Primary Ocular Surface Squamous Neoplasia Research Articles

Efficacy of topical Interferon Alfa- 2b used as an adjunct in the management of primary OSSN

To assess the efficacy of topical interferon alfa-2b as an adjunct therapy in the management of primary ocular surface squamous neoplasia (OSSN).: Clinically visible OSSN on slit lamp examination in 21 patients (21 tumors) was managed with topical interferon alfa-2b, 1 million IU/mL, 4times daily for a period of one month, before subjecting the patients to definitive surgery. The patients were periodically observed, over a period of 6 months. Tumor control and complications were evaluated according to American Joint Committee on Cancer classification. A significant reduction in size, was noted in smaller tumors. Final diagnosis and staging was done after histopathological examination of the surgically excised tumour, which had been excised with a 4mm margin. Bigger extensive lesion did not show appreciable response in terms of appearance or reduction of size. Tumor size was found to be reduced significantly in 19 out of 21 tumors (%) following topical interferon alfa-2b treatment for a period of 1 month, from the presentation. Of the 19 tumors, tumor surface area was reduced 44% (median). Two patients (8.3%) did not respond to the treatment.Based on American Joint Committee on Cancer classification, significant reduction was achieved in 2 of 3 Tis (67%), 17 of 20 T3 (85%), 19 of 23 N0 (83%), and 19 of 23 M0 (83%) category tumors. According to American Joint Committee on Cancer classification, significant reduction with topical interferon alfa-2b can be achieved in 67% of Tis, 85% of T3, and 83% of all OSSN.

DEMOGRAPHIC CLINICAL PRESENTATION AND TREATMENT OUTCOME OF OCULAR SURFACE SQUAMOUS NEOPLASIA

Purpose: The aim of the study is to analyze demographic, clinical profile and treatment outcome of ocular surface squamous neoplasia (OSSN). Methods: It was a retrospective study and analysis of 36 eyes (36 cases) diagnosed with OSSN, treated at teritiary eye care center over 3 years. Results: The median age of the treated patients was 53 years, patients with outdoor activity were 77.7% (28/36), while human immunodeficiency virus infection (2/36) with predisposing conditions had a younger median age of (32 years). Carcinoma insitu was found in half of the patients n=18 (50%) and treatment advised was wide local excision (4 mm margin clearance) with cryotherapy followed by topical treatment with mitomycin-c 0.04% . Overall, complete regression was achieved in all cases during a mean follow-up of 16.8 ± 3.65 months. No recurrence was seen. Conclusion: Although OSSN is associated with old age, earlier onset of OSSN is seen in patients with systemic predisposing conditions. Males and females are equally prone to OSSN. Most of the patients with OSSN belong to 41-60 years age group. In HIV positive patients, OSSN appeared at an early age and was more aggressive in nature. Nasal quadrant was most commonly involved and the tumor epicenter was limbus. Most common symptom was mass or growth followed by redness and diminution of vision. Sunlight exposure is a major risk factor. Carcinoma insitu was most common histopathological diagnosis followed by Dysplasia and Squamous cell carcinoma. Surgical excision and cryotherapy followed by topical Mitomycin-C weekly on and off for 3-4cycles is associated with best control of primary OSSN with no tumor recurrence.

Mitomycin-C as adjunctive treatment of Ocular Surface Squamous Neoplasia

The aim of this study is to report the efficacy of topical Mitomycin-C (MMC) as adjunctive treatment following primary excision of ocular surface squamous neoplasia (OSSN).After detailed evaluation, 25 eyes in 25 patients with localized primary OSSN were selected in a prospective, interventional study and subjected to primary excision followed by the application of topical 0.04% MMC as an adjunct and thereafter followed up over a 24 month period for signs of any tumor recurrence. The 25 patients selected with primary OSSN had a mean age of 64(SD 13) with a range of 47-87 years. They underwent surgical excision followed by 3 cycles of freshly prepared 0.04% MMC with 2 weeks on and 2 weeks off for 12weeks.All patients were followed up thereafter at 1 week, 2 weeks, monthly for 6 months and every 3 months for the next 24 months. No tumor recurrence was observed in any of the cases.Topical MMC has a definite role in preventing tumor recurrence when used as adjunctive treatment following primary surgical excision of OSSN.

