 10-year period was done. RESULTS OSSN accounted for 68 out of 91 ocular surface lesions affecting twice as many males as females and a peak incidence in the 30-39 years age group. They frequently presented as higher-grade and higher-stage lesions with invasive squamous cell carcinoma being the most frequently diagnosed OSSN. They also frequently showed an association with HIV infection and a relatively long duration of symptoms before presentation. CONCLUSION OSSN occurs in a relatively young age group in our environment. Certain clinical and epidemiological features appear to predict the occurrence of higher-grade lesions, and this may help in the clinical prediction of likely pathologic grade and/or biologic behaviour of these lesions.
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Affiliation(s)
- Dauda Eneyamire Suleiman
- Department of Histopathology, College of Medical Sciences, Abubakar Tafawa Balewa University, Bauchi, 7204212, Nigeria.
| | - Almustapha Aliyu Liman
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Garba Dahiru Waziri
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Yawale Iliyasu
- Department of Anatomic Pathology and Forensic Medicine, Faculty of Clinical Sciences, Kaduna State University, Kaduna, Nigeria
| | - Saad Aliyu Ahmed
- Departent of Pathology, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
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Julius P, Siyumbwa SN, Moonga P, Maate F, Kaile T, Kang G, West JT, Wood C, Angeletti PC. Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians. Ocul Oncol Pathol 2021; 7:108-120. [PMID: 33869164 PMCID: PMC8024974 DOI: 10.1159/000511610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/09/2020] [Indexed: 01/25/2023] Open
Abstract
AIM This study aimed to characterize the clinical and pathologic presentation of ocular surface tumors (OSTs) and to more precisely differentiate the grades of ocular surface squamous neoplasia (OSSN) and benign lesions among Zambians. METHODS Two-hundred sixty-five Zambian patients presenting with ocular surface growths, suspicious for OSSN, were recruited between November 2017 and November 2019 to a cross-sectional study to investigate their lesions. Sociodemographic data were collected, HIV infection status and vision tests were performed, and lesions were measured and documented. Lesions >2 mm in diameter were excised and sent for pathology analysis. In addition to the biopsies, tears, blood, and buccal swabs were collected. CD4+ T-cell counts were measured by flow cytometry. Lesions were classified according to the WHO guidelines. χ2 and bivariate correlations were used to analyze variable associations and strengths with phi/Cramer's V and correlation coefficients, respectively. Binary logistics was used to adjust for covariance. RESULTS In this study, 68.3% of the participants were found to be HIV positive. The most frequent diagnoses were invasive OSSN (45.3%), preinvasive OSSN (29.1%), and pterygium (22.6%). Invasive OSSN comprised keratinizing squamous cell carcinoma (SCC) (87.5%), basaloid SCC (3.3%), and spindle cell carcinoma (3.3%). Unusual carcinomas, not described previously, included hybrid SCC (5.0%) and acantholytic SCC (0.8%). Invasive OSSN had advanced tumor (T3/T4) staging (93.3%) at diagnosis. Lymphadenopathy was rare (2.3%), and metastasis was absent. Patients were mostly female (59.2%). Median age was 36 (interquartile ranges 33-41) years (ranges 18-81). Patients with invasive OSSN were more likely to present with pain (p = 0.007), redness (p = 0.034), excessive tearing (p = 0.0001), discharge (p = 0.011), bleeding (p = 0.007), reduced vision (p = 0.0001), fungating lesion (p = 0.001), and blindness (p = 0.005); location at temporal limbus (p = 0.0001), inferior limbus (p = 0.0001), or circumlimbal (p = 0.001); and extension to cornea (p = 0.006) and forniceal palpebral conjunctiva (p = 0.001). Invasive OSSN was associated with any smoking habit and alcohol consumption (p = 0.04 and 0.03, respectively). HIV positivity was strongly associated with OSSN (74.6% OSSN vs. 49.3% benign lesions; p = 0.0001; phi: 0.237 [p = 0.0001]). CONCLUSION OSTs are very common in Zambia and are strongly associated with HIV coinfection. Patients with OSSN were more likely to be HIV positive than those with pterygia. Despite the commonality of OSTs in sub-Saharan Africa, these cancers have historically been poorly characterized.
