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Alharbi I, Alfawaz AM, Otaif W, Al-Dahmash SA, Alkatan HM. Variable presentations of six conjunctival/limbal ocular surface squamous neoplasia (OSSN) cases: How good is our clinical judgment evidenced by the correlation to the histopathological findings and diagnosis? Int J Surg Case Rep 2024; 116:109359. [PMID: 38330700 PMCID: PMC10864213 DOI: 10.1016/j.ijscr.2024.109359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Ocular surface squamous neoplasia (OSSN) may have atypical or unusual presentations and may attain large sizes especially in cases of delayed presentation resulting in late diagnosis, treatment, and eventual guarded visual prognosis. We are reporting an interesting cases series of OSSN with variable clinical presentations to highlight the importance of the pre-operative clinical judgment and tissue diagnosis. PRESENTATION OF CASES Six patients (4 females and 2 males; mean age 59 years; range 42-79 years) were included with suspicious conjunctival lesions. The maximum dimension of the lesions was 17 mm. The initial suspected pre-operative clinical diagnosis -other than OSSN- included pterygium/pinguecula (n = 2), benign squamous papilloma (n = 1), cyst versus pyogenic granuloma (n = 1), and lymphoma (n = 1). This work has been reported in line with the PROCESS criteria. DISCUSSION The final histopathological diagnosis was unexpectedly invasive squamous cell carcinoma (SCC) in 4, one SCC in-situ, and squamous dysplasia in one. The primary treatment included MMC 0.02 % for 2 cycles for chemo-reduction in one of the cases where OSSN was suspected. Excisional biopsy was performed eventually for all lesions with application of one or more of the following modalities: MMC 0.02 %, absolute alcohol 99 %, and cryotherapy to the conjunctival margin. No tumor recurrence was noted in any of the patients after an average period of follow-up of 26 months. Even though the outcome was good, tumor-related morbidity and delay in the referral by general ophthalmologists are to be considered. CONCLUSION Conjunctival OSSN has wide presentation clinically and can be challenging in terms of diagnosis. Histopathological evaluation is essential for a definitive diagnosis and treatment. Accurate clinical diagnosis might affect the management plan with consideration for topical therapeutic modalities, however, these cases are best managed by wide excision using the no-touch technique and double-freeze-thaw cryotherapy to the conjunctiva with consideration of topical chemotherapy.
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Affiliation(s)
- Ibrahim Alharbi
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia
| | - Abdullah M Alfawaz
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Wael Otaif
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia
| | - Saad A Al-Dahmash
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Alkatan
- Ophthalmology Department, College of Medicine, King Saud University, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Pathology Department, College of Medicine, King Saud University, Saudi Arabia.
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Croley CR, Pumarol J, Delgadillo BE, Cook AC, Day F, Kaceli T, Ward CC, Husain I, Husain A, Banerjee S, Bishayee A. Signaling pathways driving ocular malignancies and their targeting by bioactive phytochemicals. Pharmacol Ther 2023:108479. [PMID: 37330112 DOI: 10.1016/j.pharmthera.2023.108479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
Ocular cancers represent a rare pathology. The American Cancer Society estimates that 3,360 cases of ocular cancer occur annually in the United States. The major types of cancers of the eye include ocular melanoma (also known as uveal melanoma), ocular lymphoma, retinoblastoma, and squamous cell carcinoma. While uveal melanoma is one of the primary intraocular cancers with the highest occurrence in adults, retinoblastoma remains the most common primary intraocular cancer in children, and squamous cell carcinoma presents as the most common conjunctival cancer. The pathophysiology of these diseases involves specific cell signaling pathways. Oncogene mutations, tumor suppressor mutations, chromosome deletions/translocations and altered proteins are all described as causal events in developing ocular cancer. Without proper identification and treatment of these cancers, vision loss, cancer spread, and even death can occur. The current treatments for these cancers involve enucleation, radiation, excision, laser treatment, cryotherapy, immunotherapy, and chemotherapy. These treatments present a significant burden to the patient that includes a possible loss of vision and a myriad of side effects. Therefore, alternatives to traditional therapy are urgently needed. Intercepting the signaling pathways for these cancers with the use of naturally occurring phytochemicals could be a way to relieve both cancer burden and perhaps even prevent cancer occurrence. This research aims to present a comprehensive review of the signaling pathways involved in various ocular cancers, discuss current therapeutic options, and examine the potential of bioactive phytocompounds in the prevention and targeted treatment of ocular neoplasms. The current limitations, challenges, pitfalls, and future research directions are also discussed.
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Affiliation(s)
- Courtney R Croley
- Healthcare Corporation of America, Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Hudson, FL 34667, USA
| | - Joshua Pumarol
- Ross University School of Medicine, Miramar, FL 33027, USA
| | - Blake E Delgadillo
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Andrew C Cook
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Faith Day
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Tea Kaceli
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Caroline C Ward
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Imran Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Ali Husain
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA 16509, USA
| | - Sabyasachi Banerjee
- Department of Pharmaceutical Chemistry, Gupta College of Technological Sciences, Asansol 713 301, India
| | - Anupam Bishayee
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA.
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Monroy D, Serrano A, Galor A, Karp CL. Medical treatment for ocular surface squamous neoplasia. Eye (Lond) 2023; 37:885-893. [PMID: 36754986 PMCID: PMC10050251 DOI: 10.1038/s41433-023-02434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common non-melanocytic tumour of the ocular surface. Surgical excision with wide margins using the "no-touch" method was originally the most popular treatment for OSSN. However, in the past two decades, the use of topical medications for OSSN treatment has gained a reputation amongst ophthalmologists for being an effective alternative to surgical excision. Furthermore, technological advancements, such as those seen in high-resolution optical coherence tomography (HR-OCT) for the anterior segment, have facilitated the diagnosis and monitoring of OSSN. When selecting a topical agent, interferon alpha-2b (IFNα-2b) and 5-fluorouracil (5-FU) are two of the gentlest medications used for OSSN and are often considered first line therapies due to their high-resolution rates and mild side effect profiles. Mitomycin C (MMC), on the other hand, has a highly toxic profile; therefore, while effective, in our hands it is considered as a second-line treatment for OSSN if the other modalities fail. In addition, newer and less studied agents, such as immune checkpoint inhibitors, retinoic acid, aloe vera, and anti-vascular endothelial growth factor have anti-neoplastic properties and have shown potential for the treatment of OSSN. We enclose an updated literature review of medical treatments for OSSN.
