Neoadjuvant chemotherapy for invasive squamous cell carcinoma of the conjunctiva: A case report

A 40-year-old male presented with an orbital extension of conjunctival squamous cell carcinoma (SCC). The orbital mass was seen protruding outward from the left palpebral fissure overhanging the lower eyelid, completely obscuring the globe and lower lid. The patient gave a history of excision biopsy, which was histopathologically diagnosed as ocular surface squamous neoplasia. He also gave a history of tumor recurrence, which gradually progressed to assume the form of the presently visible orbital mass. Computed tomography of the orbits showed the mass extending into the left orbit causing superior displacement of the globe. After a negative locoregional and systemic metastatic screening, neoadjuvant intravenous systemic chemotherapy with cisplatin and 5-fluorouracil were initiated in an attempt to reduce the size of the tumor. Three cycles of tri-weekly chemotherapy resulted in a significant reduction of the orbital tumor size with the globe and the lower lid being visible, thus making a lid-sparing orbital exenteration possible. The patient subsequently underwent an orbital exenteration and at 6-month follow-up, the patient was free from local and regional disease. To our knowledge, this is the first reported case where systemic neoadjuvant chemotherapy has been used to reduce the size of invasive SCC with orbital extension, thereby permitting a lid-sparing orbital exenteration.     

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

AIM—To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva.
METHODS—Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement.
RESULTS—Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18-226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths.
CONCLUSION—Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

Keywords: squamous cell carcinoma; conjunctiva     

Squamous cell carcinoma of the conjunctiva. Value of exfoliative cytology in diagnosis

Cytologic examination is of potential value to the practicing ophthalmologist in confirming the clinical impression of cancer of the eye. Scrapings of conjunctival lesions can be prepared in the office, stained with Giemsa stain and rapidly examined. Carcinoma in situ and squamous cell carcinoma of the bulbar conjunctiva were presented as illustrations of the usefulness of exfoliative cytology in clinical ophthalmology.     

Characteristics, management, and outcome of squamous carcinoma of the conjunctiva in a single tertiary cancer center in Jordan

AIM: To evaluate the features and outcome of management of malignant conjunctival squamous tumors in King Hussein Cancer Center (a referral tertiary cancer center in the Middle East). METHODS: Retrospective case series of 31 eyes for 31 patients with conjunctival squamous neoplasia. Main outcome measures included: age, gender, laterality, tumor location, pathological features, tumor stage, treatment modality, and outcome. RESULTS: Twenty (65%) patients were males and median age was 58y. Twenty-two (71%) eyes had the tumor in the nasal quadrant. Tumor invasion to nearby structures was seen in 19 (61%) eyes, including the cornea, fornix, eyelid, and orbit in 17 (55%), 1 (3%), 2 (6%), and 3 (10%) eyes, respectively. Eye salvage was achieved by surgical excision with cryotherapy followed by topical chemotherapy in 28 (90%) eyes, and orbital exenteration was necessary in 3 (10%) eyes due to orbital tumor invasion. Tumor recurrence was seen in 7 (23%) eyes, and the significant predictive factors for recurrence were tumor extension onto the nearby structures (P=0.04), tumor invasiveness (P=0.038), and tumor TNM stage (P=0.031). No significant change in visual acuity was seen, and disease related mortality was 6% (2 patients, both had orbital invasion by invasive squamous carcinoma). CONCLUSION: Conjunctival squamous carcinoma is more common in males. Advanced American Joint Committee on Cancer (AJCC) T-stage, tumor local invasion, more pathologically aggressive tumors, and surgical treatment alone (without adjuvant therapy) are associated with higher risk for recurrence, and orbital invasion is the most important poor prognostic factor for metastasis and death. Treatment strategies should be affected by tumor characteristics at presentation.     