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Affiliation(s)
- Peter Julius
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | | | - Phyllis Moonga
- University Teaching Hospital, Eye Hospital, Lusaka, Zambia
| | - Fred Maate
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | - Trevor Kaile
- Department of Pathology and Microbiology, School of Medicine, Lusaka, Zambia
| | - Guobin Kang
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - John T. West
- Nebraska Center for Virology and the Department of Biochemistry, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Charles Wood
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Peter C. Angeletti
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA,*Peter C. Angeletti, Nebraska Center for Virology, University of Nebraska-Lincoln, 4240 Fair St., Lincoln, NE 68583-0900 (USA),
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Lloyd HWCM, Arunga S, Twinamasiko A, Frederick MA, Onyango J. Predictors of Ocular Surface Squamous Neoplasia and Conjunctival Squamous Cell Carcinoma among Ugandan Patients: A Hospital-based Study. Middle East Afr J Ophthalmol 2019; 25:150-155. [PMID: 30765953 PMCID: PMC6348942 DOI: 10.4103/meajo.meajo_187_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of the study was to assess the predictors of ocular surface squamous neoplasia (OSSN) and conjunctival squamous cell carcinoma (SCC) among Ugandan patients. MATERIALS AND METHODS Patients presenting for removal of ocular surface lesions received human immunodeficiency virus (HIV) testing, completed questionnaires about demographic, behavioral, and historical potential risk factors for conjunctival neoplasia, and had lesions examined for interpalpebral versus other locations, rough versus smooth texture, and number of feeder vessels. Biopsies were classified pathologically using standard definitions classified OSSN and SCC. HIV rates were calculated for patients: with OSSN, SCC, and benign lesions. Potential risk factors and gross findings were tested for abilities to predict OSSN and SCC. RESULTS One hundred and ninety-five patients presented with 212 lesions in 203 eyes. Nearly 34% of the patients were more than 60 years old, 67% were peasants, 88% spent more than 20 h/week outdoors, and only 10% wore sun protection. No potential risk factors predicted neoplasia. HIV prevalence was 17.1% among patients with OSSN compared to 11.1% among those without OSSN; 42.9% among SCC patients compared to 12.0% among those without SCC. Rough tumor surface (adjusted odds ratio [aOR] = 4.4 and 95% confidence interval [CI]: 2.2-9.1), six or more feeder vessels (aOR = 2.6, 95% CI: 1.3-5.2), and interpalpebral tumor location (aOR = 3.3, 95% CI: 1.5-7.1) predicted OSSN. Only a rough tumor surface (aOR = 34.6, 95% CI: 7.8-153.4) predicted SCC. CONCLUSION HIV infection remained a risk factor for OSSN and particularly, SCC, but less so than in the past. Lesions' rough surface, six or more feeder vessels, and interpalpebral location increased OSSN risk. Only a rough tumor surface increased risk for SCC.
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Affiliation(s)
| | - Simon Arunga
- Department of Ophthalmology, Mbarara University of Science and Technology and Ruharo Eye Centre, Mbarara, Uganda
| | - Amos Twinamasiko
- Department of Ophthalmology, Mbarara University of Science and Technology and Ruharo Eye Centre, Mbarara, Uganda
| | - Meier A Frederick
- Department of Pathology, Mbarara University of Science and Technology and Global Health Collaboration, Seed Global Health, Boston, Massachusetts, USA
| | - John Onyango
- Department of Ophthalmology, Mbarara University of Science and Technology and Ruharo Eye Centre, Mbarara, Uganda
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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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Dalvin LA, Salomão DR, Patel SV. Population-based incidence of conjunctival tumours in Olmsted County, Minnesota. Br J Ophthalmol 2018; 102:1728-1734. [PMID: 29511061 DOI: 10.1136/bjophthalmol-2017-311530] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/27/2017] [Accepted: 02/09/2018] [Indexed: 12/12/2022]
Abstract
AIM To determine population-based incidence of conjunctival tumours in Olmsted County, Minnesota. METHODS The Rochester Epidemiology Project medical record linkage system was used to identify patients with conjunctival tumours in Olmsted County (1 January 1980 to 31 December 2015). Records were reviewed for demographics, types of tumours, histopathology, treatment and clinical course. Incidence rate of all tumours was calculated per 1 000 000 person-years. Poisson regression analysis was used to assess changes in incidence over time. RESULTS There were 504 patients with conjunctival tumours, giving an age-adjusted and sex-adjusted incidence rate of 125 per 1 000 000 (CI 113.5 to 135.5). Incidence increased over time (P<0.001). Most tumours (474, 94%) were benign. Of benign lesions, melanocytic lesions accounted for the majority (431, 86%), with adjusted incidence rates of 10.8 (CI 7.7 to 13.9) for complexion-associated melanosis, 49.7 (CI 42.9 to 56.6) for nevus and 44.1 (37.5-50.8) for primary acquired melanosis. Malignant lesions were rare (30, 6%) with 6 cases of melanoma, 21 cases of ocular surface squamous neoplasia (OSSN), 1 case of Langerhans cell histiocytosis and 2 cases of lymphoma. Adjusted incidence rates of conjunctival melanoma and OSSN were 1.5 (CI 0.3 to 2.8) and 6.1 (CI 3.5 to 8.7), respectively. Outcomes for melanoma (mean follow-up 14 years, range 0-34) and OSSN (mean follow-up 4 years, range 0-24) were favourable in 29 cases, with one fatality due to metastatic melanoma. CONCLUSIONS In a population-based setting, most conjunctival tumours are benign, and the majority of lesions are melanocytic. While it is important to remain vigilant for malignancies, most conjunctival lesions in a community-based practice are not life-threatening.