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Grants
- R01 EY026174 NEI NIH HHS
- P30 EY014801 NEI NIH HHS
- I01 BX004893 BLRD VA
- R61 EY032468 NEI NIH HHS
- I01 CX002015 CSRD VA
- The Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (Dr. Galor) and Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (Dr. Galor), Department of Defense Gulf War Illness Research Program (GWIRP) W81XWH-20-1-0579 (Dr. Galor) and Vision Research Program (VRP) W81XWH-20-1-0820 (Dr. Galor), National Eye Institute R01EY026174 (Dr. Galor) and R61EY032468 (Dr. Galor), and Research to Prevent Blindness Unrestricted Grant (institutional).
- NIH Center Core Grant P30EY014801, RPB Unrestricted Award, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough Grant,The Robert Baer Family Grant, The Roberto and Antonia Menendez Grant, The Emilyn Page and Mark Feldberg Grant, The Calvin and Flavia Oak Support Fund, The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant, The Carol Soffer Grant, and the Richard Azar Family Grant(institutional grants).
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Affiliation(s)
- David Monroy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andres Serrano
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Kumar SV, Kumar V, Mishra SK, Sati A. Clinicopathological profile, management and clinical outcomes in recurrent cases of ocular surface squamous neoplasia at a tertiary care centre. Int Ophthalmol 2023; 43:371-380. [PMID: 35857192 DOI: 10.1007/s10792-022-02432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was taken up to look into the various causes of recurrence, clinicopathological profile and final outcomes in recurrent cases of ocular surface squamous neoplasia (OSSN). METHODOLOGY A prospective cohort study was conducted and total 18 patients were recruited. All patients were subjected to detailed history, comprehensive eye examination and imaging studies. A treatment plan was formulated based on the size and extent of the lesion. The primary outcome measure was complete response to treatment with no evidence of recurrence after12 months and secondary outcome measure was complication associated with each treatment modality. RESULTS The common cause of recurrence in our study was misdiagnosis of the lesion as in 15 cases it was diagnosed as pterygium and in 03 cases it was actinic keratosis. Excision Biopsy with adjunctive cryotherapy was the preferred treatment modality followed by topical interferon-alpha 2b drop-in our study. We could achieve good outcomes in terms of complete response to the treatment in 16 cases. The complication associated with this treatment was minimal in our study as few patients complained redness and irritation which subsided after application of topical lubricants. There was no sign of recurrence even at 12 months of follow-up in all 18 cases. CONCLUSION The current study provided clinicopathological characteristics and treatment outcomes in recurrent cases of OSSN. In our study, adopting appropriate treatment strategy, regular follow-up to assess the response to treatment and change over to new treatment plan in cases with inadequate response helped in achieving good outcomes in recurrent cases of OSSN.
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Affiliation(s)
| | - Vinay Kumar
- Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India
| | | | - Alok Sati
- Army Hospital Research and Referral, Delhi, 110010, India
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Wylegala A, Sripawadkul W, Zein M, Alvarez OP, Al Bayyat G, Galor A, Karp CL. Topical 1% 5-fluorouracil eye drops as primary treatment for ocular surface squamous neoplasia: Long-term follow-up study. Ocul Surf 2023; 27:67-74. [PMID: 36476665 DOI: 10.1016/j.jtos.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the efficacy and safety of topical 1% 5-fluorouracil (5FU) eye drops as primary treatment of ocular surface squamous neoplasia (OSSN). METHODS Patients were diagnosed with OSSN based on slit-lamp examination and anterior segment optical coherence tomography (AS-OCT). In ambiguous cases an incisional biopsy was performed. All were treated with 5FU eye drops as primary therapy and retrospectively reviewed. Data on demographics, tumor characteristics, treatment outcome, and side effects were collected. The primary outcome measures were resolution frequency and recurrence rate of OSSN. Secondary outcomes were risk factors for resolution and recurrence, and side effects of treatment. RESULTS The mean age of 251 subjects (258 eyes) was 67.5 ± 11.7 years, 182 were male. Patients were followed up on average for 752 ± 580 days. Overall, 87% of patients experienced complete tumor resolution. Multivariable analysis revealed that superior tumor location (HR: 0.62, 95% CI: 0.41-0.93, p = 0.02) and leukoplakia (HR: 0.65, 95% CI: 0.41-0.93, p = 0.02), decreased the likelihood of tumor resolution. The recurrence rate was 4% at six months, 8% at one year, and 19% at two years. Larger tumor area increased chances of tumor recurrence (HR: 1.01, 95% CI: 1.00-1.02 p = 0.03). The most common side effects of 5-FU were mild hyperemia and pain, which occurred in 26% and 23% of patients, respectively. Among the sight-threatening side effects, limbal stem cell deficiency occurred in only 3% of patients. CONCLUSIONS Topical 1% 5FU eye drops are a safe and effective medication for OSSN. Superior tumor location and leukoplakia decreased the chance of tumor resolution.
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Affiliation(s)
- Adam Wylegala
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Mike Zein
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Osmel P Alvarez
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Ghada Al Bayyat
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
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Yeoh CHY, Lee JJR, Lim BXH, Sundar G, Mehta JS, Chan ASY, Lim DKA, Watson SL, Honavar SG, Manotosh R, Lim CHL. The Management of Ocular Surface Squamous Neoplasia (OSSN). Int J Mol Sci 2022; 24:ijms24010713. [PMID: 36614155 PMCID: PMC9821412 DOI: 10.3390/ijms24010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.
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Affiliation(s)
- Clarice H. Y. Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Jerome J. R. Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | - Blanche X. H. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Gangadhara Sundar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Jodhbir S. Mehta
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
| | - Anita S. Y. Chan
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Singapore National Eye Centre, Singapore 168751, Singapore
- Histopathology, Pathology Department, Singapore General Hospital, Singapore 169608, Singapore
| | - Dawn K. A. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Stephanie L. Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, NSW 2000, Australia
| | | | - Ray Manotosh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Chris H. L. Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
- Singapore Eye Research Institute, Singapore 169856, Singapore
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Du G, Qiao J, Lei X, Han R. Conjunctival squamous cell carcinoma with massive apoptosis and immune cell infiltration: A case report. Front Surg 2022; 9:1004554. [PMID: 36311937 PMCID: PMC9614080 DOI: 10.3389/fsurg.2022.1004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
This case reports a rare case of conjunctival squamous cell carcinoma in China. The elderly (86-year-old) female patient was diagnosed and treated effectively after three times of diagnosis. During this period, she was misdiagnosed and ineffective treatment for many times. Therefore, we propose to make an integrated diagnosis based on histopathological diagnosis, combined with a variety of diagnostic methods including MRI and CDFI, supplemented by updated multiple immunohistochemically techniques, so as to achieve the purpose of accurate diagnosis.
