Original Research

Screening for Ocular Surface Squamous Neoplasia (OSSN) by Slit-lamp Assisted Visual Inspection (SAVI) following a short course of mild topical steroid-test qualities

E. Katsekera, L. Tanyanyiwa, V. Chikwasha, R. Masanganise
African Vision and Eye Health | South African Optometrist: Vol 73, No 1 | a3 | DOI: https://doi.org/10.4102/aveh.v73i1.3 | © 2014 E. Katsekera, L. Tanyanyiwa, V. Chikwasha, R. Masanganise | This work is licensed under CC Attribution 4.0
Submitted: 04 August 2014 | Published: 04 August 2014

About the author(s)

E. Katsekera, Department of Ophthalmology, University of Zimbabwe College of Health Sciences, Zimbabwe
L. Tanyanyiwa, Department of Ophthalmology, University of Zimbabwe College of Health Sciences, Zimbabwe
V. Chikwasha, Department of Community Medicine, University of Zimbabwe College of Health Sciences, Zimbabwe
R. Masanganise, Department of Community Medicine, University of Zimbabwe College of Health Sciences, Zimbabwe

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Abstract

Introduction: Ocular surface squamous neoplasia (OSSN) is currently the commonest ocular malignancy affecting people of child bearing age and is associated with high morbidity and mortality rates in Zimbabwe. Early surgical intervention has been shown to mitigate the effects of OSSN amongst its victims, however this is hampered by limited histopathological services which should guide the extent of surgical excisions of these tumours.
Purpose: The purpose of this study was to determine the accuracy of Slit-lamp Assisted Visual Inspection (SAVI) in diagnosing ocular surface squamous neoplasia with the hope of recommending a fall back tool that ophthalmologists / medical practitioners / ophthalmic nurses or optometrists can use in resource limited situations without readily accessible histopathological services when surgical intervention is contemplated.
Method: This was part of a study which screened one hundred and nineteen (119) patients with conjunctival growths and recruited sixty seven (67) patients with ocular surface squamous neoplasia by visual inspection over a period of six months. All patients received a week’s course of topical fluorometholone 0.1% and had the lesions excised either completely or partially depending on size of tumour and histology performed on the tissues. The histology results were compared with the results by visual inspection to determine diagnostic accuracy. Outcome measures were specificity, sensitivity and predictive values.
Results: Total number of patients with conjunctival growths screened by visual inspection was 119, with median age of 42 years and a range of 18 to 90 years and gender ratio of 1:1.9 in favour of females. There was no significant age difference between confirmed OSSN patients and non-OSSN (pterygia) and the p-value was 0.617. Sensitivity and specificity of visual inspection in diagnosing OSSN when compared to histology were 94.3% and 74.2% respectively, with a positive predictive value of 74.6%. Histology reports indicated that 24.5% of OSSN specimens seen actually arose from pterygia.
Conclusions: Slit lamp assisted visual inspection (SAVI) is an accurate method of clinically diagnosing OSSN and can be recommended for use in resource limited settings with hard to access histopathological services.

Keywords

ocular surface squamous neoplasia; visual inspection, histology, tumour diagnosis; conjunctival growth; pterygium.

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