Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a
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(2020) 14:174
CASE REPORT
Open Access
Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a case report Norman A. Saffra1,2*, Trisha S. Emborgo1, Codrin E. Iacob3 and David S. Kirsch1
Abstract Background: 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. Case presentation: 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. Conclusions: 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. Keywords: Ocular surface squamous neoplasia, Undocumented, Uninsured, Cost-effective treatment, Case report
Background Ocular surface squamous neoplasia (OSSN) includes a variety of dysplastic changes of the conjunctiva and cornea, ranging from benign dysplasia to carcinoma in situ to invasive squamous cell carcinoma [1, 2]. Risk factors include ultraviolet (UV) light, immunosuppression, human immunodeficiency virus (HIV), human papillomavirus * Correspondence: [email protected] 1 Department of Ophthalmology, St. John’s Episcopal Hospital, Far Rockaway, NY, USA 2 Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA Full list of author information is available at the end of the article
(HPV), mutations of p53, and older age [1–3]. Patients typically complain of redness, foreign body sensation, and growth on the ocular surface [1]. Treatment of OSSN includes a variety of options and even combinations of therapy, such as excisional biopsy, cryotherapy, or topical chemotherapy [4, 5]. Personalizing treatment requires evaluation of not just the medical aspects of the condition but also the social needs of the patient. For example, the use of primary or adjunctive topical chemotherapy may not be ideal for an undocumented and uninsured New York City (NYC) pat
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