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Affiliation(s)
- Gang Du
- Ophthalmology Department, First Hospital of Lanzhou University, Lanzhou, China
| | - Jun Qiao
- Lanzhou Ophthalmology Center Affiliated to Gansu University of Chinese Medicine, Lanzhou Huaxia Eye Hospital, Lanzhou, China
| | - Xunwen Lei
- Ophthalmology Department, First Hospital of Lanzhou University, Lanzhou, China,Correspondence: Ruiqin Han Xunwen Lei
| | - Ruiqin Han
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Correspondence: Ruiqin Han Xunwen Lei
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Pérez-García P, Burgos-Blasco B, Gómez-Calleja V, Vidal-Villegas B, Méndez-Fernández R, Gegúndez-Fernández JA, Díaz-Valle D. Efficacy and safety of topical 5-fluorouracil in conjunctival intraepithelial neoplasia refractory to interferon alpha-2b. J Oncol Pharm Pract 2022:10781552221125763. [PMID: 36131486 DOI: 10.1177/10781552221125763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the efficacy and safety of 5-fluorouracil as the second line of treatment for two cases of conjunctival intraepithelial neoplasia refractive to topical interferon alpha-2b. CASE REPORT In the first case, a 77-year-old woman was evaluated because of a fleshy vascularized lesion in the temporal conjunctiva on her right eye with leukoplakia of the corneal epithelium from 10- to 5-o'clock limbus. In the second case, an 81-year-old man, a nodular lesion in the temporal conjunctiva on his RE, with corneal adjacent opalescence, one millimeter in extent, was observed. Both patients were initially treated with excisional surgery, the samples being reported as conjunctival intraepithelial neoplasia with high-grade dysplasia. Co-adjuvant treatment with topical interferon alpha-2b 1 mIU/mL was indicated 4 times/day uninterruptedly. In the first case, there was no response despite 8 months of treatment, while in the second, the corneal lesion progressed in an arboriform pattern after 4 months of topical chemotherapy. MANAGEMENT & OUTCOME In the absence of efficacy, the treatment was then changed to topical 5-fluorouracil (1%), 4 times/day for 7 days with a time-lapse of 21 days off, which constitutes a course. Two and four courses of treatment with 5-fluorouracil 1% were completed in both cases in the absence of important side effects. After the first course, both patients showed complete remission of the lesions. No clinical signs of relapse were noted after 1 year of follow-up. DISCUSSION The treatment with 5-fluorouracil is a good option as the second line of treatment for conjunctival intraepithelial neoplasia who are low-responders to interferon alpha-2b, with fewer side effects than other currently available alternatives.
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Affiliation(s)
- Pilar Pérez-García
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Bárbara Burgos-Blasco
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Verónica Gómez-Calleja
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Beatriz Vidal-Villegas
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Rosalía Méndez-Fernández
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Antonio Gegúndez-Fernández
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Díaz-Valle
- Ophthalmology Unit, 16267Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Lee BWH, Sidhu AS, Francis IC, Coroneo MT. 5-Fluorouracil in primary, impending recurrent and recurrent pterygium: Systematic review of the efficacy and safety of a surgical adjuvant and intralesional antimetabolite. Ocul Surf 2022; 26:128-141. [PMID: 35961535 DOI: 10.1016/j.jtos.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Pterygium is an ultraviolet-related disease characterized by an aberrant, wing-shaped and active wound-healing process. There is nothing quite as disheartening for the surgeon or patient as the recurrence of pterygium, and various adjuvants have been studied to ameliorate this. This systematic review provides a comprehensive summary of the efficacy and safety of 5-Fluorouracil (5-FU) as an antimetabolite agent for pterygium management. An appraisal of electronic searches of six databases identified 34 clinical studies reporting recurrence outcomes of 5-FU use in primary, impending recurrent and recurrent pterygia. In vitro and in vivo studies of 5-FU showed dose- and duration-dependent cytostatic and cytotoxic effects in human cells. 5-FU is relatively inexpensive, available, and easy to administer, making it attractive for resource-limited scenarios. However, the published evidence demonstrates a recurrence rate of 11.4-60% with the bare scleral technique, 3.5-35.8% with conjunctival rotational flaps, 3.7-9.6% with conjunctival autografts for intraoperative topical 5-FU, and 14-35.8% for preoperative and intraoperative injections. This suboptimal efficacy brings the role of 5-FU as an adjuvant for pterygium surgery into question and the authors do not recommend its use. In contrast, postoperative intralesional injections of 5-FU to arrest progression in impending recurrent pterygium and true recurrent pterygia were more promising, with success rates of 87.2-100% and 75-100%, respectively. Furthermore, 5-FU as a treatment modality, without surgery, effectively arrested progression in 81.3-96% of primary and recurrent pterygia. Other treatments such as topical and intralesional corticosteroids, cyclosporine and anti-VEGF agents are discussed. Complications of 5-FU increase with higher doses and range from transient and reversible to severe and sight-threatening. For pterygium, 5-FU has a predilection for causing scleral thinning, corneal toxicity, and graft-related complications. Additional study with extended follow-up is needed to elucidate the optimal dose, frequency, duration, and long-term safety of 5-FU injections. If 5-FU is used in the management of pterygium, it should be with caution, in selected patients and with vigilant long-term monitoring.
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Affiliation(s)
- Brendon W H Lee
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia; University of Sydney Medical School, University of Sydney, Camperdown, Australia.
| | - Amitouj S Sidhu
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Ian C Francis
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, University of New South Wales, Kensington, Australia
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Rao R, Honavar SG, Lahane S, Mulay K, Reddy VP. Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy. Br J Ophthalmol 2021; 107:621-626. [PMID: 34844918 DOI: 10.1136/bjophthalmol-2021-319201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/AIM To evaluate the safety and efficacy of ruthenium-106 (Ru-106) plaque brachytherapy in managing invasive ocular surface squamous neoplasia (OSSN). METHODS This is a retrospective, non-comparative, interventional case series of 42 eyes with OSSN with histopathologically-proven corneal stromal and/or scleral invasion that underwent Ru-106 plaque brachytherapy. Main outcome measures were tumour regression, eye salvage, final visual acuity, treatment complications and metastasis. RESULTS At presentation, the mean tumour basal diameter was 9.3 mm (range 5-26 mm) and thickness 3.1 mm (range 1.5-11 mm). Prior treatment included excision biopsy in two patients (5%), incision biopsy and topical interferon in one each (2%). Following excision with 4 mm clinically clear margins, corneal stromal and/or scleral invasion of OSSN was confirmed in all 42 cases, with the excised base showing invasive squamous cell carcinoma. A total dose of 5000 cGy over a mean duration of 19.7 hours (range 7-41 hours) was provided to an axial depth of 2 mm using Ru-106 surface plaque. Over a mean follow-up of 36.9 months (range 22.3-72 months), complete tumour regression was achieved in all eyes (100%). Two eyes (5%) showed conjunctival tumour growth remote from the site of prior treatment. Visual acuity was maintained at ≥20/200 in 35 eyes (83%), with a loss of >2 Snellen lines in 1 eye (2%). There was no evidence of regional lymph node or systemic metastasis. CONCLUSION Histopathology-guided use of Ru-106 surface plaque brachytherapy is a safe and an effective adjuvant therapy in the management of corneal stromal and/or scleral invasion of OSSN.
