Ocular surface squamous neoplasia in resource-limited settings
Improving the understanding and management of OSSN in East Africa
Ocular surface squamous neoplasia (OSSN) is a spectrum of disease that ranges from non-invasive intra-epithelial dysplasia of the conjunctival and cornea, through to invasive squamous cell carcinoma. In recent decades OSSN has undergone an epidemiological shift. In more temperate countries, it remains a rare, slow growing tumour of elderly males. In contrast, in tropical countries, particularly in Eastern Africa, it is now more common, more aggressive, affects younger people and slightly more women than men. It seems likely that much of this increased burden of disease is attributable to the HIV/AIDS epidemic. Even though OSSN is not a target condition within VISION 2020, it has the potential to lead to a poor quality of life, visual disability and death.
Histopathology is the gold standard for diagnosing OSSN and determining the stage of the disease. However, generally in sub-Saharan Africa there is very limited access to pathology services, such that most probable OSSN lesions are excised without pathological confirmation of the diagnosis or complete excision of the lesion. A simple and cheap diagnostic aid would be of considerable help to the clinician.
Additional chemotherapy treatments can be used to try to improve long-term outcomes for OSSN but these are rarely applied in sub-Saharan Africa. Larger tumours that have spread to the orbit are usually managed by exenteration. Randomized controlled trials are needed to identify the optimal treatment for this condition to minimise recurrence rates in the East African setting.
Aims of the study
Based in the ophthalmology departments of Kenyatta and Kikuyu hospitals, Kenya, this study has three main aims:
- To improve our understanding of the epidemiology and causes of OSSN in East Africa
- To develop a simple diagnostic algorithm to guide the management of possible OSSN in resource-limited settings
- To determine whether the recurrence of OSSN can be reduced through the use of additional chemotherapy
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We would like to thank the funder of this study, the British Council for the Prevention of Blindness.
Image credit: Examples of squamous cell carcinoma of the conjunctiva. Phillipe Kestelyn