scholarly journals Management of Ocular Surface Squamous Neoplasia in Association with Fungal Keratitis in a HIV Positive Individual

2021 ◽  
Author(s):  
Prabhakar Singh ◽  
Abhishek Gupta ◽  
Richa Gupta
Keyword(s):  
Risk Factors ◽  
Ocular Surface ◽  
Comprehensive Evaluation ◽  
Topical Steroid ◽  
Fungal Keratitis ◽  
Hiv Positive ◽  
Ocular Surface Squamous Neoplasia ◽  
Steroid Abuse ◽  
Positive Individual ◽  
Vegetative Matter

Ocular Surface Squamous Neoplasia (OSSN) co-existent with fungal keratitis in an immunodeficient individual has rarely been talked about in literature. Risk factors for fungal keratitis are trauma with vegetative matter, topical steroid abuse, poor ocular surface, corneal anaesthesia, systemic immunosuppression, etc., and for OSSN a major risk factor is immunodeficiency. In current report, patient had multiple risk factors. This report highlights the management of HIV positive 42-year-old male with OSSN and fungal keratitis. A comprehensive evaluation helps clinician decide on treatment priority and achieve good clinical outcome.

Bilateral ocular surface squamous neoplasia: A study of 25 patients and review of literature

2021 ◽  
pp. 112067212110071
Author(s):  
Vijitha S Vempuluru ◽  
Monalisha Pattnaik ◽  
Neha Ghose ◽  
Swathi Kaliki
Keyword(s):  
Risk Factors ◽  
Ocular Surface ◽  
Histopathological Examination ◽  
Topical Steroid ◽  
Case Series ◽  
Intraepithelial Neoplasia ◽  
Excisional Biopsy ◽  
Ocular Surface Squamous Neoplasia ◽  
Retrospective Case

Purpose: To describe the risk factors, clinical presentation, management, and outcomes of patients with bilateral ocular surface squamous neoplasia (OSSN). Methods: Retrospective case series. Results: Of the 25 patients with bilateral OSSN, the mean age at diagnosis of OSSN was 31 years (median, 24 years; range, 2–60 years). Risk factors for bilateral OSSN included xeroderma pigmentosum ( n = 15, 60%), human immunodeficiency virus infection ( n = 3, 12%), conjunctival xerosis ( n = 1, 4%), and topical steroid use ( n = 1, 4%). There were no identifiable ocular or systemic risk factors in 7 (28%) patients. Presentation was synchronous in 14 (56%) and metachronous in 11 (44%) patients. Tumor morphology was bilaterally similar in 12 (48%) patients. Histopathological examination ( n = 36) revealed conjunctival intraepithelial neoplasia (CIN) grade 1 in 4 (8%); grade 2 in 7 (14%); carcinoma in situ in 5 (10%), and invasive carcinoma in 20 (40%). Primary management of OSSN ( n = 49) included excisional biopsy ( n = 31, 62%), topical immunotherapy (IFN α2B) ( n = 11; 22%), topical Mitomycin C (MMC) ( n = 3, 6%), enucleation ( n = 1, 2%), orbital exenteration ( n = 2, 4%), and plaque brachytherapy (PBT) ( n = 1, 2%). One patient was lost to follow-up after detection of tumor in the second eye. Recurrent tumors were noted in 16 (32%) eyes and binocular globe salvage was achieved in 16 (64%) patients at a mean follow up of 41 months (median 30 months; range, 1–164 months). Conclusion: OSSN occurrence can be synchronous or metachronous. Meticulous examination of the fellow eye is important for an early diagnosis of OSSN.

scholarly journals Clinical analysis of fungal keratitis according to prior topical steroid use: A retrospective study

2019 ◽  
Author(s):  
Chan Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Ocular Surface ◽  
Clinical Characteristics ◽  
Topical Steroid ◽  
Fungal Keratitis ◽  
Ocular Surface Disease ◽  
Ocular Infection ◽  
Steroid Use

Abstract Background: To compare the clinical characteristics and treatment outcomes of microbiologically-proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically-proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors and clinical characteristics, microbiological profiles, and treatment outcomes were compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. No significant differences were observed in mean age, sex, occupation, and baseline clinical characteristics between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048), identified fungal isolates (53.3% vs. 26.4%, p=0.014), and diagnosed by repeat microbiological tests (40.0% vs. 17.0%, p=0.020). Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.015). Regarding treatment outcomes, the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 5.95, p=0.003), prior topical steroid use (odds 3.45, p=0.034), and non-vegetable corneal trauma (odds 4.46, p=0.037). Conclusions: The PS group was more associated with previous ocular surface disease, and no significant differences were observed in the baseline clinical characteristics between the two groups. Diagnosis was more difficult and treatment results were worse in the PS group in this study. Repeat microbiological tests can be helpful in diagnosing fungal infections especially in the prior topical steroid used group. Keywords: Fungal ocular infection, Steroids, Ulcerative keratitis.

scholarly journals Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: A retrospective study in South Korea

