Ocular Surface Squamous Neoplasia : The Role Of Ki67

The purpose of this case series is to highlight the management of difficult cases of Ocular Surface Squamous Neoplasia.

Various patients of OSSN on topical therapy for their lesions were observed over a perios od 6 months. Monthly size and surface activity were recorded and monitored. Patients who had not shown any adequate reduction in size or improvement in ocular surface were subjected to partial/total surgical excision of their lesions with a histopathological evaluation postoperatively. 

Patients on topical therapy with interferon-alpha 2b and mitomycin C were thoroughly evaluated, 8 patients were selected after 6 months to undergo surgical excision of their mass/surface lesions with histopathological analysis to determine the cause of poor response to topical therapy. 

Histopathological examination included ki67 values which denote the level of mitotic activity. With poor response to antimitotic agents it was presumed that perhaps the ki67 values would be low. Post operatively, with surgical excision alone there was significant improvement in the ocular surface of these patients, hinting the need for debulking the large or thoroughly spread lesions as well.

On histopathological analysis along with confirmation of the diagnosis of OSSN the ki67 values of each of these 8 patients were abnormally high. An abnormally high value of ki67 would denote high mitotic activity with good response to antimitotic agents, however the opposite was seen in our patients. Our patients not only required surgical excision for some ocular relief, but they failed to respond at all to any antimitotic therapy topically.

The high values of ki67 might persuade us to look for possible targetted therapeutic options (Against ki67 ) in these patients especially in cases where total resection is not feasible.

OSSN significantly reduces the quality of life of these patients, with further poor response to expensive topical drugs these patients may all but lose hope for any therapeutic relief. Surgical excision or de bulking is needed with a thorough histopathological examination. Targetted therapy against ki67 may be the key to help alleviate the painful manifestations of this disease.