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Affiliation(s)
- Raksha Rao
- Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
| | - Sumeet Lahane
- Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
| | - Kaustubh Mulay
- Ocular Pathology Service, Centre for Sight, Hyderabad, Telangana, India
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11
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Abstract
Purpose of review To review and update the latest findings in diagnosis and management of ocular surface squamous neoplasia (OSSN). Recent findings OSSN is the most common anterior segment neoplastic disease process. Several ocular surface imaging techniques have been developed for the early diagnosis and management of clinical and subclinical ocular surface squamous neoplasia, including high-resolution optical coherence tomography (HR-OCT), in vivo confocal microscopy, and ultrasound biomicroscopy. Treatment modalities include both surgical and medical management, with a recent trend towards primary and adjunctive pharmacotherapy. Summary There is increasing use of HR-OCT for the diagnosis and monitoring of clinical and subclinical OSSN lesions. Topical pharmacotherapy agents, including interferon α-2b, 5-fluorouracil, and mitomycin C, have demonstrable efficacy in the treatment of OSSN and their use may be dictated based upon tumor factors, patient factors, cost, and side effect profile. Both surgical excision and adjunctive topical medications have excellent success, with the favored treatment method trending towards topical pharmacotherapy as primary therapy.
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12
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Ocular surface squamous neoplasia: management and outcomes. Eye (Lond) 2021; 35:1562-1573. [PMID: 33564137 PMCID: PMC8169825 DOI: 10.1038/s41433-021-01422-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common ocular tumour with an incidence ranging from 0.03 to 1.9 per 100,000 persons/year. The diagnosis is made on clinical suspicion and confirmed with anterior-segment optical coherence tomography (AS-OCT), cytology, or histology. The purpose of this review is to provide an overview of the management options available for OSSN and review their success and recurrence rates. Surgery is the gold standard for the management of small OSSN lesions. With the increased use of less invasive diagnostic modalities such as AS-OCT and cytology, there has been a move to use topical therapies for the management of OSSN. The most commonly used agents are interferon-α2b (IFN), mitomycin-C (MMC) and 5-fluorouracil (5FU). They have been shown to have similar resolution and recurrence rates but differ in cost and side effect profile. IFN has the lowest side effect profile, but is also the most expensive, whereas MMC has the greatest surface toxicity and is priced midway between the three. 5FU is the cheapest of the three topical agents with less surface toxicity than MMC. Radiotherapy is mostly employed as adjuvant therapy. Newer novel therapies are available but have not been widely adopted as mainstream therapy due to cost and lack of clinical evidence. OSSN has the benefit of many management options. No single modality has been shown to superior and some patients will need the use of combination therapy to achieve an optimal clinical outcome.
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13
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Iatrogenic Ocular Surface Diseases Occurring during and/or after Different Treatments for Ocular Tumours. Cancers (Basel) 2021; 13:cancers13081933. [PMID: 33923737 PMCID: PMC8073875 DOI: 10.3390/cancers13081933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The ocular surface represents a finely regulated system that allows the protection of the eye. It can be affected by therapies used for the treatment of various intraocular tumours, particularly conjunctival cancers and uveal melanoma. In these conditions, treatments are chosen according to the characteristics of the lesion, and include a combination of selective surgery, anticancer eye drops, and/or radiotherapy delivered through different mechanisms. Possible side effects affecting the ocular surface range from transient dry eye or keratitis up to more severe complications such as corneal melting and perforation. These complications deserve careful evaluation for the risk of permanent sight-threatening sequelae. Physicians involved in the management of patients affected by ocular tumours should be aware of this risk in order to reach an early diagnosis and promptly set up an adequate treatment. The present review summarizes acute and chronic complications affecting the ocular surface following different therapies for the treatment of conjunctival cancers and uveal melanoma, and also reports clinical cases of representative patients who experienced these complications. Abstract The ocular surface represents a finely regulated system that allows the protection of the eye. It is particularly susceptible to different treatments for intraocular tumours, such as uveal melanoma and conjunctival cancers. Traditionally, the management of ocular tumours depends on the characteristics of the lesion, and is based on a combination of selective surgery, topical chemotherapy, and/or radiotherapy delivered through different mechanisms (e.g., charged-particle radiotherapy or brachytherapy). Possible complications involving the ocular surface range from transient dry eye disease or keratitis up to corneal melting and perforation, which in any case deserve careful evaluation for the risk of permanent sigh-threatening complications. Clinicians involved in the management of these patients must be aware of this risk, in order to reach an early diagnosis and promptly set up an adequate treatment. The present review of the literature will summarize acute and chronic complications affecting the ocular surface following different therapies for the treatment of ocular tumours.
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14
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Delgado EC. Topical chemotherapy with mitomycin C in a feline corneal squamous cell carcinoma. JFMS Open Rep 2020; 6:2055116920917833. [PMID: 32528721 PMCID: PMC7263118 DOI: 10.1177/2055116920917833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Case summary A 9-year-old cat was presented with a right globe lesion of 6 months’ duration. A large pink elevated mass covering two-thirds of the right cornea was detected. The corneal mass was surgically removed by superficial keratectomy and diagnosed by histopathology as a squamous cell carcinoma (SCC). The surgical procedure led to a relatively transparent cornea, but recurrence was likely. To avoid relapse, 1 month after surgery three cycles of mitomycin C 0.04% eye drops were applied q8h for 15 days on/15 days off. No local or systemic side effects were seen, and no recurrence was detected after 1 year of follow-up. Topical mitomycin C was successfully used as adjuvant local chemotherapy agent and prevented relapses owing to its cytostatic effect. Relevance and novel information SCCs are relatively common in feline patients, especially in the non-pigmented extremities of the nose, ears and eyelids, but with the cornea being a rare location. They rarely metastasise and they seldom relapse locally after surgical excision. Surgical-free margins of 2 cm are advisable to prevent relapses. Corneal tumours are rare, as the cornea is avascular; corneal transparency is essential to assure clear vision. In corneal SCC this margin is impossible to achieve without enucleation. In the present report, surgical removal of the neoplasm was combined with topical administration of the anticancer drug mitomycin C and a good prognosis was obtained. This combined treatment may be an appropriate therapeutic option for feline corneal SCC.
