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Abstract

Spectrum Of Ocular Surface Squamous Neoplasia – A prospective study

Introduction: Introduction: The corneal epithelial stem cells located at the basal layer of the limbal epithelia proliferate continuously and give rise to the superficial layer that subsequently differentiate into superficial cells. Regulation of cell growth and metabolism are critical to maintain an intact ocular surface and transparent cornea. Primary tumors of the conjunctiva and cornea can be grouped into two major categories: congenital and acquired. The acquired lesions are composed of a variety of neoplasms which originate from squamous epithelia, melanocytes, and lymphocyte cells. Tumors of squamous epithelium occupy a large spectrum of lesions, ranging from benign lesions like squamous papilloma, to precancerous lesions which are confined to the surface epithelium (intraepithelial neoplasia or dysplasia, previously known as Bowen’s disease). There are even more invasive squamous cell carcinomas that break through the basement membrane to the underlying substantriapropia of the conjunctiva or corneal stroma. Methods: The study aim to include 50 eyes of 50 patients with biopsy-proven ocular surface neoplasia at C.H. Nagri Eye Hospital, Ahmedabad. The details of patients were taken regarding Age, Gender, Laterality and Risk factors. Each patient was assessed bio microscopically for type and complications of ocular surface neoplasia. Results: A clinical case series was conducted on 50 eyes of 50 patients who are histhopathologically diagnosed as ocular surface squamous neoplasia at a tertiary care eye hospital. Out of the 50 patients, there were 28 females and 22 males, with mean age being 51.70 ± 10.84 Years. Conclusion: Ocular Surface Squamous Neoplasia is a spectrum of diseases ranging from simple Dysplasia to Invasive carcinoma. This lesion is considered a low grade malignancy, but its invasive counterpart can spread to the globe or orbit. It is the most common ocular surface tumor.OSSN was commonly seen in elderly female patient (56%). The main risk factor was UV-B exposure (42%). However we couldn’t find any risk factors in many patients. This might happened because it was not possible to use certain higher diagnostic tools in lower socio-economical patients. Most of the patients presented without any symptoms. Clinically, these tumors most commonly arise in the interpalpebral area, particularly at the limbal region in the temporal quadrant. Morphologically Gelatinous (56%) and leukoplakic (30%) were the most common types to be present. In clinical practice, OSSN is generally evaluated by Histopathological examination. invasive forms (42%)were commonly seen, this might be related to ignorance of the patient. Surgical excision adjunct with Cry therapy combined with alcohol abrasion in cases of corneal involvement are the main treatment strategy. Recurrence rates were found higher for more severe grades of OSSN. Topical chemotherapy such as MMC may reduce the recurrence rate, but incomplete excision still remains the main reason for recurrence. Invasive disease may cause intraocular or orbital involvement with eye loss. Recurrence after initial treatment is variable and warrants life-long follow-up in all case of OSSN. Keywords: Ocular spectrum; UV exposure; Gelatinous; Cryotherapy; Limbus


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