2019 ◽  
Author(s):  
Chan Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Ocular Surface ◽  
Clinical Characteristics ◽  
Topical Steroid ◽  
Fungal Keratitis ◽  
Ocular Surface Disease ◽  
Steroid Use ◽  
Deep Infiltration

Abstract Background: To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between prior topical steroid users (PS) and no prior topical steroid users (NPS). Methods: Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. The treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated on the bases of the total cohort and analyzed using multivariate logistic regression. Results: A total of 30 cases with PS group and 53 cases with NPS group were included. In those, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while the Aspergillus (4 cases) was found only in the PS group (p=0.103). No significant differences were observed in mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting BCVA between the two groups. Differences were observed between the PS and NPS groups in the cases of previous ocular surface disease (43.3% vs. 22.6%, p=0.048) and deep infiltration (53.3% vs. 32.1%, p=0.057). Regarding treatment outcomes, final BCVA <0.1 (60% vs. 44.2%, p=0.133), the use of voriconazole (topical 10% vs. 0%, p=0.044; systemic 23.3% vs. 1.9%, p=0.003), surgical intervention (43.3% vs. 20.8%, p=0.029) and treatment failure (46.7% vs. 22.6%, p=0.023) were more common in the PS group than in the NPS group. The risk factors for treatment failure were hypopyon (odds 6.01, p=0.005), deep infiltration (odds 4.38, p=0.013), prior topical steroid use (odds 2.79, p=0.091), and previous ocular surface disease (odds 2.82, p=0.093). Conclusions: The PS group was more associated with previous ocular surface disease and deep infiltration when compared with the NPS group. Treatment progresses and treatment results were worse in the PS group. Careful attention should be paid to the use of steroids in clinical practice.

scholarly journals Clinical analysis of microbiologically proven fungal keratitis according to prior topical steroid use: a retrospective study in South Korea

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chan-Ho Cho ◽  
Sang-Bumm Lee
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Topical Steroid ◽  
Clinical Analysis ◽  
Fungal Keratitis ◽  
Topical Steroids ◽  
Deep Infiltration

Abstract Background To compare the clinical characteristics and treatment outcomes of microbiologically proven fungal keratitis between users and non-users of prior topical steroids (PS and NPS, respectively). Methods Eighty-three cases with microbiologically proven fungal keratitis between January 2000 and December 2016 were reviewed retrospectively. Diagnosis of fungal keratitis was made through potassium hydroxide smear, culture, PCR, or biopsy. Baseline epidemiology, predisposing factors, clinical characteristics, microbiological profiles, and treatment outcomes were evaluated and compared between the PS and NPS groups. Treatment failure was defined as any case with complications or requiring surgery. The risk factors for treatment failure were evaluated using multivariate logistic regression in the overall cohort. Results A total of 30 cases with PS group and 53 cases with NPS group were included. Of these, sixteen fungal isolates were identified in the PS group and 14 isolates in the NPS group. Candida was the most common organism in both groups (6 cases, respectively), while Aspergillus (4 cases) was found only in the PS group (p = 0.103). No significant differences were observed in the mean age, sex, occupational distribution, epithelial defect size, hypopyon, and presenting best-corrected visual acuity (BCVA) between the two groups. Differences were observed between the PS and NPS groups in terms of previous ocular surface disease (OSD) (43.3% vs. 22.6%, p = 0.048) and deep infiltration (53.3% vs. 32.1%, p = 0.057). Regarding treatment outcomes, final BCVA < 0.1 (60% vs. 44.2%, p = 0.133), the use of voriconazole (topical 10% vs. 0%, p = 0.044; systemic 23.3% vs. 1.9%, p = 0.003), surgical intervention (43.3% vs. 20.8%, p = 0.029), and treatment failure (46.7% vs. 22.6%, p = 0.023) were more common in the PS group than in the NPS group. The significant risk factors for treatment failure were hypopyon (odds ratio [OR] 6.01, p = 0.005) and deep infiltration (OR 4.38, p = 0.013). Conclusions Previous OSD and deep infiltration were more common in the PS group compared to the NPS group. The PS group also experienced worse disease progression and treatment outcomes. These results highlight the need for paying attention to the use of steroids in clinical practice.

scholarly journals Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study

2016 ◽  
Vol 21 (12) ◽  
pp. 1522-1530 ◽  
Author(s):  
Stephen Gichuhi ◽  
Ephantus Macharia ◽  
Joy Kabiru ◽  
Alain M'bongo Zindamoyen ◽  
Hillary Rono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ocular Surface ◽  
Case Control Study ◽  
Case Control ◽  
Ocular Surface Squamous Neoplasia ◽  
Control Study

scholarly journals Ocular surface squamous neoplasia: Population demographics, pathogenesis and risk factors

2020 ◽  
Vol 79 (1) ◽  
Author(s):  
Roland Hollhumer ◽  
Susan Williams ◽  
Pamela Michelow
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Squamous Cell ◽  
Ocular Surface ◽  
Cellular Proliferation ◽  
Hpv Infection ◽  
Incidence Rates ◽  
Ultraviolet B ◽  
Genetic Mutations ◽  
Ocular Surface Squamous Neoplasia