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Affiliation(s)
- Esmeralda Costa Delgado
- CIISA (Centre for Interdisciplinary Research in Animal Health), Faculty of Veterinary Medicine, University of Lisbon, Lisbon, Portugal
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15
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Ahmed SN, Shahid SM, Nanavaty MA. Delayed Onset Scleromalacia and Conjunctival Bleb Formation Following Intraoperative Mitomycin C Application during Conjunctival Melanoma Excision. Vision (Basel) 2020; 4:vision4020024. [PMID: 32384819 PMCID: PMC7356894 DOI: 10.3390/vision4020024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose: To present a case of delayed onset scleromalacia and conjunctival bleb formation one year after conjunctival melanoma excision with intraoperative use of mitomycin-C (MMC) and double-freeze-thaw technique. Methods: Case report. Results: A 69-year-old woman had a conjunctival melanoma excised by the ‘no touch technique’ with intraoperative application of 0.02% MMC for 3 min on bare sclera, freeze-thaw cryotherapy and amniotic membrane transplant performed elsewhere. Three months later, she presented to us with a red, sore and painful right eye. Examination revealed severe scleritis. She was treated with lubricants and oral steroids for 6 weeks. She settled well with no recurrence of melanoma. At one year, she developed scleromalacia and conjunctival blebs in the inferonasal quadrant of right eye. She remains under closer observation as she is at high risk of perforation. Conclusion: Caution should be exercised with intraoperative use of MMC on bare sclera during excision and cryotherapy of conjunctival melanoma. As published in the literature, when using MMC, it is recommended to use the lowest dose topically in the form of eye drops in the postoperative period for the shortest time to avoid any sight-threatening complications.
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Affiliation(s)
- Syed Naqib Ahmed
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK;
| | | | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence:
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16
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Elhamaky TR, Elbarky AM. AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C. Clin Ophthalmol 2019; 13:2269-2278. [PMID: 31819351 PMCID: PMC6877399 DOI: 10.2147/opth.s229399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT). Subjects and methods A prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results. Results The study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm2) was significantly lower than in no MMC group (92.4±17.3 mm2). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Conclusion The treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.
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Affiliation(s)
- Tarek Roshdy Elhamaky
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Egypt
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17
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Management Issues in Conjunctival Tumours: Ocular Surface Squamous Neoplasia. Ophthalmol Ther 2019; 9:181-190. [PMID: 31760597 PMCID: PMC7054503 DOI: 10.1007/s40123-019-00225-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Indexed: 11/11/2022] Open
Abstract
Ocular surface squamous neoplasia is the most common tumour of the ocular surface. It is a spectrum of disease from intraepithelial dysplasia to invasive squamous cell carcinoma. Recent years have seen an increase in the use of topical chemotherapeutic agents to treat this condition, often as primary treatment without full-thickness biopsy. This practical approach provides a critical appraisal of the evidence base with the goal being to aid the clinician in the management of these patients.
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18
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Eghtedari M, Beigi V, Maalhagh M, Ashraf H. Expression of interleukin-6 in ocular surface squamous neoplasia. Clin Ophthalmol 2019; 13:1675-1680. [PMID: 31564816 PMCID: PMC6722455 DOI: 10.2147/opth.s221911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose Interleukin-6 (IL-6) is an important cytokine in the cascade of inflammation and cancer progression. The aim of this study was to identify IL-6 expression in ocular surface squamous neoplasia (OSSN) in comparison with non-neoplastic conjunctival tissue. Methods Twenty paraffin-embedded tissue sections of conjunctiva from patients with OSSN including conjunctival intraepithelial neoplasia (CIN) in all grades of severity and squamous cell carcinoma (SCC) were assessed by immunohistochemistry staining for IL-6. Twenty non-neoplastic conjunctival sections from age matched patients were selected as the control group. Tissues with more than one focus of inflammatory cell infiltration were excluded from the study. The mean area of positive staining was recorded and the intensity of staining was scored in both groups and compared by statistical methods. Results The mean staining area in the dysplasia group was significantly more than non-neoplastic conjunctival tissue (63.5±25.96 and 30±15.98 percent respectively; P-value of <0.0001). Nuclear staining was observed in both groups and the difference was not statistically significant. Conclusion IL-6 expressed more in the dysplastic group in compare to non-neoplastic conjunctiva and can therefore be used to diagnose dysplastic state of the conjunctiva; however, in our study, intensity of staining does not correlate with the severity of dysplasia statistically; most probably because of a low sample size in each category. The role of nuclear staining is not clear. Our findings can be an introduction toward targeted treatment of ocular surface neoplasia by the aim of newer anti-IL agents. Further investigation is needed.
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Affiliation(s)
- Masoomeh Eghtedari
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Beigi
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Maalhagh
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ashraf
- Ophthalmology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Al Bayyat G, Arreaza-Kaufman D, Venkateswaran N, Galor A, Karp CL. Update on pharmacotherapy for ocular surface squamous neoplasia. EYE AND VISION 2019; 6:24. [PMID: 31417938 PMCID: PMC6689886 DOI: 10.1186/s40662-019-0150-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia (OSSN). Over the past two decades, the pharmacological management of OSSN has grown, with topical 5-fluorouracil, mitomycin, and interferon alpha 2b all being successfully used to treat this disease. Other agents, such as anti-vascular endothelial growth factor (VEGF), retinoic acid, cidofovir and Aloe vera, have less frequently been used in the treatment of OSSN. This review will discuss these pharmacologic agents, summarizing available data and presenting the approach to the treatment of these tumors.
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Affiliation(s)
- Ghada Al Bayyat
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Dan Arreaza-Kaufman
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA.,Miami Veterans Hospital, Miami, FL 33125 USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
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20
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Theotoka D, Morkin MI, Galor A, Karp CL. Update on Diagnosis and Management of Conjunctival Papilloma. EYE AND VISION (LONDON, ENGLAND) 2019; 6:18. [PMID: 31236424 PMCID: PMC6580461 DOI: 10.1186/s40662-019-0142-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/24/2019] [Indexed: 02/08/2023]
Abstract
Conjunctival papilloma is an acquired benign squamous cell tumor that can present at any age, but most frequently in the third and fourth decades of life. Papillomas have been associated with human papilloma virus (HPV) infection, usually types 6 and 11. Although histopathological diagnosis remains the gold standard, the advent of newer non-invasive imaging modalities such as optical coherence tomography (OCT) is transforming the way we diagnose and treat ocular surface tumors, including conjunctival papilloma. Management of these lesions can prove a challenge to the treating physician since not all lesions respond to medical and/or surgical therapy and in fact may worsen after surgical manipulation. In this review, the epidemiology, pathophysiology, clinical characteristics, and diagnosis of conjunctival papilloma including the use of OCT are discussed. Indications, efficacy, and side effects of currently available management options are also reviewed to guide the selection of the best treatment approach.