A 3‐year follow‐up study on the risk of stroke among patients with conjunctival haemorrhage

Purpose: To the best of our knowledge, no large population‐based studies on the relationship between conjunctival haemorrhage and stroke have been conducted to date. Using a nationwide population‐based data set, this study investigated the relationship between conjunctival haemorrhage and the subsequent risk of stroke within a 3‐year period following diagnosis. Methods: We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2000. The study cohort consisted of 17 349 patients with conjunctival haemorrhage and 86 745 comparison subjects. Each patient was individually tracked for a 3‐year period from their index date to identify all those who had subsequently received a diagnosis of stroke. Results: The incidence rate of stroke was 2.44 (95% CI = 2.31–2.55) per 100 person‐years in patients with conjunctival haemorrhage and 1.63 (95% CI = 1.59–1.68) per 100 person‐years in comparison patients. After adjusting for patients’ monthly income and geographic location, as well as for hypertension, atrial fibrillation, diabetes, hyperlipidaemia and coronary heart disease, stratified Cox proportional hazards regressions revealed a statistically significant hazard ratio for stroke in patients with conjunctival haemorrhage (HR = 1.33; 95% CI = 1.24–1.42, p < 0.001). Conclusions: In this study, patients with conjunctival haemorrhage were found to be at a significant risk of stroke during a 3‐year follow‐up period after diagnosis.     

Squamous cell carcinoma of the conjunctiva. Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction.

Squamous cell carcinoma of the conjunctiva is a distinct rarity, often arising at the corneoscleral limbus and initially resembling pterygium or chronic keratoconjunctivitis. In this paper we report 4 patients with conjunctival squamous cell carcinoma/carcinoma in situ, which comprise all the cases found in the files of Kuopio University Hospital during 1959-1991. The clinical appearance, diagnosis and treatment of the lesions are described. All biopsies were studied for the presence of Human papillomavirus (HPV) DNA (recently demonstrated in conjunctival squamous cell papillomas, precancer lesions and carcinomas) by using in situ DNA hybridization (ISH) and polymerase chain reaction (PCR). Both techniques failed to demonstrate the DNA of any of the following HPV types: HPV 6, 11, 16 and 18 in any of the lesions. The results are discussed in the light of the recently proposed HPV etiology of these lesions.     

Spindle cell carcinoma of the conjunctiva. An immunohistochemical and ultrastructural study of six cases.

Six cases of conjunctival spindle cell carcinoma, a rare variant of squamous cell carcinoma, were studied. The median age of the three men and three women was 63.5 years. The tumors appeared as a single nodule in some patients or diffusely involved the conjunctiva in others. Two of the four individuals with intraocular extension presented with phthisis bulbi. Polyclonal antikeratin antibody was helpful and gave the most consistent results when compared with monoclonal antikeratin antibodies, AE1/3 and PKK1. The electron microscopic study of four lesions also established the epithelial nature of the tumor cells. Intracytoplasmic tonofilaments and a few desmosomes were present. Histopathologically, this variant of squamous cell carcinoma is difficult to distinguish from other spindle cell tumors, and this study demonstrates the value of immunohistochemistry and electron microscopy in supporting the correct diagnosis.     

Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi.

The histological features of 234 conjunctival biopsies from Africans in Malawi have been re-examined. The appearances of solar keratosis, pinguecula, and pterygium are presented as part of a continuous spectrum of the same pathological process and aetiology, which may lead to carcinomatous change. The results are discussed with regard to the specific geographical distribution of such lesions found by other workers, with particular emphasis on ultraviolet radiation as the main aetiological factor.     

Mucoepidermoid carcinoma of the palpebral mucocutaneous junction. A clinical, light microscopic and electron microscopic study of an unusual tubular variant

An 81-year-old man developed a left lower lid lesion. The lid margin was red, thickened, and indurated with foci of ulceration and telangiectasia on the palpebral conjunctiva. The initial clinical impression was either a chalazion or sebaceous carcinoma, and an incisional biopsy was performed. By light and electron microscopy, the tumor demonstrated infiltrating cords of cells with an admixture of epidermoid and mucus-secreting elements arranged in a distinctive elongated tubular fashion. The involved lid was resected and reconstructed by a Hughes' tarso-conjunctival graft with marsupialization of the canaliculus. No recurrence has been encountered after a year. Mucoepidermoid carcinoma of the conjunctiva is a rare, locally aggressive neoplasm characterized in all seven previously reported cases by recurrence within 6 months, and a high incidence of intraocular or orbital invasion.     