Background: Ocular surface squamous neoplasia (OSSN) is a unifying term used to describe conjunctival intra-epithelial neoplasia, squamous cell carcinoma in situ and invasive squamous cell carcinoma.Aim: The aim of this article was to describe the demographics, clinical features, pathogenesis and risk factors of OSSN.Method: A literature search was conducted using the search criteria ‘ocular surface squamous neoplasia’, ‘diagnosis’, ‘epidemiology’, ‘pathogenesis’ and ‘risk factors’.Results: Ocular surface squamous neoplasia is the most common ocular tumour, with incidence rates ranging from 0.01 to 3.4 per 100 000 persons/year. There are two main patterns  of disease presentation: older white males in temperate climates where human immunodeficiency virus (HIV) and human papilloma virus (HPV) are not associated; and a younger patient population in tropical climates where HIV and HPV are more prevalent. The pathogenesis primarily revolves around ultraviolet B exposure and HPV infection that cause genetic mutations and uncontrolled cellular proliferation, whilst HIV infection and vitamin A impair tumour surveillance mechanisms. Ocular surface squamous neoplasia is first suspected clinically before formal confirmation of the diagnosis. Morphologically, it can be divided into three groups: placoid, nodular and diffuse. Placoid lesions can further be sub-divided into gelatinous, leukoplakic and papilliform lesions. Nodular lesions have the poorest prognosis, with the highest risk of metastasis and recurrence.Conclusion: Ocular surface squamous neoplasia is a common ocular tumour associated with ultraviolet radiation, HPV and HIV infection. The pathogenesis revolves around acquired genetic mutations, unregulated cellular proliferation and impaired tumour surveillance mechanisms.

Combined treatment modality for invasive ocular surface squamous neoplasia in an HIV positive patient: a case report

2012 ◽  
Vol 2 (1) ◽  
pp. 25 ◽  
Author(s):  
Shubhangi Nigwekar ◽  
Tanvi Haldipurkar ◽  
Somen Misra ◽  
Bharati Baviskar ◽  
Megha Bhosale ◽  
...  
Keyword(s):  
Case Report ◽  
Ocular Surface ◽  
Treatment Modality ◽  
Combined Treatment ◽  
Positive Patient ◽  
Hiv Positive ◽  
Ocular Surface Squamous Neoplasia

scholarly journals Screening for Ocular Surface Squamous Neoplasia (OSSN) by Slit-lamp Assisted Visual Inspection (SAVI) following a short course of mild topical steroid-test qualities

2014 ◽  
Vol 73 (1) ◽  
Author(s):  
E. Katsekera ◽  
L. Tanyanyiwa ◽  
V. Chikwasha ◽  
R. Masanganise
Keyword(s):  
Ocular Surface ◽  
Visual Inspection ◽  
Surgical Intervention ◽  
Topical Steroid ◽  
Age Difference ◽  
High Morbidity ◽  
Slit Lamp ◽  
Ocular Surface Squamous Neoplasia ◽  
Resource Limited ◽  
Number Of Patients

Introduction: Ocular surface squamous neoplasia (OSSN) is currently the commonest ocular malignancy affecting people of child bearing age and is associated with high morbidity and mortality rates in Zimbabwe. Early surgical intervention has been shown to mitigate the effects of OSSN amongst its victims, however this is hampered by limited histopathological services which should guide the extent of surgical excisions of these tumours.Purpose: The purpose of this study was to determine the accuracy of Slit-lamp Assisted Visual Inspection (SAVI) in diagnosing ocular surface squamous neoplasia with the hope of recommending a fall back tool that ophthalmologists / medical practitioners / ophthalmic nurses or optometrists can use in resource limited situations without readily accessible histopathological services when surgical intervention is contemplated.Method: This was part of a study which screened one hundred and nineteen (119) patients with conjunctival growths and recruited sixty seven (67) patients with ocular surface squamous neoplasia by visual inspection over a period of six months. All patients received a week’s course of topical fluorometholone 0.1% and had the lesions excised either completely or partially depending on size of tumour and histology performed on the tissues. The histology results were compared with the results by visual inspection to determine diagnostic accuracy. Outcome measures were specificity, sensitivity and predictive values.Results: Total number of patients with conjunctival growths screened by visual inspection was 119, with median age of 42 years and a range of 18 to 90 years and gender ratio of 1:1.9 in favour of females. There was no significant age difference between confirmed OSSN patients and non-OSSN (pterygia) and the p-value was 0.617. Sensitivity and specificity of visual inspection in diagnosing OSSN when compared to histology were 94.3% and 74.2% respectively, with a positive predictive value of 74.6%. Histology reports indicated that 24.5% of OSSN specimens seen actually arose from pterygia. Conclusions: Slit lamp assisted visual inspection (SAVI) is an accurate method of clinically diagnosing OSSN and can be recommended for use in resource limited settings with hard to access histopathological services.

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