Primary and tertiary management of ocular surface lesions in HIV-infected patients in Ehlanzeni, Mpumalanga Province
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i16b.1310Keywords:
Ocular manifestations of HIV, ocular surface squamous neoplasia, HIV, primary health care, conjunctival growth, ocular surface lesionAbstract
Background. In sub-Saharan Africa, ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour and is strongly associated with HIV infection. This range of ocular malignancies can be managed early to prevent large tumours requiring invasive treatment, facial disfigurement and mortality. Primary healthcare workers (HCWs) play a critical role in the early identification of the lesion. In addition, the ocular lesion can also be the presenting sign of HIV infection in individuals who have not yet been diagnosed. The aim of the present study was to assess the management of suspicious conjunctival growths in HIV-infected patients in primary health facilities and a specialist eye clinic in South Africa.
Objectives. To assess the knowledge, attitude and current practice of HCWs working in HIV clinics regarding ocular surface lesions and to evaluate the management of patients with ocular surface lesions at a tertiary hospital.
Methods. A cross-sectional study design was used (November 2020 - May 2021), for which 149 HCWs were invited to assessments about their knowledge, attitudes and practices regarding ocular surface lesions. In addition, files of patients with ocular surface lesions who presented between January 2018 and August 2020 to the eye clinic were reviewed using a data extraction sheet.
Results. One hundred-and-three HCWs agreed to participate in the survey (response rate 69.1%). Of these participants, 84.5% were experienced professional nurses (6 - 15 years of work experience) but had minimal experience with detection and management of eye complaints and lesions. Twenty-seven (26.2%) of the participants recognised some ocular surface lesions and 86 (83.5%) reported that they would refer patients with suspicious lesions. Sixty-two files were reviewed and 51 (82.2%) of the patients had an HIV-positive diagnosis. Fifty percent had carcinoma-in situ and squamous cell carcinoma of the conjunctiva. Thirty-one (50%) of the patients were lost to follow-up.
Conclusion. OSSN is an important manifestation of HIV infection. It would be beneficial for patients to receive a basic ocular examination as part of the baseline clinical evaluation; this may contribute to early referral to an eye care facility. The health system would benefit from establishing an eye health support system with the nearby health facilities, thereby educating primary HCWs about the association between HIV and OSSN.
References
Steele KT, Steenhoff AP, Bisson GP, Nkomazana O. Ocular surface squamous neoplasia among HIV- infected patients in Botswana. S Afr Med J 2015;105(5):379-383.
Rathi SG, Ganguly Kapoor A, Kaliki S. Ocular surface squamous neoplasia in HIV-infected patients: Current perspectives. HIV/AIDS: Research and Palliative Care 2018;10:33-45.
Hӧllhumer R, Williams S, Michelow P. Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa. PloS One 2020;15(8):e0237453. https://doi.org/10.1371/journal.pone.0237453
Suleiman DE, Liman AA, Waziri GD, Iliyasu Y, Ahmed SA. Clinicopathological characteristics of ocular surface squamous neoplasia: A 10-year review from a referral tertiary centre in Nigeria. Int Ophthalmology 2022;42(12):3905-3911.
Shields CL, Chien JL, Surakiatchanukul T, Sioufi K, Lally SE, Shields JA. Conjunctival tumors: Review of clinical features, risks, biomarkers, and outcomes--the 2017 J Donald M Gass Lecture. Asia-Pacific J Ophthalmology 2017;6(2):109-120.
Gichuhi S. Epidemiology and Management of Ocular Surface Squamous Neoplasia in Kenya [dissertation]. London School of Hygiene & Tropical Medicine.
Kiire CA, Stewart RMK, Srinivasan S, Heimann H, Kaye SB, Dhillon B. A prospective study of the incidence, associations and outcomes of ocular surface squamous neoplasia in the United Kingdom. Eye: The Scientific Journal of The Royal College of Ophthalmologists 2019;33(2):283-294. https://doi. org/10.1038/s41433-018-0217-x
Khan L, Malukani M, Saxena A. Conjunctival lesions: When should we perform biopsy? Nepalese Journal of Ophthalmology 2017;9(2):160-169.
Merz LE, Afriyie O, Jiagge E, et al. Clinical characteristics, HIV status, and molecular biomarkers in squamous cell carcinoma of the conjunctiva in Ghana. Health Science Reports 2019;2(2):e108.
Hollhumer R, Michelow P, Williams S. Ocular surface squamous neoplasia: Population demographics, pathogenesis and risk factors. Afr Vision Eye Health 2020;79(1):1-8.
Gichuhi S, Macharia E, Kabiru J, et al. Risk factors for ocular surface squamous neoplasia in Kenya: A case-control study. Tropical Medicine & International Health 2016;21(12):1522-1530.
Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical management of ocular surface squamous neoplasia: A review of the current evidence. Ophthalmology and Therapy 2018;7(2):247-262.
Giles K, Bilong Y, Arlette N, Chantal N, Lucienne BA. Orbital exenteration in immunodeficiency virus- infected patients. Clin Ophthalmology 2016; 0:2055-2059.
