Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia

Ann Q Tran,Anat Galor,Nandini Venkateswaran,Carol L Karp

doi:10.1186/s40662-019-0152-3

Abstract

BackgroundTo evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia (OSSN) detected by high-resolution anterior segment tomography (HR- OCT) in patients with clinically unapparent disease following topical treatment.MethodsA retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted. Patients undergoing primary therapy with topical 5-fluorouracil 1% (5-FU) (4 times a day for 7 days with a 21-day break) or interferon-alpha-2b (IFN) (4 times a day) were reviewed. Patients were separated into two groups. Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT. Group 2 (sub-clinical OSSN group) included individuals with clinical OSSN resolution but with features of persistent disease on HR- OCT. Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct.ResultsA total of 95 patients (95 eyes) were reviewed. Sub-clinical OSSN was detected at a frequency of 17% in our study patients (n = 16 patients, 9 treated with 5-FU and 7 treated with IFN). In the 16 individuals, the mean time to clinical resolution was 3.6 ± 1.0 cycles for 5-FU and 4.0 ± 0.0 months for IFN. An additional 2.1 ± 0.8 cycles for 5-FU and 1.2 ± 0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN. Recurrence in Group 1 was noted in 10 patients (12%) while no recurrences occurred in Group 2, the cohort with subclinical disease that received the extended medical therapy. The mean follow-up was 24.0 ± 17.9 months.ConclusionWe found that at least 17% of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT. This information can be used to optimize treatment and extend therapy past the point of clinical resolution.

Highlights

To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia (OSSN) detected by high-resolution anterior segment tomography (HR- OCT) in patients with clinically unapparent disease following topical treatment
In Group 1 with clinically resolved disease, 79 patients (79 eyes, 83% of all patients) had simultaneous clinical and high-resolution optical coherence tomography (HR-OCT) resolution of their OSSN, 43 of whom were first treated with IFN and 36 of whom were first treated with 5-fluorouracil 1% (5-FU)
2 were subsequently switched from IFN to 5-FU due to persistence of clinically apparent disease. After treating these patients with 5-FU, there was clinical resolution of OSSN, but persistent sub-clinical OSSN detected by HR-OCT

Summary

Introduction

To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia (OSSN) detected by high-resolution anterior segment tomography (HR- OCT) in patients with clinically unapparent disease following topical treatment. The use of anterior segment high-resolution optical coherence tomography (HR-OCT) provides a non-invasive imaging modality to aid in the diagnosis and management of OSSN [3]. It has proved to be a highly effective treatment modality, with the most commonly used chemotherapeutic agents being interferon (IFN), 5-fluorouracil 1% (5-FU), and mitomycin C (MMC) [6]. These agents have high success rates and are used until the lesion is clinically resolved. Potential side effects of topical therapy include pain, hyperemia, conjunctivitis, and corneal toxicity, which are most prominent with MMC and least prominent with IFN [7]

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