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Patrick Oellers, Carol L. Karp, Andrew A. Kao, Amany Abdelaziz, Jared Matthews, Anoop Sheth, Sander R. Dubovy, Anat Galor; Subclinical Ocular Surface Squamous Neoplasia in Pterygia. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4228.
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To determine the outcomes of incidental ocular surface neoplasia (OSSN) found after routine pterygium surgery at a tertiary referral ophthalmology center in South Florida, USA.
Charts of 510 patients with ocular surface squamous carcinoma (OSSN) seen at Bascom Palmer Eye Institute from 2000 to 2010 were reviewed. 20 patients with a clinical diagnosis of pterygium, surgical excision and histopathological diagnosis of OSSN were identified. These charts were further analyzed for treatment, histopathology and recurrence.
In 20 of 510 (4%) specimens, histopathologic examination revealed OSSN within lesions that were clinically diagnosed as pterygium. Surgical excision was performed as the routine procedure for pterygium. Two had intraoperative mitomycin-C as part of the normal surgical routine, none had cryotherapy and none of the specimens were oriented. The histologic OSSN grade was mild in 4 (20%), moderate in 8 (40%), severe in 1 (5%) and full thickness lesion (CIS) in 7 (35%). Margins were negative in 10 (50%), positive in 3 (15%) and non-assessable in 7 (35%) cases. Following the diagnosis, adjuvant therapy for OSSN was elected in 7 (35%) patients. Interferon therapy was administered in 6 (30%) and further excision was performed in 1 (5%). Ninety percent (n=18) of eyes remained free of recurrence with a mean follow-up of 1 year and 9 months (median: 11 months). Of the two patients who experienced a recurrence, the histologic grades were mild (n=1) and severe (n=1), with non-assessable margins in both.
Despite not conforming to the standard OSSN approach of a no-touch wide surgical excision and cryotherapy, patients with subclinical OSSN within pterygia had an excellent prognosis after simple excision. Future studies will be needed to assess whether adjuvant therapy is beneficial and cost effective in these patients.
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