Assessing Profile and Treatment Outcome in Patients of Ocular Surface Squamous Neoplasia (OSSN).

This study has attempted to assess the profile and treatment outcome of patients with OSSN and report the recurrence rate following treatment of primary OSSN. This was a retrospective, non-comparative hospital based observational study. The case files of OSSN patients from Jan 2010 to Dec 2017were assessed. The study site was Himalaya Eye Hospital, Gharipatan, Pokhara. This hospital is the only eye hospital in province 4, Nepal. All the files of suspicious cases of conjunctival mass or OSSN were reviewed. Data regarding demographic characteristics, vision acuity, involved eye, clinical features, conjunctival lesion type, duration of symptoms, preoperative clinical diagnosis, history, other eye disease, associated systemic diseases, occupation as well as treatment modalities of the patients and its outcome were taken. Out of 40 cases, females were 21(52.5%) vesus 19(47.5%) male. Amongthem, 19 patients had keratinized stratified squamous epithelium, 17 had conjunctiva intraepithelial squamous neoplasia and 4 had invasive squalors cell carcinoma. Predominance age group was 15-59 age (25/40, 62.5%), among which 12 had keratinized stratified squamous epithelium, 11 conjunctival intraepithelial squamousneoplasia and 2 had invasive squamous cell carcinoma conjunctival lesion. The mean duration of symptoms was about nine months (S.D. = 5.972). The mean size of lesion mass was 3.28 mm (SD=1.569). More than half of the cases (55%, 22/40) had the mass located at nasal limbus. 95% (38/40) cases underwent lesion total excision and direct closure and 5% (2/40) underwent lesion excision followed by Amniotic Membrane grafting. Only 5% (2/40) cases, those who had undergone lesion excision, the lesion recurrence was observed during follow up period of 31 months. The outcome of the OSSN following the treatment was found to be satisfactory. Further studies with prolonged follow-up are recommended to evaluate the risk of recurrence and other adverse effects.

Ocular surface squamous neoplasia: angiographic characteristics and response to subconjunctival/perilesional 5-fluorouracil injections.

Introduction: To investigate the angiographic characteristics of ocular surface squamous neoplasia (OSSN) and to evaluate the efficacy of subconjunctival/perilesional 5-fluorouracil injections in OSSN cases.Materials and methods: Six eyes of six patients with primary OSSN, received perilesional, subconjunctival, 25-mg/mL 5-fluorouracil injections at certain intervals. Anterior segment digital photography images, anterior segment optical coherence tomography (AS-OCT), and conjunctival indocyanine green angiography (ICGA) were obtained simultaneously with fluorescein angiography.Results: The mean best-corrected vision acuity significantly improved after treatment. At baseline, the median of the largest thickness of OSSN was 905.0 (interquartile range: 492.0–1592.5) μm based on AS-OCT data. There was an abrupt transition between normal and abnormal epithelium, a thickened hyper-reflective epithelium, and a sharp plane of cleavage between the lesion and underlying tissue, all indicative of OSSN. The angiographic characteristics of OSSN included focal or seafan-shaped intratumoral and conjunctival feeding vessels visible via ICGA, and abnormal vascular leakage visible with fluorescein angiography. The median time to tumor regression after treatment was 35.0 (interquartile range: 32.0–45.5) days in five eyes without recurrence, and OSSN in one eye regressed partially 40 days after treatment.Conclusion: This is the first report of the angiographic characteristics of OSSN and its response to subconjunctival/perilesional 5-fluorouracil injections by simultaneous conjunctival angiography and AS-OCT. The improved subconjunctival/perilesional 5-fluorouracil injection was an effective therapy for OSSN in both best-corrected vision acuity gain and anatomic outcomes.

Amniotic membrane transplantation with topical interferon alfa-2b after excision of ocular surface squamous neoplasia.