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Affiliation(s)
- Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diva R Salomão
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Kheir WJ, Tetzlaff MT, Pfeiffer ML, Mulay K, Ozgur O, Morrell G, Esmaeli B. Epithelial, non-melanocytic and melanocytic proliferations of the ocular surface. Semin Diagn Pathol 2016; 33:122-32. [DOI: 10.1053/j.semdp.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lucas RM, Norval M, Wright CY. Solar ultraviolet radiation in Africa: a systematic review and critical evaluation of the health risks and use of photoprotection. Photochem Photobiol Sci 2016; 15:10-23. [DOI: 10.1039/c5pp00419e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The majority of the African continent experiences high solar UVB radiation throughout the year. The adverse consequences of this on the health of populations living in Africa are reviewed.
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Affiliation(s)
- Robyn M. Lucas
- National Centre for Epidemiology and Population Health
- The Australia National University
- Canberra
- Australia
| | - Mary Norval
- Biomedical Sciences
- University of Edinburgh
- Edinburgh
- UK
| | - Caradee Y. Wright
- South African Medical Research Council and University of Pretoria
- Pretoria
- South Africa
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Reynolds JW, Pfeiffer ML, Ozgur O, Esmaeli B. Prevalence and Severity of Ocular Surface Neoplasia in African Nations and Need for Early Interventions. J Ophthalmic Vis Res 2016; 11:415-421. [PMID: 27994810 PMCID: PMC5139553 DOI: 10.4103/2008-322x.194139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is a common ocular surface tumor with an increased incidence in African countries (3.4 and 3.0 cases/year/100,000). Despite its potential for vision loss and death, OSSN remains largely neglected by both eye and HIV care programs in Africa. The purpose of this review is to identify the barriers to timely diagnosis and early interventions for OSSN in Africa. PubMed searches were conducted targeting previous use of topical chemotherapy (interferon alpha 2b, Mitomycin-C, 5-Fluorouracil) and Human papillomavirus (HPV) vaccination in Africa. We found that OSSN is a significant vision and life-threatening health problem in Africa leading to significant loss of vision, as well as facial disfigurement and social stigma. We did not find any reports on the use of topical interferon, Mitomycin-C or HPV vaccination for OSSN in Africa. One report on the use of topical 5-FU for OSSN in Africa was found. Common barriers to early detection and management of OSSN in Africa include lack of sufficient laboratory infrastructure, lack of trained healthcare personnel, lack of compliance with follow-up visits, cost of topical chemotherapies, and cultural preferences for traditional medicines. In conclusion, OSSN is a significant vision and life-threatening health problem in Africa. There is not much literature on prevention or treatment options for early stages of OSSN in Africa. The use of topical chemotherapy as early interventions and judicious use of smart phone Apps to help with remote diagnosis of early OSSN should be further explored.
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Affiliation(s)
- Jacob W Reynolds
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margaret L Pfeiffer
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, Texas, USA
| | - Omar Ozgur
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Morphological Spectrum of Orbitoocular Diseases in a Tertiary Health Centre in Keffi, North Central Nigeria. Adv Med 2015; 2015:619414. [PMID: 26576453 PMCID: PMC4630344 DOI: 10.1155/2015/619414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. The aim of this study was to carry out a retrospective clinicopathological analysis of the ocular lesions requiring biopsy seen in the Department of Histopathology, Federal Medical Centre (FMC), Keffi, in North Central Nigeria. Materials and Method. A retrospective review of the clinicopathologic profile of orbitoocular lesions diagnosed at the FMC, Keffi, was done. Clinical and pathological data were obtained from the patients' clinical records and original biopsy reports, respectively. Results. Sixty-six cases of orbitoocular lesions were reviewed for this study. Of the 54 cases investigated, 28 were HIV negative while 26 were HIV positive (37.1% of all cases). There were 30 cases of Ocular Surface Squamous Neoplasia (OSSN) with a male-to-female ratio of 0.9 : 1. Squamous cell carcinoma (SCC) was the most frequent OSSN with 17 cases. The mean age of cases of SCC is 37.1 ± 7.6 SD (years). The mean age of carcinoma in situ is 35.8 ± 11.4 years. Conclusion. There was no significant difference in the sex distribution of patients with OSSN. It is probable that a diagnosis of squamous cell carcinoma may be encountered in about a year after diagnosis of a carcinoma in situ especially if the in situ carcinoma is left untreated or improperly treated.
