P-180
OCULAR SURFACE DISORDERS
       PRESENTING AUTHOR: DR.SRIVIDYA
      CHIEF AUTHOR: DR.KAVITA SALAGAR
               (KOS-NO:1422).
     CO-AUTHOR: DR.VISHWANATH REDDY.
                 DR.VEERESH KORWAR.
                 DR.VINEETH BHIMSHETTY.
      M R MEDICAL COLLEGE,KALABURGI
    AUTHOR HAS NO FINANCIAL INTEREST
INTRODUCTION
   OCULAR      SURFACE           SQUAMOUS         NEOPLASIA        is   a
    uncommon tumor.
    LEE and HERST describes spectrum of conjunctival, corneal
    intraepithelial Neoplasia .
   Manifest as Dysplasia, CIN and invasive squamous cell carcinoma.
   Risk factors include a history of intense sunlight exposure, male sex,
    outdoor occupations, advanced age, smoking, light complexion, AIDS,
    Xeroderma pigmenntosa, HPV 6,11,16, 18
   The pathogenesis of tumors appears to be disordered epithelial
    maturation induced by various irritants.
                     People with AIDS tends to
                      develop conjunctival and
                      corneal SSC at a young
                    age and aggressive than the
                      typical conjunctiva scc.
  No of OSSN                                       Templeton
     cases                                          found an
relative to total                                    average
 No of orbital
 tumor ranges
                            OSSN                  incidence of
                                                  0.13/1 lakh
  from 4% to                                       population,
      29%.
                      Primarily occurs in older
                       males with incidence of
                             1.9/1 lakh
32 year male presented with complaints of Mass in left eye since 8
                             months
        Mass was Insidious in onset,gradually progressive
 Dimension of vision in left eye since 3 months insidious in onset
                     gradually progressive .
                     No History of Trauma
       Patient was diagnosed to be HIV positive 1 year back
  On regular ART treatment (Zidovudine-Lamivudine-Nevirapine
                         OD                      OS
     VA                   20/20                 20/30
     With                20/20                  20/20
     pinhole
     Near Vision N6                             N6
                                  LEFT EYE
•   Placoid lesion with shiny velvetty
                                         •Encroaching 2mm on cornea      with
    elevated surface at interpalpebral
                                         Tufted Feeder vessels   and   surface
    fissure conjunctiva straddling the
                                         keratin inferiorly.
    limbus
                       Rest all anterior segment was normal
             Total mass excision done
           Excisional biopsy sent for HPR.
                               Topical chemotherapy using
   CRYOTHERAPHY                mitomycin C (0.02%) drops
[Freeze-thaw technique]         administered 4 times daily
                                     for 1 to 2 weeks
        HISTOPATHOLOGY                       GOLD STANDARD
                                               TECHNIQUE
•   Report revealed Hyperplastic,
    Acanthotic Stratified
    Squamous Epithelium(SSE)
                                    •Dysplastic        changes   and
                                    subepithelial infilterate.
                                    •   Tumor       Cells were
                                        arranged in a nest and
                                        scattered singly.
No symblepharon, restricted ocular
motility, or scleral melting was seen
following Cryotherapy.
Patient was followed up regularly.
No recurrent intraepithelial neoplasia
even upto 9 months following the
excision.
No metastasis noted.
    CONCLUSION
•   Unilateral gelatinous papilliform squamous cell carcinoma in
    patients with concurrent AIDS are rare, particularly likely to
    exhibit rapidly progressive malignant conjunctival and corneal
    neoplasms of the SSE and metastasis of those neoplasms.
•   Role of complete surgical excision + cryotherapy +
    mitomycin therapy
•   It has favourable outcome with prevention of recurrence.
    REFERENCES
    British Journal of Ophthalmology 2012:84: Page
    268-272.
   Delhi Journal of Ophthalmology 2012;23(2):89-96.
   Albert and Jakobiec, Principles and Practice of
    Ophthalmology, 3rd Edition, Vol-3, Page 3584-3586.
   American Academy of Ophthalmology 2015 Edition,
    Page 2001.
    Yanoff and Duker, Ophthalmology, 4th Edition,
    Page 196-198.
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