To evaluate the outcome of amniotic membrane transplantation (AMT) after tumor excision followed by topical interferon alfa-2b (IFNα2b) drops for primary ocular surface squamous neoplasia (OSSN). Twelve eyes of 12 patients with a mean age of 66±10y were included. The average follow-up was 23±10mo. All 12 patients had limbal involvement. Smooth ocular surface and transparent cornea were achieved in all cases. No sign of inflammation, neovascularization, symblepharon or recurrence was noted at the last follow-up. We conclude that AMT with topical IFNα2b drops restores a healthy ocular surface in OSSN without recurrence.

Topical Interferon α-2b as a Single Therapy for Primary Ocular Surface Squamous Neoplasia.

The aim of this study was to evaluate the efficacy and safety of topical interferon α-2b (IFNα2b) as a single therapy for primary ocular surface squamous neoplasia (OSSN). Medical records of 24 eyes of 24 patients with primary OSSN were reviewed retrospectively. The diagnosis of OSSN was primarily based on the slit-lamp examination. All cases were treated with topical IFNα2b (1 million IU/mL) 4 times daily. The duration of treatment, tumor response, adverse effects, and number of vials of topical IFNα2b were noted. Complete response was defined as total disappearance of lesions. The complete remission of the tumor was observed in 22 patients (91.6%). Two patients (8.3%) did not respond to the treatment. The mean age was 62.44 ± 13.65 years (range, 50-92 years). The mean follow-up period was 18.81 ± 3.81 months (range, 14-22 months). The median greatest linear dimension was 6 mm (range, 5.2-12 mm). In all successful remissions, the median time to lesion resolution was 3.25 months. Adverse effects of topical IFNα2b included spontaneous intratumoral bleeding after 3 weeks of topical therapy in 1 patient. No long-term complication or recurrence was found at the end of the follow-up period. Topical IFNα2b is effective and safe as a single therapy in the management of primary OSSN with minimal self-limited adverse effects. It may provide the least invasive way of treating OSSN.

Topical interferon alpha-2b for treatment of noninvasive ocular surface squamous neoplasia with 360° limbal involvement.

Purpose:To report the results of topical interferon alpha-2b (IFNα2b) for the treatment of ocular surface squamous neoplasia (OSSN) with 360° limbal involvement.Methods:In a prospective observational study, five patients with biopsy proven primary or recurrent OSSN with 360° limbal involvement received topical IFNα2b (3 million IU/ml, 4 times daily) and were followed from 8 to 12 months. Outcome measures included resolution of the lesion, relief of symptoms, systemic and ocular side effects, and recurrence rate.Results:Five patients including 4 primary OSSNs and one recurrent OSSN received topical interferon alpha-2b. The mean age was 60.2 (range: 52–73) years and mean follow up duration was 10.2 months. Clinical resolution of the tumor occurred in all cases 2 months after initiation of treatment and no patient developed ocular or systemic complications. No recurrence of OSSN developed during the follow up period.Conclusion:Topical recombinant IFNα2b appears to be an effective alternative treatment for OSSN with 360° limbal involvement. This approach precludes the high risk of limbal stem cell deficiency which results from surgical excision or topical chemotherapeutic agents.

Risk Factors for Ocular Surface Squamous Neoplasia Recurrence after Treatment With Topical Mitomycin C and Interferon Alpha-2b

To determine the rate of recurrence and associated risk factors after the use of mitomycin C (MMC), interferon alpha-2b, or both for management of noninvasive ocular surface squamous neoplasia (OSSN). Retrospective, noncomparative, interventional case series. Clinical practice setting of 135 patients treated consecutively with topical MMC (0.4 mg/mL), interferon alpha-2b (1 million units/mL), or both for OSSN observed for clinical recurrence. Clinical recurrences were diagnosed in 19 (14.1%) of 135 eyes after topical treatment. The mean time to recurrence was 17.2 months (range, 4 to 61 months), with 14 eyes (73.7%) recurring within a 2-year period. There was no greater risk of recurrence identified for variables including lesion size, lesion location, gender, age, treatment type, or treatment duration. Post hoc log-rank pairwise comparisons revealed that lesions initially treated using surgery alone had significantly reduced time to recurrence (21.1 ± 5.6 months) compared with previous topical treatment with MMC (with or without surgery; 29.6 ± 4.7 months; P = .04) and primary OSSN (23.2 ± 1.8 months; P = .09). Topical MMC and interferon alpha-2b are an effective treatment method for a wide range of noninvasive OSSNs. Topical therapy avoids the morbidity of excisional surgery with equivalent or reduced recurrence rates and should be considered as primary therapy.

