Meta-analysis of 8688 specimens reveals incidental ocular surface squamous neoplasia prevalence and risk factors in pterygium
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Key Takeaway
Consider UV exposure and equator proximity as risk factors for incidental ocular surface squamous neoplasia in pterygium.
This systematic review and meta-analysis synthesized data from 8688 specimens of clinically diagnosed pterygia to assess the prevalence of incidental ocular surface squamous neoplasia. The review examined risk factors including ultraviolet exposure, geographic proximity to the equator, and publication year across multiple regions and countries.
The pooled prevalence of incidental ocular surface squamous neoplasia was 1.32%, representing 202 cases with a 95% CI 0.41% to 4.21%. Higher prevalence was associated with greater ultraviolet exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01), while lower prevalence correlated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01). Regional prevalence varied significantly, ranging from Europe 0.29%, Asia 0.76%, North America 1.03%, Oceania 8.57%, to South America 14.97%.
Comparisons with benign pterygia showed no significant differences regarding age, sex, lesion location, or primary versus recurrent pterygia. Publication year showed no effect on prevalence (p=0.98). Authors note low- to very low-certainty evidence limits strong conclusions. Findings may guide management by differentiating pterygium from ocular surface squamous neoplasia, though clinical application requires caution due to evidence limitations. Regional prevalence varied significantly, ranging from Europe 0.29% to South America 14.97%.
View Original Abstract ↓
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed pterygia.
METHODS: Ovid Embase, MEDLINE, Cochrane Library and Web of Science were systematically searched from January 2000 to February 2025. Included studies analysed ≥100 clinically diagnosed pterygia via histopathology. Random-effects meta-analysis assessed the prevalence of incidental OSSN among pterygia. Risk factors were evaluated using the Mantel-Haenszel and inverse variance methods, and meta-regression analysed the influence of publication year, geographic proximity to the equator, and country-level ultraviolet (UV) radiation exposure.
RESULTS: 12 studies, comprising 8688 specimens, identified 202 cases of incidental OSSN (pooled prevalence=1.32%, 95% CI 0.41% to 4.21%, I=95.3%). Meta-regression revealed that lower OSSN prevalence was associated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01), while higher prevalence was associated with greater UV exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01). Publication year had no effect (p=0.98). Age (p=0.18), sex (p=0.45) and lesion location (p=0.60-0.82) did not differ between incidental OSSN cases and benign pterygia. Incidental OSSN prevalence also did not differ between primary and recurrent pterygia (p=0.23). Regional analyses revealed variation in prevalence: Europe (0.29%), Asia (0.76%), North America (1.03%), Oceania (8.57%) and South America (14.97%).
CONCLUSIONS: This meta-analysis, based on low- to very low-certainty evidence, identified a 1.32% pooled prevalence of incidental OSSN in clinically diagnosed pterygia, highlighting the potential influence of UV exposure and equatorial proximity. The overlap in demographic and lesion characteristics between benign pterygia and OSSN underscores diagnostic challenges.
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