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Purpose To identify predictors of ocular surface squamous neoplasm (OSSN) recurrence after surgical resection. Design Retrospective case series. Participants Three hundred and eighty nine consecutive patients who underwent excisional biopsy for OSSN lesions at the Bascom Palmer Eye Institute from January 1, 2001, to September 20, 2010 Methods Review of pathology records and patient charts. Main Outcome Measures Identification of factors predictive of OSSN recurrence. Results Of 389 excised OSSN lesions, forty-four recurred during follow up. The 1 year recurrence rate was 10% and the 5 year recurrence rate was 21% with a mean time to recurrence in those with a recurrence of 2.5 years (standard deviation (SD) 3.4). Using the American Joint Committee on Cancer (AJCC) clinical staging system, T3 and T2 lesions portended a higher risk of recurrence compared to T1 (T2/T1: hazard ratio (HR) = 2.05, p=0.04; T3/T1: HR= 2.31, p=0.07). In addition, a location characteristic that increased the risk of tumor recurrence was tarsal involvement (AJCC T3 stage lesion) (HR=4.12, p = 0.007). Nasal location was associated with a decreased risk of tumor recurrence (HR=0.41, p=0.008). Pathologic characteristics significantly associated with tumor recurrence were the presence of positive margins (HR=2.73, p= 0.008) and higher grade lesions (carcinoma in situ and squamous cell carcinoma versus dysplasia) (HR=2.55, p=0.02). Treatment with adjuvant cryotherapy significantly decreased the risk of tumor recurrence (HR=0.51, p=0.03). In those patients with positive margins, the use of post-operative topical interferon therapy lowered the recurrence rate to a level similar to that of patients with negative margins. Conclusions Certain patient and tumor factors are associated with a higher risk of OSSN recurrence after surgical excision, such as tarsal tumor location and positive surgical margins. Post-operative adjuvant therapy should be considered in patients with high risk OSSN characteristics.

Purpose To assess the use of ultra high resolution optical coherence tomography (UHR-OCT) in the diagnosis of ocular surface lesions. Design Prospective, non-comparative, interventional case series. Participants Fifty four eyes of 53 consecutive patients with biopsy proven ocular surface lesions; 8 primary acquired melanosis, 5 amelanotic melanoma, 2 nevi, 19 ocular surface squamous neoplasia, 1 histiocytosis, 6 conjunctival lymphoma, 2 conjunctival amyloidosis, and 11 pterygia. Intervention UHR-OCT imaging of the ocular surface lesions. Main Outcome Measures Clinical course and photographs, UHR-OCT image and histopathological findings. Results UHR-OCT images of all examined ocular surface lesions showed close correlation with the obtained histopathological specimens. When clinical differential diagnosis of ocular surface lesions was broad, UHR-OCT images provided optical signs that guided towards a more specific diagnosis and management. In cases of amelanotic melanoma, conjunctival amyloidosis, and primary histiocytosis and in one case of ocular surface squamous neoplasia, UHR-OCT was instrumental in guiding the diagnosis. In those cases, UHR-OCT suggested that the presumed clinical diagnosis was incorrect and favored a diagnosis which was later confirmed by histopathological examination. Conclusions Correlations between UHR-OCT and histopathology confirm that UHR-OCT is an adjunctive diagnostic modality that can provide a non-invasive means to help and guide diagnosis and management of ocular surface lesions.

Purpose Treatment for ocular surface squamous neoplasia (OSSN) has historically been surgery, but non-surgical interventions are increasingly employed. Treatment with interferon is efficacious, but evidence is needed regarding recurrence and complication rates in comparison to surgery. The objective of this study is to compare the recurrence and complication rates of surgical versus interferon treatment for OSSN. Design A matched, case-control study. Participants Ninety eight patients with OSSN, 49 of whom were treated with interferon alpha 2b (IFNα2b) therapy and 49 of whom were treated with surgical intervention. Methods Patients with OSSN were treated with surgery versus IFNα2b therapy, either in topical or injection form. Median follow up after lesion resolution for the IFNα2b group was 21 months (range 0–173 months) and for the surgery group was 24 months (range 0.9–108 months). Main outcome measure The primary outcome measure for the study was the rate of recurrence of OSSN in each of the treatment groups. Recurrence rates were evaluated using Kaplan-Meier survival analysis. Results Mean patient age and gender were similar between the groups. There was a trend toward higher clinical American Joint Committee on Cancer tumor grade in the IFNα2b group. Despite this, the number of recurrences was equal at 3 per group. The one year recurrence rate was 5% in the surgery group versus 3% in the IFNα2b group (p=0.80). There was no statistically significant difference in the recurrence rate between the surgically and medically treated groups. Non-limbal location was a risk factor for recurrence (hazard ratio 8.96), in the entire study population. In patients treated successfully, the side effects of the two treatments were similar, with mild discomfort seen in the majority of patients in both groups. There was no limbal stem cell deficiency, symblephara, or diplopia noted in either group. Two patients were excluded from the IFNα2b group due to intolerance to the medication. Conclusion No difference in the recurrence rate of OSSN was found between surgical versus IFNα2b therapy.

Purpose The purpose of this study was to determine the prevalence of ocular surface neoplasia (OSSN) coexistent with pterygia in South Florida and to study the treatment and related outcomes. Design Non-interventional retrospective study. Participants Two thousand and five patients with surgically excised pterygia at the Bascom Palmer Eye Institute from 2000 – 2010. Methods Pathology reports of patients with pterygia were reviewed for evidence of OSSN. Patients were divided into the following groups: pterygium and no OSSN (group1), clinically suspected OSSN with pterygium (group 2) and unexpected OSSN with pterygium found on histopathology (group 3). Clinical charts of patients in group 2 and 3 were reviewed. Main outcome measures Period prevalence, treatment and outcome. Results In surgically excised pterygia, we found the prevalence of coexistent OSSN to be 1.7% (n=34), of which 41% (n=14) were clinically suspected preoperatively (group 2) and 59% (n=20) were unexpectedly found on histopathology (group 3). Clinically suspected OSSN with pterygia was generally treated with wide surgical margins and cryotherapy, whereas unexpected OSSN with pterygia was treated with simple excision, followed by adjuvant interferon treatment in 30% (n=6). After a mean follow up of 2 years, there were no recurrences in the suspected OSSN group and 2 recurrences in the unexpected OSSN group. The recurrence rate in the latter group was 11% at 1 year and 24% at 2 years. Conclusion OSSN is uncommonly found to coexist with pterygium. The prognosis in suspected OSSN cases is excellent with no recurrences noted despite positive margins in 50% of cases. The recurrence rates of unexpected OSSN mirrors that of OSSN not associated with pterygium, and thus vigilance for recurrence is important.