Combined excision, cryotherapy, and intraoperative mitomycin C (EXCRIM) for localized intraepithelial and squamous cell carcinoma of the conjunctiva

To report the results of patients undergoing combined excision, cryotherapy, and intraoperative mitomycin-C (EXCRIM) for primary ocular surface squamous neoplasia (OSSN) METHODS: A retrospective review of a non-comparative interventional case series. Histopathologically confirmed primary localized (less than four clock hours) OSSN treated with EXCRIM using adjuvant 0.02 % mitomycin-C (MMC) were included in the study. The main outcome measures were recurrence and complications related to MMC. The study enrolled 28 eyes of 28 patients with OSSN with a median age of 64.5 (range 43 to 84) years. The mean tumor size was 6.9 × 4.35 mm. There was corneal involvement in 23 of 28 (82 %). Seven patients (21 %) had delayed epithelial healing. Two of eight patients (25 %) with squamous cell carcinoma (SCC) had positive lateral margins. There were no recurrences over a mean follow-up of 49 months (range 24 to 96). The excision of OSSN combined with cryotherapy and intraoperative MMC is effective with a low recurrence rate. Long-term follow-up yielded favorable results.

Mitomycin C: An effective adjuvant in the management of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) forms a spectrum of dysplasia from conjunctival-corneal intraepithelial neoplasia to an invasive squamous cell carcinoma (SCC). Management of OSSN is surgical excision; however, with a high reported recurrence rates (33 to 56%). Hence, Mitomycin C, a tumor-targeted deoxyribonucleic acid (DNA) synthesis inhibitor is considered as an adjuvant following excision of primary OSSN. Aim: To report the cure and recurrence rate with excision of primary OSSN with Mitomycin C as an adjunctive ina single ocular center over 1 year period. Materials and Methods: Twelve eyes of 12 patients with histologically proven primary were included in the study between 1 st Jan 2009 and 31 st Dec. 2009. Protocol for the management comprised of surgical excision of the lesion with a 3 mm of healthy rim with cryotherapy followed by topical Mitomycin C 0.04% four times a day to all postoperative patients in 3-4 cycles of alternate on and off weekly courses. At each visit, looked for recurrence of tumor and corneal alterations like keratitis or erosions. Efficacy of Mitomycin C as an adjuvant therapy was measured in terms of clinical cure and recurrence of the tumor. Results: Average age 45.25 years with 42% below 40 years with 83% male preponderance. With a follow up period of 44.5 months, 91.7% success rate found despite late stage presentation in our study. Conclusion: Hence, we conclude that, Mitomycin C treatment following surgical excision decreases the recurrencerate of primary ocular surface neoplasia and should be considered as adjunctive therapy in primary treatment.

Topical Interferon or Surgical Excision for the Management of Primary Ocular Surface Squamous Neoplasia

To describe the successful treatment and long-term outcomes of primary ocular surface squamous neoplasia (OSSN) with topical interferon alfa-2b or surgical excision. Retrospective, comparative, interventional case series. Twenty-nine consecutive patients with OSSN never before treated. Patients with primary OSSN chose topical interferon alfa-2b or excision with wide surgical margins, with crossover to surgery in those interferon-treated patients whose OSSN failed to regress within 2 months after beginning therapy. Successful resolution of clinical disease at 2 months after topical interferon treatment and time to recurrence after either topical interferon or surgical excision. Of 29 patients with primary OSSN, 15 elected topical interferon and 14 chose surgical excision. Two patients in the interferon group subsequently underwent surgical excision for apparent lack of response to interferon. No patient in either group developed a recurrence during the study period (disease-free follow-up: interferon group, mean, 35.6 months [95% confidence interval, 21.9-49.3]; surgery group, mean, 35.6 months [22.9-48.3]). Both topical interferon alfa-2b and aggressive surgical excision appear to be effective for primary OSSN.