Saffra Norman A, Emborgo Trisha S, Iacob Codrin E, Kirsch David S
Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, NY, USA.
Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
J Med Case Rep. 2020 Oct 2;14(1):174. doi: 10.1186/s13256-020-02510-w.
New York City has a heterogeneous population with many undocumented and uninsured immigrants from equatorial areas who have a higher incidence of ocular surface squamous neoplasia. To the best of our knowledge, this is the first documented selection of this cost-effective treatment of ocular surface squamous neoplasia (the use of absolute ethanol along the corneal margin, primary excision, double freeze-thaw cryopexy, and primary conjunctival closure) for an undocumented and uninsured New York City patient.
A 35-year-old man from Ecuador presented to a New York City emergency department due to worsening discomfort of a long-standing left eye pterygium. A slit-lamp examination of the left eye demonstrated a nasally located conjunctival mass measuring 6 × 8 mm extending onto the cornea (3 mm superiorly and 6 mm inferiorly on the cornea). Histological diagnosis confirmed squamous cell carcinoma in situ arising from the pterygium. Surgical excision with adjunctive absolute alcohol with additive double freeze-thaw cryopexy was performed. Our patient has remained free of tumor recurrence at year 2 postoperative visit.
Our case highlights the need to choose a cost-effective treatment for ocular surface squamous neoplasia in an at-risk population among undocumented and uninsured patients. Areas in the world with similar types of populations or treatment challenges may need to consider this approach as a primary treatment option.
纽约市人口构成多样，有许多来自赤道地区的无证和未参保移民，他们患眼表鳞状上皮肿瘤的几率较高。据我们所知，这是首次有文献记载为一名纽约市的无证且未参保患者选择这种具有成本效益的眼表鳞状上皮肿瘤治疗方法（沿角膜缘使用无水乙醇、一期切除、双重冻融冷冻治疗以及一期结膜闭合）。
一名来自厄瓜多尔的35岁男性因长期左眼翼状胬肉不适加重前往纽约市一家急诊科就诊。左眼裂隙灯检查显示鼻侧结膜肿物大小为6×8毫米，延伸至角膜（角膜上方3毫米，下方6毫米）。组织学诊断证实为翼状胬肉原位鳞状细胞癌。实施了手术切除并辅助使用无水乙醇以及附加双重冻融冷冻治疗。在术后第2年的随访中，我们的患者未出现肿瘤复发。
我们的病例凸显了在无证和未参保的高危人群中，为眼表鳞状上皮肿瘤选择具有成本效益的治疗方法的必要性。世界上具有类似人口类型或治疗挑战的地区可能需要将这种方法作为主要治疗选择加以考虑。