单纯胬肉切除、角膜缘干细胞移植与带蒂结膜瓣移植治疗翼状胬肉疗效比较

目的比较单纯胬肉切除、角膜缘干细胞移植及带蒂结膜瓣移植术治疗翼状胬肉的疗效，探讨降低术后复发率的方法。方法667例（718眼）翼状胬肉，采用上述三种术式治疗，术后随访5～20个月观察胬肉复发情况。结果单纯胬肉切除术组62例（62眼），6眼胬肉复发，复发率为9．68％。联合角膜缘干细胞移植术组430例（462眼），3眼复发，复发率0．65％。联合带蒂结膜瓣移植术组175例（194眼），2眼复发，复发率1．03％。单纯切除组与其他两组复发率之间差异具有统计学意义（P〈0．01）。联合角膜缘干细胞移植组与联合带蒂结膜瓣移植组之间差异不具有统计学意义（P〉0．05）。结论胬肉切除联合角膜缘干细胞移植术治疗翼状胬肉其复发率与联合带蒂结膜瓣移植术相比无明显优势。两者术后复发率均明显低于单纯胬肉切除术。     

干眼角膜上皮损伤患者患病率和危险因素的回顾性研究

目的：探究干眼角膜上皮损伤患者的流行病学特征及相关危险因素。方法：回顾2018-07/2019-06期间就诊于北京大学第三医院的干眼角膜上皮损伤患者的门诊病历,对患者性别、年龄、就诊日期、合并症以及同一时期的气象指标进行统计学分析。结果：回顾性分析291名干眼角膜上皮损伤患者,其中有75.3%为女性。21-30岁的青年患者占比最大(26.5%),青少年(&#x0026;#x003C;18岁,5.8%)和老年人(≥61岁,17.2%)较少。然而,中青年患者虽然占比较大,其平均就诊次数较少(5.4±12.4)。春季和冬季是最主要的就诊季节。分析表明,PM10、二氧化硫(SO2)、二氧化氮(NO2)、以及较低的平均相对湿度与干眼角膜上皮损伤显著相关(P&#x0026;#x003C;0.05)。结膜炎、白内障、视物模糊以及倒睫是排名前四位的合并症。结论：女性、青年人群干眼角膜上皮损伤问题不容忽视。PM10、SO2、NO2和空气湿度降低与干眼角膜上皮损伤显著相关。对于合并有结膜炎、白内障、视物模糊以及倒睫的干眼患者,更应关注其角膜状况。     

A five-year retrospective study of the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in a Mediterranean area

Background  

To determine the epidemiological characteristics and visual outcome of ocular trauma in southern Italy.     

柔红霉素对人晶体上皮细胞生长抑制和角膜内皮细胞毒性试验研究

目的：研究柔红霉素对体外培养人晶体上皮细胞增殖的抑制作用和对角膜内皮细胞的毒性,探索使用柔红霉素预防后发障的适宜浓度,方法：第三代人晶 皮细胞接种于24孔培养板内,24h后加入不同浓度柔红霉素作用10min后,吸出药物并冲洗后再培养48h,细胞计数,原代培养角加入膜内皮细胞,加入不同浓度柔红霉素作用10min,观察细胞生长形态学变化,结果：柔红霉素依浓度梯度抑制晶体上皮细胞增殖,其LD50为4．9ug/ml,10ug/ml以下浓度对角膜内皮细胞无损害,结论：柔红霉素有可能作为预防后发障的辅助药物之一,选择适宜浓度是防止其对其他组织产生毒性的关键。     

A multicentre,double‐masked,randomized, controlled trial assessing the effect of oral supplementation of omega‐3 and omega‐6 fatty acids on a conjunctival inflammatory marker in dry eye patients

Purpose: To determine whether oral supplementation with omega‐3 and omega‐6 fatty acids can reduce conjunctival epithelium expression of the inflammatory marker human leucocyte antigen‐DR (HLA‐DR) in patients with dry eye syndrome (DES). Methods: This 3‐month, double‐masked, parallel‐group, controlled study was conducted in nine centres, in France and Italy. Eligible adult patients with mild to moderate DES were randomized to receive a placebo containing medium‐chain triglycerides or treatment supplement containing omega‐3 and omega‐6 fatty acids, vitamins and zinc. Treatment regimen was three capsules daily. Impression cytology (IC) was performed at baseline and at month 3 to assess the percentage of cells expressing HLA‐DR and to evaluate fluorescence intensity, an alternate measure of HLA‐DR. Dry eye symptoms and objective signs were also evaluated. Analyses were performed on the full analysis set (FAS) and per‐protocol set (PPS). Results: In total, 138 patients were randomized; 121 patients with available IC were included in the FAS, and of these, 106 patients had no major protocol deviations (PPS). In the PPS, there was a significant reduction in the percentage of HLA‐DR‐positive cells in the fatty acids group (p = 0.021). Expression of HLA‐DR as measured by fluorescence intensity quantification was also significantly reduced in the fatty acids group [FAS (p = 0.041); PPS (p = 0.017)]. No significant difference was found for the signs and symptoms, but there was a tendency for improvement in patients receiving the fatty acids treatment. Conclusion: This study demonstrates that supplementation with omega‐3 and omega‐6 fatty acids can reduce expression of HLA‐DR conjunctival inflammatory marker and may help improve DES symptoms.     

Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients.

PURPOSE: To analyze the predisposing factors for the development of endogenous fungal endophthalmitis (EFE) for its early diagnosis and treatment. SUBJECTS AND METHODS: Seventy-nine eyes of 46 patients with EFE treated in the 12-year period between 1986 and 1998 were included. A retrospective analysis was conducted in respect to age, sex, underlying disease, visual acuity, findings in the anterior and posterior segments, fungal culture of surgical specimens, fever of unknown origin, neutrophils < or = 500/mL, Cand-tec > or = x 4, beta-D-glucan > or = 20 pg, and final visual acuity. RESULTS: The patients were 34 men (74%) and 12 women (26%) between 18 and 78 years of age (mean 57.2 years). Thirty-three of the 46 patients (72%) also were diagnosed with cancer. Fungal infiltration limited to the retina (Stage I) was noted in 13%, budding in the vitreous cavity (Stage II) in 40%, vitreous opacity (Stage III) in 29%, and retinal detachment with Stage III (Stage IV) in 18% of 79 eyes with EFE. Forty patients (87%) were undergoing intravenous hyperalimentation (IVH). The mean interval between the start of IVH and the onset of disease was 11 days. Vitreous surgery was performed in 26 eyes (33%). Candida albicans was detected from surgical specimens in 38%. Fever of unknown origin was noted in 76%, neutrophils < or = 500/mL in 67%, Cand-tec > or = x 4 in 57%, and beta-D-glucan > or = 20 pg in 90% of subjects. CONCLUSION: In patients susceptible to opportunistic infection, beta-D-glucan > or = 20 pg (90%), IVH (87%), fever of unknown origin (76%), male sex (74%), the presence of cancer (72%), neutrophils < or = 500/mL (67%), and Cand-tec > or = x 4 (57%) were considered to be predisposing factors for the development of EFE.     

The effect of diet on the ophthalmological,clinical and biochemical aspects of Richner-Hanhart syndrome: A morphological ultrastructural study of the cornea and the conjunctiva

Type II tyrosinemia (Richner-Hanhart syndrome) is a familial aminoacid disorder, clinically characterized by ocular changes (keratitis), palmo-plantar hyperkeratosis, no constant mental changes with mental deterioration, abnormal urinary excretion and high serum tyrosine level in consequence of the absence of tyrosine-aminotransferase. Almost 20 families have been described in the literature of which 50% are of Italian origin, suggesting that this disorder is particularly frequent in our country.We report a family with 2 affected members with typical clinical and biochemical findings (keratitis, palmo-plantar hyperkeratosis, abnormal urinary and serum tyrosine concentrations), not suffering from mental retardation. Clinical symptoms completely disappeared after the decrease of urinary and serum tyrosine levels following a tyrosine- and phenylalanine-free diet. These cases are compared with those reported in literature, and the usefulness of diet for the improvement of clinical and metabolic symptoms is discussed.     

Tonography, Valsalva manoeuvre and central visual fields. A study of 429 patients

Four hundred and twenty nine patients (846 eyes) referred to the glaucoma clinic at Concord Hospital between 1979 and 1989, were included in a prospective study. This study investigated the circulatory status of each eye during tonography, by using a modified Valsalva manoeuvre to induce changes in intraocular pressure (IOP) and amplitude of tonography pulse pressure (TPP). Of the large falls in IOP, 85% of the eyes had a Po/C > 150. The average IOP without medication, on the morning of the test, was 20 mmHg (2.67 kPa). Central visual field defects were found in 495 eyes, and these were far more prevalent in the Po/C> 150 category. An unexpected finding was the ratio of 67:33 right to left eyes in the Po/C < 100 category. The commonest reasons for referral were intermittent rises of IOP, suspicious optic disc cupping, and the need to confirm a previously made diagnosis.