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Affiliation(s)
- Despoina Theotoka
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Melina I. Morkin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
- Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, 33125 FL USA
| | - Carol L. Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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21
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Mohamed-Noriega K, Treviño-Herrera AB, Olvera-Barrios A, Morales-Wong F, Mohamed-Hamsho J. Resolution of giant ocular surface squamous neoplasia with topical 5-fuorouracil 1. SAGE Open Med Case Rep 2019; 7:2050313X19843392. [PMID: 31024731 PMCID: PMC6472153 DOI: 10.1177/2050313x19843392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
Abstract
An 82-year-old man presented with a left eye elevated single ocular surface
squamous neoplasia. The tumor involved 360° of limbus, three quadrants of cornea
and conjunctiva; this was compatible with the diagnosis of giant ocular surface
squamous neoplasia. Topical 5-fluorouracil 1% was planned four times daily for
1 week followed by 3 weeks off-treatment. Patient inadvertently continued
5-fluorouracil, four times daily for 4 weeks, presenting with clinical
resolution of the ocular surface squamous neoplasia and subtotal corneal
epithelial defect associated with 5-fluorouracil toxicity. One month later, we
observed a transparent cornea and no signs of toxicity. Total tumor resolution
was observed for at least 6 months of follow-up.
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Affiliation(s)
- Karim Mohamed-Noriega
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Alan Baltazar Treviño-Herrera
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Abraham Olvera-Barrios
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Fernando Morales-Wong
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
| | - Jesus Mohamed-Hamsho
- Department of Ophthalmology, Faculty of Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez," Autonomous University of Nuevo Leon (UANL), Monterrey, Mexico
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22
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Conway MR, Cherepanoff S, Joshua AM. Managing ocular surface neoplasia without biopsy: The end of pathology as we know it? Clin Exp Ophthalmol 2019; 47:163-164. [PMID: 30892791 DOI: 10.1111/ceo.13475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Max R Conway
- Ocular Oncology Unit, Sydney Eye Hospital and The Kinghorn Cancer Centre, Sydney, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Svetlana Cherepanoff
- Anatomical Pathology, St Vincent's Hospital Sydney, Australia.,Ophthalmic Pathology Research Group, The University of Sydney, Sydney, Australia
| | - Anthony M Joshua
- Medical Oncology, The Kinghorn Cancer Centre at St Vincent's Hospital/Garvan Institute of Medical Research, Sydney, Australia
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23
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Polski A, Sibug Saber M, Kim JW, Berry JL. Extending far and wide: the role of biopsy and staging in the management of ocular surface squamous neoplasia. Clin Exp Ophthalmol 2018; 47:193-200. [PMID: 30156057 DOI: 10.1111/ceo.13382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/22/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Although the most recent American Joint Committee on cancer staging guidelines for ocular surface squamous neoplasia place a heightened emphasis on biopsy and histopathologic analysis, the interpretation and clinical relevance of these staging criteria are not always clear. We address limitations of using histopathologic analysis to predict clinical outcomes and suggest less-invasive assessments. BACKGROUND To investigate the impact of histopathologic depth of invasion on outcomes for tumours with the common presentation of multiple structure involvement. DESIGN Retrospective chart review at tertiary institution. SAMPLES Of 41 eyes with ocular surface squamous neoplasia between 2012 and 2017, 27 tumours involving multiple ocular structures clinically were included. METHODS Biopsied tumours were determined to be invasive beyond the basement membrane or non-invasive; non-biopsied tumours were clinically identified with unknown depth of invasion. Outcomes were compared using Fisher's exact or Student's t tests. MAIN OUTCOME MEASURES Proportion of tumours cured, recurred and/or persisting. RESULTS Twelve tumours (44%) received primary excisional biopsy, 10 (37%) received chemotherapy without biopsy and 5 (19%) received chemotherapy and biopsy. Clinical diagnosis was correct in all biopsied cases. While there were no significant differences in outcomes between invasive vs non-invasive tumours or treatments, there was a trend toward larger basal diameter in recurrent tumours regardless of treatment. CONCLUSIONS AND RELEVANCE When ocular surface squamous neoplasia tumours with similar clinical involvement were compared, histopathologic depth of invasion was not predictive of clinical outcomes. Future staging criteria may consider the potential of largest basal dimension for more accurate prognostication.
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Affiliation(s)
- Ashley Polski
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Maria Sibug Saber
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jonathan W Kim
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California.,The Vision Center, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Jesse L Berry
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California.,The Vision Center, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
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24
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Patel H, Jeang LJ, Shah A, Espana EM, Margo CE. Widespread Ocular Surface Squamous Neoplasia Treated with Topical Interferon Alpha-2b. Ocul Oncol Pathol 2018; 4:298-303. [PMID: 30320101 DOI: 10.1159/000486339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To emphasize the importance of staging ocular surface squamous neoplasia when contemplating use of topical interferon alpha-2b alone. Cases Two patients with 360 degrees of limbal involvement. Results Two patients with in situ squamous cell carcinoma of the conjunctiva and clinical involvement of the entire limbus were treated with topical interferon alpha-2b. Thorough examination and multiple biopsies excluded invasive disease. The patients had complete response to therapy. Conclusion Widespread intraepithelial squamous neoplasia involving the entire limbus can be successfully treated with topical therapies. Biopsy plays a role in excluding invasive disease. Interferon alpha-2b is a preferable agent to start with because it is well tolerated. Since long-term risks of recurrence are unknown, appropriate monitoring is essential.
