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

Abstract

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

Keywords

• dysplasia
• histopathology
• impression cytology
• mitomycin c
• ossn
• shield’s no touch technique
• squamous cell carcinoma