title: Ocular Surface Squamous Neoplasia in 200 Patients: A Case-Control Study of Immunosuppression Resulting from Human Immunodeficiency Virus versus Immunocompetency.
abstract: OBJECTIVE
  To describe and compare the clinical presentation, treatment outcomes, and histopathologic features of ocular surface squamous neoplasia (OSSN) based on human immunodeficiency virus (HIV) status.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A total of 200 patients with OSSN, of whom 83 (41%) had positive results for HIV and were classified as cases and 117 (59%) had negative results for HIV and were classified as controls.
  
  
  METHODS
  Enzyme-linked immunosorbent assay for HIV, conjuntival excision biopsy, extended enucleation, orbital exenteration.
  
  
  METHODS
  Clinical features, treatment outcomes, and histopathologic characteristics.
  
  
  RESULTS
  The mean age at presentation of OSSN in both cases and controls was 40 years (median, 40 years; range, 13-65 years) and in controls was 40 years (median, 38 years; range, 15-80 years). On comparison of cases versus controls with OSSN, HIV-positive individuals had larger (12 vs. 8 mm; P < 0.001) and thicker (3.2 vs. 2.3 mm; P = 0.041) tumors, with a higher incidence of corneal (60% vs. 40%; P = 0.007), scleral (19% vs. 9%; P = 0.044), and orbital (13% vs. 3%; P = 0.019) invasion and a higher need for extended enucleation or exenteration (27% vs. 11%; P < 0.001). The bilateral presentation (11% vs. 4%; P = 0.13), need for lamellar sclerectomy (13% vs. 8%; P = 0.29), and tumor recurrence after primary treatment (30% vs. 20%; P = 0.12) was higher in HIV-positive cases compared with HIV-negative controls. However, these features were not statistically significant. Based on American Joint Committee on Cancer classification, T1 tumor was more common in controls (13% in cases vs. 35% in controls; P = 0.0009), and T4 tumor was more common in cases (13% in cases vs. 4% in controls; P = 0.019). None of the patients demonstrated systemic metastases or died of disease during a mean follow-up period of 10 months (median, 4 months; range, <1-75 months) in cases and 9 months (median, 4 months; range, <1-99 months) in controls.
  
  
  CONCLUSIONS
  Ocular surface squamous neoplasia in HIV-positive individuals is aggressive with larger and thicker tumors and with higher incidence of corneal, scleral, and orbital invasion. These patients are associated with poor ocular prognosis with higher need for extended enucleation, exenteration, or both.
authors.affiliation: Institute for Eye Cancer, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kamal
authors.affiliation: Institute for Eye Cancer, L. V. Prasad Eye Institute, Hyderabad, India. Electronic address: kalikiswathi@yahoo.com.
authors.forename: Swathi
authors.initials: S
authors.lastname: Kaliki
authors.affiliation: Ophthalmic Pathology Service, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Mishra
authors.affiliation: Institute for Eye Cancer, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Batra
authors.affiliation: Institute for Eye Cancer, L. V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Milind N
authors.initials: MN
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology* / Q000628:therapy / Q000821:virology; D016022:Case-Control Studies; D003230:Conjunctival Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D003316:Corneal Diseases / Q000473:pathology / Q000628:therapy / Q000821:virology; D004797:Enzyme-Linked Immunosorbent Assay; D015353:Eye Enucleation; D015828:Eye Infections, Viral / Q000276:immunology* / Q000628:therapy; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007121:Immunocompetence; D007165:Immunosuppression Therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017233:Orbit Evisceration; D009916:Orbital Diseases / Q000473:pathology / Q000628:therapy / Q000821:virology; D012189:Retrospective Studies; D015422:Scleral Diseases / Q000473:pathology / Q000628:therapy / Q000821:virology; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome