Conjunctival squamous cell carcinoma, a tumour of the thin membrane that covers the white of the eye, is becoming more common, more aggressive, and affecting more young people, especially women. This pattern is associated with the HIV/AIDS pandemic, exposure to solar radiation, and infection with human papilloma virus (HPV). Various treatment modalities exist, but the recurrence rate is high and the cosmetic outcome of late disease unsightly (Figure 1). Death may occur when the disease spreads to the surrounding structures and the brain. This review was conducted to evaluate the effects of the current interventions. No randomised controlled trials of any interventions for this cancer were found. Current clinical practice appears to be based on case series and case reports. These are weak sources of evidence for the effectiveness of a treatment. Randomised controlled clinical trials are needed.
"Experienced surgeons report lower recurrences (3.2%) after excision (Waddell et al. 2006). Trial data to guide management in this context are lacking (Gichuhi & Irlam 2013). For the temperate pattern of disease, one randomised controlled crossover trial in Australia compared mitomycin-C with placebo in participants "
[Show abstract][Hide abstract] ABSTRACT: To describe the epidemiology and an aetiological model of ocular surface squamous neoplasia (OSSN) in Africa.
Systematic and non-systematic review methods were used. Incidence was obtained from the International Agency for Research on Cancer. We searched PubMed, EMBASE, Web of Science and the reference lists of articles retrieved. Meta-analyses were conducted using a fixed-effects model for HIV and cigarette smoking and random effects for human papilloma virus (HPV).
The incidence of OSSN is highest in the Southern Hemisphere (16° South), with the highest age-standardised rate (ASR) reported from Zimbabwe (3.4 and 3.0 cases/year/100 000 population for males and females, respectively). The mean ASR worldwide is 0.18 and 0.08 cases/year/100 000 among males and females, respectively. The risk increases with exposure to direct daylight (2-4 h, OR = 1.7, 95% CI: 1.2-2.4 and ≥5 h OR = 1.8, 95% CI: 1.1-3.1) and outdoor occupations (OR = 1.7, 95% CI: 1.1-2.6). Meta-analysis also shows a strong association with HIV (6 studies: OR = 6.17, 95% CI: 4.83-7.89) and HPV (7 studies: OR = 2.64, 95% CI: 1.27-5.49) but not cigarette smoking (2 studies: OR = 1.40, 95% CI: 0.94-2.09). The effect of atopy, xeroderma pigmentosa and vitamin A deficiency is unclear.
Africa has the highest incidence of OSSN in the world, where males and females are equally affected, unlike other continents where male disease predominates. African women probably have increased risk due to their higher prevalence of HIV and HPV infections. As the survival of HIV-infected people increases, and given no evidence that anti-retroviral therapy (ART) reduces the risk of OSSN, the incidence of OSSN may increase in coming years.
Tropical Medicine & International Health 12/2013; 18(12):1424-43. DOI:10.1111/tmi.12203 · 2.33 Impact Factor
"Human immunodeficiency virus was shown to be a strong risk factor for OSSN. A recent systematic review aiming at evaluating the effect of interventions for treating SCCC among HIV-infected patients showed that no randomised controlled trial had been conducted in HIV-positive patients, and the evidence on currently available treatments comes from analyses of case reports or cases series (Gichuhi and Irlam, 2013). Further research is needed on strategies to improve early diagnosis and treatment of OSSN among HIV-positive patients. "
[Show abstract][Hide abstract] ABSTRACT: Background:
The frequency of ocular surface squamous neoplasias (OSSNs) has been increasing in populations with a high prevalence of infection with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and infection with human papillomavirus (HPV). We aimed to quantify the association between HIV/AIDS and HPV infection and OSSN, through systematic review and meta-analysis.
The articles providing data on the association between HIV/AIDS and/or HPV infection and OSSN were identified in MEDLINE, SCOPUS and EMBASE searched up to May 2013, and through backward citation tracking. The DerSimonian and Laird method was used to compute summary relative risk (RR) estimates and 95% confidence intervals (95% CI). Heterogeneity was quantified with the I2 statistic.
HIV/AIDS was strongly associated with an increased risk of OSSN (summary RR=8.06, 95% CI: 5.29–12.30, I2=56.0%, 12 studies). The summary RR estimate for the infection with mucosal HPV subtypes was 3.13 (95% CI: 1.72–5.71, I2=45.6%, 16 studies). Four studies addressed the association between both cutaneous and mucosal HPV subtypes and OSSN; the summary RR estimates were 3.52 (95% CI: 1.23–10.08, I2=21.8%) and 1.08 (95% CI: 0.57–2.05, I2=0.0%), respectively.
Human immunodeficiency virus infection increases the risk of OSSN by nearly eight-fold. Regarding HPV infection, only the cutaneous subtypes seem to be a risk factor.
British Journal of Cancer 09/2013; 109(7). DOI:10.1038/bjc.2013.539 · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article reviews the magnitude and spectrum of ocular complications of HIV infection in sub-Sahara Africa. A literature search was done using PubMed, Google, and UpToDate and by talking to ophthalmologists and HIV experts working in the region. Ocular complications of HIV infection, mostly retinal, are seen in 29% to 71% of patients. Cytomegalovirus retinitis affects 0% to 16.5% of HIV-infected patients and is treated successfully with intravitreal ganciclovir in South Africa and Botswana. Ocular surface squamous neoplasia is seen in 4% to 7.8% of persons with HIV (a 5%-6% increase in Uganda and Tanzania), and recurrence after surgery occurs in 3.2% to 31.2%. In Zimbabwe, 45% of meningitis in adults is cryptococcal, and cryptococcal meningitis is the third leading cause of death in HIV patients in rural Uganda. In Rwanda, 9% of patients with cryptococcal meningitis developed visual loss and sixth nerve palsy. Thus, HIV infection leads to significant ocular morbidity in sub-Sahara Africa.
Current HIV/AIDS Reports 08/2008; 5(3):120-5. DOI:10.1007/s11904-008-0019-z · 3.80 Impact Factor
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