HoffmanJ,BurtonM.Ocularsurfacedisorders.CommEyeHealthJ2016;29(95):41.
Del Barrio LT, Cuadrado MM, Camacho LM, Enériz AZ, Laflin MD, Soler AA. Epithelial conjunctival neoplasias–the importance of an early diagnosis and optimal treatment. GMS Ophthalmology Cases
;10.
Reynolds JW, Pfeiffer ML, Ozgur O, Esmaeli B. Prevalence and severity of ocular surface neoplasia in
African nations and need for early interventions. J Ophthalmic Vision Res 2016;11(4):415-421.
Rathi SG, Ganguly Kapoor A, Kaliki S. Ocular surface squamous neoplasia in HIV infected patients: Current perspectives. HIV AIDS (Auckl) 2018;14:10:33-45. https://doi.org/10.2147/HIV.S120517.
eCollection 2018.
PadmavathiP,PrabhaDP,AtherM,KavithaT,PadmaM.Clinicalbehaviourofocularsurfacesquamous
neoplasia (OSSN) in HIV positive patients. MRIMS J Health Sci 2016;4(2):114-117.
Ong Beng Seng M, Meyer D, Gichuhi S, et al. Ocular surface disorders in patients with human
immunodeficiency virus (HIV) infection. Ocular Immunol Inflamm 2020;28(7):1015-1021.
GichuhiS,KabiruJ,M’BongoZindamoyenA,etal.Delayalongthecare-seekingjourneyofpatientswith
ocular surface squamous neoplasia in Kenya. BMC Health Serv Res 2017;17(1):485.
Hӧllhumer R, Michelow P, Williams S. Demographics, clinical presentation and risk factors of ocular surface squamous neoplasia at a tertiary hospital, South Africa. Eye (Lond) 2023;37(17):3602-3608.
https://doi.org/10.1038/s41433-023-02565-1
LloydHW,ArungaS,TwinamasikoA,FrederickMA,OnyangoJ.Predictorsofocularsurfacesquamous
neoplasia and conjunctival squamous cell carcinoma among Ugandan patients: A hospital-based study.
Middle East African J Ophthalmology 2018;25(3-4):150.
Kamal S, Kaliki S, Mishra DK, Batra J, Naik MN. Ocular surface squamous neoplasia in 200 patients:
A case-control study of immunosuppression resulting from human immunodeficiency virus versus immunocompetency. Ophthalmology 2015; 22(8):1688-1694. https://doi.org/10.1016/j. ophtha.2015.04.027
Julius P, Siyumbwa SN, Moonga P, et al. Clinical and pathologic presentation of primary ocular surface tumors among Zambians. Ocular Oncology Pathology 2021;7(2):108-120.
Cicinelli MV, Marchese A, Bandello F, Modorati G. Clinical management of ocular surface squamous neoplasia: A review of the current evidence. Ophthalmology Therapy 2018;7:247-262.
Fasina O. Ocular surface squamous neoplasia at a tertiary eye facility, Southwestern Nigeria: A 10-year review. Int Ophthalmology 2021;41(10):3325-3331.
Patel U, Karp CL, Dubovy SR. Update on the management of ocular surface squamous neoplasia. Curr Ophthalmology Reports 2021;9:7-15.
Tananuvat N, Niparugs M, Wiwatwongwana D, Lertprasertsuk N, Mahanupap P. Ocular surface squamous neoplasia in Northern Thailand: A 16-year review. BMC Ophthalmol 2022;22(1):121.
Höllhumer R, Michelow P, Williams S. Diagnosis and staging of ocular surface squamous neoplasia. African Vision and Eye Health 2020;79(1):8.
CohenVM,O’DayRF.Managementissuesinconjunctivaltumours:Ocularsurfacesquamousneoplasia. Ophthalmology Ther 2020;9:181-190.
Liu T, Cohen D, Sabharwal S. Diagnosis and management of ocular surface neoplasia. Adv Ophthalmology Optometry 2023 ;8(1):299-312.
HӧllhumerR,WilliamsS,MichelowP.Ocularsurfacesquamousneoplasia:Managementandoutcomes. Eye 2021;35(6):1562-1573.
Manda CS, Kayange PC, Moyo VV, Nyaka A, Khalua K. Health care seeking behaviour characteristics of patients presenting with advanced ocular surface squamous neoplasia at Queen Elizabeth Central Hospital in Malawi. J Ophthalmology of Eastern, Central and Southern Africa 2016;20(1).
Koomson NY, Adaboh H, Nkansah EK, Amponsah JK, Larbi D, Odotei SO. Accessibility and barriers to uptake of ophthalmic services among rural communities in the Upper Denkyira West district, Ghana. J Ophthalmic Sci 2019;2(1):24-34.
Lilian RR, Railton J, Schaftenaar E, et al. Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package. PloS One 2018;13(5):e0197432. 36. Ekpenyong BN, Ndep AO, Osuchukwu N, Ezenwankwo A, Aruotu N. Achieving access to eye care services through primary health care facilities: Current situation in Nigeria. J Public Health Dev
Countries 2017;3(2):413-417.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 S Mhlanga, A C Turner, S J Biddulph

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.