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Abstract
OBJECTIVES To describe the epidemiology and an aetiological model of ocular surface squamous neoplasia (OSSN) in Africa. METHODS Systematic and non-systematic review methods were used. Incidence was obtained from the International Agency for Research on Cancer. We searched PubMed, EMBASE, Web of Science and the reference lists of articles retrieved. Meta-analyses were conducted using a fixed-effects model for HIV and cigarette smoking and random effects for human papilloma virus (HPV). RESULTS The incidence of OSSN is highest in the Southern Hemisphere (16° South), with the highest age-standardised rate (ASR) reported from Zimbabwe (3.4 and 3.0 cases/year/100 000 population for males and females, respectively). The mean ASR worldwide is 0.18 and 0.08 cases/year/100 000 among males and females, respectively. The risk increases with exposure to direct daylight (2-4 h, OR = 1.7, 95% CI: 1.2-2.4 and ≥5 h OR = 1.8, 95% CI: 1.1-3.1) and outdoor occupations (OR = 1.7, 95% CI: 1.1-2.6). Meta-analysis also shows a strong association with HIV (6 studies: OR = 6.17, 95% CI: 4.83-7.89) and HPV (7 studies: OR = 2.64, 95% CI: 1.27-5.49) but not cigarette smoking (2 studies: OR = 1.40, 95% CI: 0.94-2.09). The effect of atopy, xeroderma pigmentosa and vitamin A deficiency is unclear. CONCLUSIONS Africa has the highest incidence of OSSN in the world, where males and females are equally affected, unlike other continents where male disease predominates. African women probably have increased risk due to their higher prevalence of HIV and HPV infections. As the survival of HIV-infected people increases, and given no evidence that anti-retroviral therapy (ART) reduces the risk of OSSN, the incidence of OSSN may increase in coming years.
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Affiliation(s)
- Stephen Gichuhi
- Department of Ophthalmology, University of NairobiNairobi, Kenya
- London School of Hygiene and Tropical MedicineLondon, UK
| | - Mandeep S Sagoo
- Moorfields Eye HospitalLondon, UK
- UCL Institute of Ophthalmology, University College LondonUK
| | - Helen A Weiss
- London School of Hygiene and Tropical MedicineLondon, UK
| | - Matthew J Burton
- London School of Hygiene and Tropical MedicineLondon, UK
- Moorfields Eye HospitalLondon, UK
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Steffen J, Rice J, Lecuona K, Carrara H. Identification of ocular surface squamous neoplasia by in vivo staining with methylene blue. Br J Ophthalmol 2013; 98:13-5. [PMID: 24158840 DOI: 10.1136/bjophthalmol-2013-303956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the diagnostic accuracy of methylene blue used as a non-invasive in vivo stain to detect ocular surface squamous neoplasia (OSSN). METHODS A test validation study was performed according to Standards for the reporting of diagnostic accuracy studies (STARD) guidelines on 75 consecutive patients who presented with ocular surface lesions suspicious of OSSN. Methylene blue 1% was instilled in vivo following local anaesthetic. Stain results were documented photographically and read by an independent observer. Lesions were excised at the same visit and evaluated histologically by pathologists who were blind to the stain results. Sensitivity, specificity, positive and negative predictive values were determined. RESULTS Thirty-three patients had histologically malignant lesions, of which 32 stained with methylene blue, and 42 patients had benign or premalignant lesions, of which 21 stained with methylene blue. Methylene blue had a sensitivity of 97%, specificity of 50% and positive and negative predictive values of 60% and 96%, respectively. CONCLUSIONS The topical application of methylene blue is a simple, inexpensive, non-invasive diagnostic test that can be helpful in excluding malignant ocular surface lesions but cannot replace histology as gold standard for diagnosis of OSSN.
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Affiliation(s)
- Jonel Steffen
- Division of Ophthalmology, University of Cape Town, , Cape Town, Western Cape, South Africa
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Tiong T, Borooah S, Msosa J, Dean W, Smith C, Kambewa E, Kiire C, Zondervan M, Aspinall P, Dhillon B. Clinicopathological review of ocular surface squamous neoplasia in Malawi. Br J Ophthalmol 2013; 97:961-4. [DOI: 10.1136/bjophthalmol-2012-302533] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kao AA, Galor A, Karp CL, Abdelaziz A, Feuer WJ, Dubovy SR. Clinicopathologic correlation of ocular surface squamous neoplasms at Bascom Palmer Eye Institute: 2001 to 2010. Ophthalmology 2012; 119:1773-6. [PMID: 22771047 DOI: 10.1016/j.ophtha.2012.02.049] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/24/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To describe the clinical and histologic characteristics of ocular surface squamous neoplasia (OSSN) lesions and provide clinicopathologic correlation to determine clinical features that may indicate higher-grade lesions. DESIGN Retrospective case series. PARTICIPANTS A total of 612 consecutive OSSN lesions sent to the Bascom Palmer ocular pathology laboratory from January 1, 2001 to September 20, 2010. METHODS Pathologic examination of lesions by a single experienced ocular pathologist (S.R.D.). Review of pathology records and patient charts. MAIN OUTCOME MEASURES Correlation of clinical factors and histology of higher-grade OSSN. RESULTS Over the studied period, 33% of submitted specimens were characterized as mild, moderate, or severe dysplasia; 52% were classified as carcinoma in situ; and 11% were graded as squamous cell carcinoma. Characteristics associated with higher-grade OSSN lesions included male gender, biopsy at Bascom Palmer Eye Institute, temporal and superior locations, lack of corneal involvement, papillomatous and nodular appearance, microscopic multifocality, and positive margins on biopsy. CONCLUSIONS Certain clinical factors are associated with higher-grade histologic lesions. These findings may help clinicians more accurately evaluate and anticipate the pathologic grade of conjunctival and corneal lesions suspected to be OSSN.
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Affiliation(s)
- Andrew A Kao
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Florida, USA
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Galor A, Karp CL, Oellers P, Kao AA, Abdelaziz A, Feuer W, Dubovy SR. Predictors of ocular surface squamous neoplasia recurrence after excisional surgery. Ophthalmology 2012; 119:1974-81. [PMID: 22704832 DOI: 10.1016/j.ophtha.2012.04.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/07/2012] [Accepted: 04/19/2012] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To identify predictors of ocular surface squamous neoplasm (OSSN) recurrence after operative resection. DESIGN Retrospective case series. PARTICIPANTS Three hundred eighty-nine consecutive patients who underwent excisional biopsy for OSSN lesions at the Bascom Palmer Eye Institute from January 1, 2001, to September 20, 2010. METHODS Review of pathology records and patient charts. MAIN OUTCOME MEASURES Identification of factors predictive of OSSN recurrence. RESULTS Of 389 excised OSSN lesions, 44 recurred during follow-up. The 1-year recurrence rate was 10% and the 5-year recurrence rate was 21%, with a mean time to recurrence in those with a recurrence of 2.5 years (standard deviation, 3.4). Using the American Joint Committee on Cancer (AJCC) clinical staging system, T3 and T2 lesions portended a higher risk of recurrence compared with T1 (T2/T1 hazard ratio [HR], 2.05 [P = 0.04]; T3/T1 HR, 2.31 [P = 0.07]). In addition, a location characteristic that increased the risk of tumor recurrence was tarsal involvement (AJCC T3 stage lesion; HR, 4.12; P = 0.007). Nasal location was associated with a decreased risk of tumor recurrence (HR, 0.41; P = 0.008). Pathologic characteristics significantly associated with tumor recurrence were the presence of positive margins (HR, 2.73; P = 0.008) and higher grade lesions (carcinoma in situ and squamous cell carcinoma versus dysplasia; HR, 2.55; P = 0.02). Treatment with adjuvant cryotherapy significantly decreased the risk of tumor recurrence (HR, 0.51; P = 0.03). In those patients with positive margins, the use of postoperative topical interferon therapy lowered the recurrence rate to a level similar to that of patients with negative margins. CONCLUSIONS Certain patient and tumor factors are associated with a higher risk of OSSN recurrence after operative excision, such as tarsal tumor location and positive surgical margins. Postoperative adjuvant therapy should be considered in patients with high-risk OSSN characteristics.
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Affiliation(s)
- Anat Galor
- Miami Veteran Affairs Medical Center, Miami, Florida, USA
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Furahini G, Lewallen S. Conjunctival Squamous Cell Carcinoma. Ophthalmology 2010; 117:1458; author reply 1458. [DOI: 10.1016/j.ophtha.2010.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 03/03/2010] [Indexed: 11/25/2022] Open
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Karcioglu ZA, Wagoner MD. Author reply. Ophthalmology 2010. [DOI: 10.1016/j.ophtha.2010.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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