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Affiliation(s)
- Hershel Patel
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lauren J Jeang
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Edgar M Espana
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Surgical versus medical treatment for ocular surface squamous neoplasia: A quality of life comparison. Ocul Surf 2018; 17:60-63. [PMID: 30217629 DOI: 10.1016/j.jtos.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/08/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To characterize vision-related and psychosocial quality of life (QoL) parameters in medically and surgically treated patients with OSSN. METHODS Forty-one patients with OSSN treated with medical therapy consisting of interferon alpha 2b drops 1 MIU/ml (n = 22) or who underwent surgical excision (n = 19) were contacted. All subjects answered a quality of life assessment with an original questionnaire in which they were asked about a range of parameters. Overall satisfaction and motivating factors for treatment were also reviewed. RESULTS The mean age at the time of the survey was 64.6 and 51% were male with similar demographics between groups. Based on the previous cohort, rates of tumor resolution and recurrences were comparable in the two groups. Reasons for choosing a particular treatment varied between the groups. Forty percent of individuals in the medical group reported a fear of surgery (p = 0.03) and often made the decision after personal research (p = 0.008). Thirty-two percent of patients in the surgical group chose surgery due to fear of decreased vision due to lesion growth, therefore wanting immediate resolution (p = 0.09). Drops precipitated more ocular symptoms such as tearing and itchiness, on the other hand, patients who had surgery reported having more pain. CONCLUSION Quality of life considerations before, during, and after OSSN treatment is an important yet understudied topic. Our study is the first to look at QoL parameters in OSSN treatment and we found that patients in both medically and surgically treated groups had similar QoL metric but were driven to choose chemotherapy due to fear of surgery and/or prior literature review.
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Eisenberg S, Pacheco L. Applying Hazardous Drug Standards to Antineoplastics Used for Ophthalmology Surgery. AORN J 2018; 107:199-213. [DOI: 10.1002/aorn.12022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Midena E, Frizziero L, Parrozzani R. Pharmacotherapy and Immunotherapy of Conjunctival Tumors. Asia Pac J Ophthalmol (Phila) 2017; 6:121-131. [PMID: 28399343 DOI: 10.22608/apo.201751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 11/08/2022] Open
Abstract
Conjunctiva and cornea tumors represent a large spectrum of conditions ranging from benign lesions to aggressive and life-threatening malignancies. Topical pharmacotherapies and immunotherapies have recently acquired a relevant role in the management of conjunctival tumors and, in the past 2 decades, there has been a shift from surgery alone toward the use of these agents, both as a sole therapy or as adjunct to surgery (before or after surgery). The 3 main agents that have been used for topical medical treatment of conjunctival tumors are mitomycin-C, 5-fluorouracil, and interferon-α2b. Advantages of topical pharmacotherapies and immunotherapies include the ability to treat the entire ocular surface and prevention of surgical side effects and complications. The aim of this review is to summarize the current use of topical pharmacotherapy and immunotherapy in the management of conjunctival tumors.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova
- G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Rome, Italy
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Parrozzani R, Frizziero L, Trainiti S, Testi I, Miglionico G, Pilotto E, Blandamura S, Fassina A, Midena E. Topical 1% 5-fluoruracil as a sole treatment of corneoconjunctival ocular surface squamous neoplasia: long-term study. Br J Ophthalmol 2016; 101:1094-1099. [PMID: 27941046 PMCID: PMC5537525 DOI: 10.1136/bjophthalmol-2016-309219] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/11/2016] [Accepted: 11/19/2016] [Indexed: 11/15/2022]
Abstract
Aims To report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN). Methods 41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval. Results Mean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes. Conclusion Topical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.
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Affiliation(s)
- Raffaele Parrozzani
- G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy
| | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Sara Trainiti
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Ilaria Testi
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | | | - Stella Blandamura
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Ambrogio Fassina
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Edoardo Midena
- G.B. Bietti Foundation, IRCCS, Ocular Oncology and Toxicology Research Unit, Roma, Italy.,Department of Ophthalmology, University of Padova, Padova, Italy
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Sayed-Ahmed IO, Palioura S, Galor A, Karp CL. Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 12:11-19. [PMID: 28184236 DOI: 10.1080/17469899.2017.1263567] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Topical chemotherapy has gained popularity among clinicians for the treatment of ocular surface squamous neoplasia (OSSN). The principal topical chemotherapy agents used in the management of OSSN are interferon-α2b, 5-fluorouracil, and mitomycin C. High-resolution optical coherence tomography (HR-OCT) is a non-invasive technique that can differentiate OSSN from other ocular surface lesions. AREAS COVERED This review highlights the current regimens and diagnostic modalities used in managing OSSN. A review of the literature was performed using the keywords "conjunctival intraepithelial neoplasia", "ocular surface squamous neoplasia", "optical coherence tomography", "interferon-α2b", "5-fluorouracil" and "mitomycin C". EXPERT COMMENTARY Topical chemotherapy for OSSN can be used as primary therapy, for chemoreduction prior to surgical excision, and postoperatively to prevent tumor recurrence. It has the advantage of treating microscopic disease as well as large tumors. HR-OCT provides an "optical biopsy" that can assist in diagnosis and guide management of OSSN lesions.
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Affiliation(s)
- Ibrahim O Sayed-Ahmed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Kalamkar C, Radke N, Mukherjee A, Radke S. Topical Mitomycin-C Chemotherapy in Ocular Surface Squamous Neoplasia. J Clin Diagn Res 2016; 10:NJ01. [PMID: 27790482 DOI: 10.7860/jcdr/2016/22006.8427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Charudutt Kalamkar
- Clinical Director, Orbit, Oular Oncology and Oculoplasty, Shri Ganesh Vinayak Eye Hospital , Raipur, India
| | - Nishant Radke
- Consultant Retina and Vitreous, Shri Ganesh Vinayak Eye Hospital , Raipur, India
| | - Amrita Mukherjee
- Director Charity Services, Anterior Segment Surgeon, Shri Ganesh Vinayak Eye Hospital , Raipur, India
| | - Snehal Radke
- Consultant Ophthalmologist, Shri Ganesh Vinayak Eye Hospital , Raipur, India
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31
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Torres Suárez E, Pinheiro R, Schrage N. [Complications in the treatment of ocular surface squamous neoplasia with interferon α‑2b in rheumatoid arthritis]. Ophthalmologe 2016; 114:155-158. [PMID: 27300720 DOI: 10.1007/s00347-016-0292-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Interferon α‑2b (IFN α‑2b) is an established and well-tolerated treatment for ocular surface squamous neoplasia (OSSN). METHOD Report of complications in two patients with OSSN and rheumatoid arthritis treated with adjuvant topical IFN α‑2b. RESULTS One patient developed a scleral melt and the other one severe keratitis. After discontinuing treatment with IFN α‑2b both patients showed considerable improvement. CONCLUSION Immunosuppressed patients with OSSN under topical IFN α‑2b should be closely monitored for early detection of complications.
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Affiliation(s)
- E Torres Suárez
- Augenklinik, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
| | - R Pinheiro
- Augenklinik, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - N Schrage
- Augenklinik, Krankenhaus Merheim, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
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Kalamkar C, Radke N, Mukherjee A, Radke S. Xeroderma pigmentosum with bilateral ocular surface squamous neoplasia and review of the literature. BMJ Case Rep 2016; 2016:bcr-2016-215364. [PMID: 27166000 DOI: 10.1136/bcr-2016-215364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Xeroderma pigmentosum is a rare genetic disorder associated with various ocular malignancies. Here we report a single paediatric case of xeroderma pigmentosum with bilateral ocular surface squamous neoplasia (OSSN) presenting with diffuse lesion in one eye and a large mass in the other eye. Diffuse OSSN in one eye was treated with topical chemotherapy using mitomycin-C (0.04%) and the large OSSN in the other eye was treated with a combination of surgery and topical chemotherapy. Long-term follow-up and a multimodality treatment approach are necessary to identify and manage recurrences of OSSN in XP.
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Affiliation(s)
- Charudutt Kalamkar
- Department of Ophthalmology, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
| | - Nishant Radke
- Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
| | | | - Snehal Radke
- Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
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Joag MG, Sise A, Murillo JC, Sayed-Ahmed IO, Wong JR, Mercado C, Galor A, Karp CL. Topical 5-Fluorouracil 1% as Primary Treatment for Ocular Surface Squamous Neoplasia. Ophthalmology 2016; 123:1442-8. [PMID: 27030104 DOI: 10.1016/j.ophtha.2016.02.034] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To determine the efficacy of topical 5-fluorouracil 1% (5-FU) as a primary treatment of ocular surface squamous neoplasia (OSSN). DESIGN Retrospective study. PARTICIPANTS Topical 5-FU was used as primary therapy in 44 patients with OSSN. METHODS 5-Fluorouracil 1% administered topically 4 times daily for 1 week followed by a drug holiday of 3 weeks. Patients were identified through a pharmacy database. Patients were excluded if 5-FU was used as adjuvant therapy, if they did not complete therapy, or if they were still actively receiving treatment for OSSN at the time of last follow-up. MAIN OUTCOME MEASURES The primary outcome measures were the frequency of complete resolution with topical 5-FU treatment and the rate of OSSN recurrence. RESULTS Of the 44 patients identified, 32 were men and 12 were women. The mean age was 68 years. Complete resolution of OSSN was noted in 82% of patients (36/44); 18% (8/44) were considered treatment nonresponders. Patients were treated with a median of 4 cycles (range, 2-9 cycles). Nasal location was the only risk factor identified for nonresponse to therapy (P = 0.04). The median follow-up after resolution was 10 months (range, 2-77 months). In the 36 patients who showed complete resolution, 4 experienced tumor recurrence. Recurrence rates at 1 and 2 years were 6% and 15%, respectively, using Kaplan-Meier survival analysis. At least 1 side effect from the medication was reported by 61% of patients (21/44), but only 1 patient discontinued the medication because of intolerance. The most common side effect was pain (n = 17; 39%), followed by tearing (n = 10; 23%), photophobia (n = 6; 14%), itching (n = 4; 9%), swelling (n = 2; 5%), and infection (n = 1; 2%). No long-term complications were reported. CONCLUSIONS 5-Fluorouracil is effective and well tolerated as a primary treatment for OSSN, with 82% of tumors responding completely to therapy.
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Affiliation(s)
- Madhura G Joag
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Adam Sise
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | | | - James R Wong
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Carolina Mercado
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Veterans Affairs Medical Center, Miami, Florida
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
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Jongkhajornpong P, Nakamura T, Sotozono C, Nagata M, Inatomi T, Kinoshita S. Elevated expression of ABCB5 in ocular surface squamous neoplasia. Sci Rep 2016; 6:20541. [PMID: 26843453 PMCID: PMC4740799 DOI: 10.1038/srep20541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/07/2016] [Indexed: 11/09/2022] Open
Abstract
ATP-binding cassette subfamily B member 5 (ABCB5) is a new member of the ATP-binding cassette superfamily and has been reported as a novel marker for limbal stem cell (LSC), which is essential for corneal homeostasis. ABCB5 expression has also been discovered in the subpopulation of several cancer cells containing the cancer stem cell (CSC). However, the pathogenetic relationship between LSC and CSC and ABCB5 in the ocular surface squamous neoplasm (OSSN) is still entirely unknown. To improve understanding of the role of ABCB5 in OSSN, we performed immunohistochemistry for ABCB5 in nine OSSN case series. While expression of ABCB5 is restricted to the basal epithelial cell layer in the normal limbus, elevated expressions of ABCB5 were clearly observed in all OSSN, and there was some breadth in the range of intensity of ABCB5 expression. Interestingly, the elevated expression patterns of ABCB5 in OSSN could be classified in three categories: perivascular, marginal and diffuse patterns. Our findings demonstrated for the first time that the expression of ABCB5 was upregulated in OSSN and that elevated expression of ABCB5 may be involved in the pathogenesis of OSSN.
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Affiliation(s)
- Passara Jongkhajornpong
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Takahiro Nakamura
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maho Nagata
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Inatomi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Reynolds JW, Pfeiffer ML, Ozgur O, Esmaeli B. Prevalence and Severity of Ocular Surface Neoplasia in African Nations and Need for Early Interventions. J Ophthalmic Vis Res 2016; 11:415-421. [PMID: 27994810 PMCID: PMC5139553 DOI: 10.4103/2008-322x.194139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is a common ocular surface tumor with an increased incidence in African countries (3.4 and 3.0 cases/year/100,000). Despite its potential for vision loss and death, OSSN remains largely neglected by both eye and HIV care programs in Africa. The purpose of this review is to identify the barriers to timely diagnosis and early interventions for OSSN in Africa. PubMed searches were conducted targeting previous use of topical chemotherapy (interferon alpha 2b, Mitomycin-C, 5-Fluorouracil) and Human papillomavirus (HPV) vaccination in Africa. We found that OSSN is a significant vision and life-threatening health problem in Africa leading to significant loss of vision, as well as facial disfigurement and social stigma. We did not find any reports on the use of topical interferon, Mitomycin-C or HPV vaccination for OSSN in Africa. One report on the use of topical 5-FU for OSSN in Africa was found. Common barriers to early detection and management of OSSN in Africa include lack of sufficient laboratory infrastructure, lack of trained healthcare personnel, lack of compliance with follow-up visits, cost of topical chemotherapies, and cultural preferences for traditional medicines. In conclusion, OSSN is a significant vision and life-threatening health problem in Africa. There is not much literature on prevention or treatment options for early stages of OSSN in Africa. The use of topical chemotherapy as early interventions and judicious use of smart phone Apps to help with remote diagnosis of early OSSN should be further explored.
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Affiliation(s)
- Jacob W Reynolds
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margaret L Pfeiffer
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Ruiz Department of Ophthalmology and Visual Science, The University of Texas Medical School at Houston, Houston, Texas, USA
| | - Omar Ozgur
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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