眼球表面鳞状细胞肿瘤107例临床分析

为探讨眼球表面鳞状细胞肿瘤（Ｏｃｕｌａｒｓｕｒｆａｃｅｓｑｕａｍｏｕｓｎｅｏｐｌａｓｉａ，ＯＳＳＮ）的分型及临床特点。对赞比亚恩多拉中心医院眼科门诊１０７例眼球表面鳞状细胞肿瘤进行回顾性分析。结果：在１０７例眼球表面鳞状细胞肿瘤中，结角膜上皮内肿瘤（Ｃｏｎｊｕｎｃｔｉｖａｌａｎｄｃｏｒｎｅａｌｉｎｔｒａｅｐｉｔｈｅｌｉａｌｎｅｏｐｌａｓｉａ，ＣＩＮ）５３例，鳞状细胞癌（Ｓｑｕａｍｏｕｓｃｅｌｃａｒｃｉｎｏｍａ，ＳＣＣ）５４例，在ＣＩＮ中，非典型增生（Ｄｙｓｐｌａｓｉａ）４４例，原位癌（Ｃａｒｃｉｎｏｍａｉｎｓｉｔｕ）９例，在ＳＣＣ中，４例侵犯眼球或眼眶。患者多为年轻人，年龄最小１４岁，最大６２岁，平均年龄ＣＩＮ为３４岁，ＳＣＣ为３６岁。女性略多于男性，病变多为早期，较少侵犯眼内。结论：该肿瘤为赞比亚常见眼病，年轻患者多，紫外线照射和感染可能是其主要发病因素；早期诊断、早期手术是治疗本病的关键     

Retrospective study of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) encompasses the conditions of simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma. It has a high rate of recurrence after treatment and the potential to metastasize. The present retrospective study was aimed at further defining the characteristics and clinical course of OSSN.
Methods: With ethical approval, the records of all major pathology laboratories in Queensland were surveyed. Two hundred and eighty-eight cases were identified: 155 dysplasia, 71 carcinomas in situ and 62 invasive squamous cell carcinoma. The records were analysed and an attempt was made to contact and re-examine the patients.
Results: Ocular surface squamous neoplasia occurs mainly in males (78.5%) with a mean age of 60.1 years (range 20–88 years). They present as irritation (40.1%) and are located usually at the limbus (87.8%). The majority of OSSN are treated by simple excision (87.5%), after which there is a high rate of recurrence (23.3%). The main predictors for recurrence include histological grade of the lesion, corneal location and larger size (> 2 mm).
Conclusions: Management of OSSN requires adequate excision and careful follow up to monitor any recurrence. As with other ultraviolet light-related conditions, preventative measures must remain the key to disease control.     

眼表鳞状上皮瘤研究进展

眼表鳞状上皮瘤(OSSN)是临床上少见的眼表肿瘤,由于其发病率低,且易与翼状胬肉等混淆,给诊断造成困难。近年来,各种诊断技术的提高,以及干扰素(interferon,IFN)广泛应用于OSSN治疗,大幅度降低复发率,OSSN诊断治疗手段趋于多样化。了解当前OSSN发病原因以及治疗方式,可以更好地指导OSSN研究。     

Electron beam radiotherapy for the management of recurrent extensive ocular surface squamous neoplasia with orbital extension

Recurrent extensive ocular surface squamous neoplasia (OSSN) with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 5040 cGy radiotherapy (15eV electrons) resulting in complete disease regression. At the end of 3 years follow-up, the patient was disease free, maintained a vision of 20/25, with mild dry eye, well-managed with topical lubricants. Extensive OSSN with orbital invasion does not always need exenteration. External beam electron radiotherapy provides a noninvasive cure with organ and vision salvage and should be considered in extensive OSSN not amenable to simple excision biopsies. Long-term studies to evaluate the effect of radiation on such eyes are suggested.     

