Risk factors for ocular surface squamous neoplasia in Kenya: a case–control study

Abstract

ObjectiveTo determine modifiable risk factors of ocular surface squamous neoplasia (OSSN) in Kenya using disease‐free controls.MethodsAdults with conjunctival lesions were recruited at four eye care centres in Kenya and underwent excision biopsy. An equal number of controls having surgery for conditions not affecting the conjunctiva and unrelated to ultraviolet light were group‐matched to cases by age group, sex and eye care centre. Associations of risk factors with OSSN were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Continuous variables were compared using the t‐test or the Wilcoxon–Mann–Whitney U‐test depending on their distribution.ResultsA total of 131 cases and 131 controls were recruited. About two‐thirds of participants were female, and the mean age of cases and controls was 42.1 years and 43.3 years, respectively. Risk factors for OSSN were HIV infection without antiretroviral therapy (ART) use (OR = 48.42; 95% CI: 7.73–303.31) and with ART use (OR = 19.16; 95% CI: 6.60–55.57), longer duration of exposure to the sun in the main occupation (6.9 h/day vs. 4.6 h/day, OR = 1.24; 95% CI: 1.10–1.40) and a history of allergic conjunctivitis (OR = 74.61; 95% CI: 8.08–688.91). Wearing hats was protective (OR = 0.22; 95% CI: 0.07–0.63).ConclusionMeasures to prevent and control HIV, reduce sun exposure such as wearing hats and control allergic conjunctivitis are recommended.

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

“…HIV is an established cause of conjunctiva cancer, based on the results of a number of case–control and cohort studies 2, 31, 32, 33. Of note, although conjunctiva was rarely specified in BCCOE medical records, our observed association was mainly due to squamous cell carcinoma (2 HIV‐positive out of 4) compared to other histologies (0 out of 13) of eye cancer.…”

A prospective study of the incidence, associations and outcomes of ocular surface squamous neoplasia in the United Kingdom

“…There appears to be an important association between human immunodeficiency virus (HIV) seropositivity and OSSN [3,[12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Patients presenting with OSSN might therefore benefit from HIV testing.…”

“…Other potential risk factors or associations include human papilloma virus (HPV) infection; [17,24,26] sunlight exposure [23,24,27], which can lead to mutations in the tumour suppressor gene p53; [28] p63, a homologue of p53; [29,30] smoking; [24,31] immunosuppression; [32][33][34] and xeroderma pigmentosa [35,36]. There have also been suggestions of a possible association between OSSN and atopic keratoconjunctivitis [23,32,[37][38][39]. A larger tumour size might be predictive of invasive SCC or risk of recurrence [40,41].…”

Repurposing blue laser autofluorescence to measure ocular sun exposure

“…High ocular exposure to sun or ultraviolet (UV) light increases the risk of developing eye diseases such as pterygium, cataract and ocular surface squamous neoplasia . Conjunctival UV autofluorescence (CUVAF) is a method of detecting pre‐clinical signs of ocular sunlight‐induced damage .…”

“…High ocular exposure to sun or ultraviolet (UV) light increases the risk of developing eye diseases such as pterygium, 1,2 cataract 3 and ocular surface squamous neoplasia. 4,5 Conjunctival UV autofluorescence (CUVAF) is a method of detecting pre-clinical signs of ocular sunlightinduced damage. 6 The mechanistic link between sun damage and CUVAF is unknown, but clinical and epidemiological evidence support CUVAF arising as a consequence of sun exposure.…”