眼表鳞状细胞瘤局部药物治疗进展

眼表鳞状细胞瘤（ocular surface squamous neoplasia,OSSN）是眼科常见的眼表肿瘤,眼局部药物治疗具有非侵入性、创伤小的优点,有逐渐取代手术切除成为其首选治疗方式的趋势。目前局部药物除采用抗代谢、抗肿瘤、免疫调节作用的药物（丝裂霉素C、5-氟尿嘧啶、干扰素 α2b、维甲酸等）外,一些抗肿瘤血管及病因治疗的药物（抗血管内皮生长因子类药物、西多福韦等）也被用于OSSN临床治疗研究中。（国际眼科纵览,2020, 45： 380-386）     

Pseudoepitheliomatous hyperplasia mimicking ocular surface squamous neoplasia following cultivated limbal epithelium transplantation

A 12-year-old girl with total limbal stem cell deficiency in the right eye following chemical burns underwent autologous cultivated limbal epithelium transplantation from the healthy left eye. Postoperatively at 6 weeks a mass at the limbus was noted, which increased in size and involved infero-nasal limbus extending over 5 mm on bulbar conjunctiva. It was a gelatinous, placoid freely movable mass with irregular surface, multiple intralesional cysts without feeder vessels or intrinsic vascularization and stained brilliantly with rose bengal. Histopathology following excision biopsy showed hyperplastic epithelium with stratified columnar cells and goblet cells. At the last follow-up, 6 months following cultivated limbal epithelium transplantation the ocular surface was stable without any recurrence of the lesion. We herein report a rare complication of epithelial hyperplasia presenting as leukoplakia following cultivated limbal epithelium transplantation mimicking ocular surface squamous neoplasia.     

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia

To evaluate the outcome of amniotic membrane transplantation (AMT) after tumor excision followed by topical interferon alfa-2b (IFNα2b) drops for primary ocular surface squamous neoplasia (OSSN). Twelve eyes of 12 patients with a mean age of 66±10y were included. The average follow-up was 23±10mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2b drops restores a healthy ocular surface in OSSN without recurrence.     

Amniotic membrane transplantation for ocular surface reconstruction

AIMS: To evaluate the efficacy of amniotic membrane transplantation (AMT) for ocular surface reconstruction. METHODS: 10 consecutive patients who underwent AMT were included. The indications were: group A, cases with persistent epithelial defect after corneal abscess (n = 1), radiation (n = 1), or chemical burn (n = 3); group B, cases with epithelial defect and severe stromal thinning and impending or recent perforation, due to chemical burn (two patients, three eyes) or corneal abscess (n = 2); group C, to promote corneal epithelium healing and prevent scarring after symblepharon surgery with extensive corneo-conjunctival adhesion (n = 1). Under sterile conditions amniotic membrane was prepared from a fresh placenta of a seronegative pregnant woman and stored at -70 degrees C. This technique involved the use of amniotic membrane to cover the entire cornea and perilimbal area in groups A and B, and the epithelial defect only in group C. RESULTS: The cornea healed satisfactorily in four of five patients in group A, but the epithelial defect recurred in one of these patients. After AMT three patients underwent limbal transplantation and one penetrating keratoplasty and cataract extraction. In group B amniotic membrane transplantation was not helpful, and all cases underwent an urgent tectonic corneal graft. Surgery successfully released the symblepharon, promoted epithelialisation and prevented adhesions in the case of group C. CONCLUSION: AMT was effective to promote corneal healing in patients with persistent epithelial defect, and appeared to be helpful after surgery to release corneo-conjunctival adhesion. Most cases required further surgery for visual and ocular surface rehabilitation. Amniotic membrane used as a patch was not effective to prevent tectonic corneal graft in cases with severe stromal thinning and impending or recent perforation.     

Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes

BACKGROUND: The amniotic membrane is a useful tool in the management of several ocular surface diseases. Despite numerous studies, standardization of the use of the membrane and of outcome measures is lacking. Herein, the authors' results of amniotic membrane transplantation (AMT) in ocular surface reconstruction against defined outcome measures are reported. METHODS: A retrospective case study of 74 consecutive procedures (58 patients) performed against predefined outcome measures. The cases were divided into three groups. Group A AMT in the presence of stem cell loss (32 procedures), Group B AMT without stem cell loss (24 procedures) and Group C AMT for conjunctival reconstruction (18 procedures). The outcomes were evaluated against defined criteria based on the purpose (patch or graft) and objective for use of the membrane. Results were analysed by defining the outcomes as success, partial success or failure. RESULTS: Unequivocal success of the procedure was observed in 22% in Group A, 62.5% in Group B and 50% in Group C. AMT was significantly more successful in the presence of functioning stem cells (P = 0.01). In Group A acute and subacute cases (less than 3 months) needed more procedures compared with chronic cases (P = 0.02). In Group C, results were comparatively worse when AMT was used in progressive cicatrizing conditions. CONCLUSION: Use of AMT can be associated with a significant number of failures. It provides a useful alternative for specific indications where its use should be encouraged. It is important to define criteria for success in order to accurately evaluate efficacy.     

糖尿病眼表病变的临床分析

目的:观察和分析糖尿病患者眼表受损害的情况。方法:对40例(80眼)糖尿病住院患者和25例(50眼)无糖尿病者(年龄匹配)做眼表检查,包括泪膜破裂时间(tear breaku time,BUT),泪液分泌试验(SchirmerⅠtest),角膜荧光素染色,结膜印迹细胞学检查。结果:糖尿病组有82%的患者主诉眼干涩和异物感,对照组为44%;糖尿病组和对照组的BUT分别为4.49±1.95s和6.76±4.11s(t检验,P=0.000)。糖尿病组的SchirmerⅠ试验值为4.48±2.68mm,明显低于对照组6.28±3.65mm(t检验,P=0.003)。Schirmer值<5mm者,糖尿病组占65%,对照组占30%(χ2=15.09,P=0.000)。角膜荧光素染色:糖尿病组阳性率为56%,对照组为26%(χ2=11.39,P=0.001)。糖尿病组的杯状细胞数明显少于对照组(P=0.000)。结论:糖尿病也容易引起患者的眼表损害,会诊时应该予以重视。     

2型糖尿病角膜知觉减退及其与眼表异常的相关性研究

目的 探讨2型糖尿病患者角膜知觉减退及其与眼表异常的相关性.方法 采用前瞻性病例对照研究.采用Cochet-Bonnet角膜知觉测量仪分别测定并比较38例（68眼）2型糖尿病患者（糖尿病组）和33例（57眼）无糖尿病患者（对照组）中央角膜知觉,同时对糖尿病患者行泪膜破裂时间测定（break up time,BUT）、基础泪液分泌试验（Schiemer Ⅰ）及角膜荧光素染色.对角膜知觉与后三者进行相关性研究.结果 糖尿病组角膜知觉为（36.07±14.26）mm,对照组为（52.98±3.89）mm,两者差异有显著性（P＜0.01）.糖尿病患者Schirmer Ⅰ试验平均值为（12.41±3.22）mm,BUT值平均为（8.82±2.70）s,角膜荧光素染色累积分平均值为（3.94±1.66）分.糖尿病患者角膜知觉与泪膜破裂时间（r=0.330,P=0.006）、角膜荧光素染色（r=-O.342,P=0.004）有相关关系,与泪液分泌量无相关关系（P=0.538）.结论 糖尿病患者角膜知觉明显减退,而角膜知觉减退是影响角膜上皮病变、干眼症等眼表疾病的因素之一.     

Surgical Management of Double-Head Pterygium Using a Modified Split-Conjunctival Autograft Technique

Aim: To describe a modified split–conjuctival autograft technique for double–head pterygium and evaluate the postoperative outcomes. Methods: A retrospective analysis of all patients who underwent split-conjunctival autograft surgery for double–head pterygium from November 2012 to March 2014. Conjunctival autograft was split vertically, in order to obtain limbal sides of cojunctival autograft for both sides. No adjunctive agent was used. Records of included patients were reviewed and outcomes and recurrence rates were noted. Results: Eight cases of double–head pterygia were noted in 158 total cases of pterygia evaluated (5%). The baseline characteristics included 2 female and 6 male with an age between 26 and 71 (average 42.63) years. All eyes had 12–month follow–ups in average (6–21 months). No intraoperative or postoperative complications were noted. No recurrence was observed. Conclusion: A modified, vertical–split conjunctival autograft without any adjunctive agents is a successful and safe technique in management of double–head pterygium.     

Pegylated Interferon Alpha 2b for Treatment of Ocular Surface Squamous Neoplasia: A Pilot Study

Purpose: To conduct a pilot study of pegylated interferon alpha 2b (PEGIFNα2b) for treatment of ocular surface squamous neoplasia (OSSN).

Methods: Three patients with histologically proven OSSN were studied prospectively. Patients were given subconjunctival/perilesional injections of 1?μg/kg of PEGIFNα2b (PEG Intron, Schering-Plough, Kenilworth, NJ) until the tumor resolved. Patients were followed clinically and photographically for evidence of tumor resolution and recurrence.

Results: All patients had clinical resolution of the tumor. The mean time to resolution was 47 days. During the follow-up time after resolution of the lesion (mean 41 months), one patient had disease recurrence 7 months after clinical resolution. This was successfully treated with one further injection.

Conclusion: PEGIFNα2b may be a viable medical alternative for the treatment of OSSN. Future studies will be needed to evaluate whether PEGIFNα2b is as effective as recombinant interferon alpha 2b.     

Role of high resolution optical coherence tomography in diagnosing ocular surface squamous neoplasia with coexisting ocular surface diseases

Purpose

Coexistence of an ocular surface disease can mask the typical features of ocular surface squamous neoplasia (OSSN). The purpose of this study was to evaluate high resolution optical coherence tomography (HR-OCT) as an adjunct in the detection and differentiation of OSSN within coexisting ocular surface pathologies.

The clinical value of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia

Purpose

To determine the reliability and efficiency of in vivo confocal microscopy for the diagnosis of ocular surface squamous neoplasia (OSSN).

Methods

A case series with five consecutive cases of OSSN were investigated retrospectively, of which the characteristics and subspecial types had been estimated by in vivo confocal microscopy before surgery. The structure and cellular features of OSSN were analyzed with other examinations, such as anterior-segment optical coherence tomography (AS-OCT), and confirmed by histopathological biopsy.

Results

The tumors revealed red gelatinous surfaces with vascular dilatation on the ocular surface of the conjunctival and corneal epithelium in anterior segment photography. Involvement of only corneal epithelium was observed by AS-OCT in three cases, whereas the Bowman''s layer and anterior stroma were also invaded in the other two cases. In vivo confocal microscopy showed cellular anisocytosis and enlarged nuclei with high nuclear to cytoplasmic ratio in three cases diagnosed as conjunctival intraepithelial neoplasia; moreover, nests were partially formed by isolated keratinized, binucleated, and actively mitotic dysmorphic epithelial cells in the other two cases diagnosed as carcinoma in situ and ocular surface squamous carcinoma (OSSC). The characteristics assessed from histopathological biopsy were similar to that revealed by in vivo confocal microscopy in all five cases.

Conclusion

In vivo confocal microscopy analysis of cytological characteristics of OSSN is a safe, relatively noninvasive, and effective diagnostic tool in detecting characteristics of OSSN before surgical resection. Although in vivo confocal microscopy cannot replace excisional biopsy for definitive diagnosis, it can be valuable for initial diagnosis and management of patients with OSSN.     

Ocular surface squamous neoplasia

Ocular surface squamous neoplasia presents as a spectrum from simple dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva as well as the cornea. It is a distinct clinical entity, although it has been known by a variety of different names thorughout the literature. Most commonly it arises in the limbal region, occurring particularly in elderly males who have lived in geographic areas exposed to high levels of ultraviolet-B radiation. Symptoms range from none to severe pain and visual loss. The development of preoperative diagnostic techniques, such as impression cytology, are of value in clinical decision making and follow-up management. Simple excision with adequate margins is currently the best established form of treatment despite trials of other modalities. The course of this disease may be evanescent, but is more frequently slowly progressive and may require exenteration and occasionally may lead to death.