1
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Teixeira GC, de Resende MIL, Morales MC, Fernandes AG. Topical 5-Fluorouracil 0.5% as primary treatment for Ocular Surface Squamous Neoplasia. Eur J Ophthalmol 2024:11206721241256687. [PMID: 38780319 DOI: 10.1177/11206721241256687] [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: 05/25/2024]
Abstract
PURPOSE To evaluate the efficacy of topical treatment with 5-Fluorouracil (5-FU) 0.5% in cases of Ocular Surface Squamous Neoplasia (OSSN), and to assess the tolerance of patients undergoing treatment. METHODS Patients with clinical diagnosis of OSSN referred to the Ocular Oncology division from the Federal University of Sao Paulo, Brazil, were recruited for the current study. Patients were treated with topical 5-FU 0.5% using a regimen of 4 times daily for 10 days, followed by a 3-week drug holiday, continued up to 3 cycles before an alternative treatment. Lesions were evaluated at baseline and throughout treatment. Treatment adherence was assessed using the Morisky Medication Adherence scale. Any adverse events along the treatment were noted. RESULTS A total of 30 eyes of 30 patients adherent to the treatment were included in the study. Among the total cases treated with 5-FU 0.5%, 24 patients achieved therapeutic success after a mean treatment duration of 21.71 ± 7.77 days, representing a success rate of 80.00% (95% CI: 60.75-91.18%). For each 1 mm2 increase in the lesion area, the odds of treatment success decrease by 6% (OR: 0.94; 95%CI: 0.88-0.99; p = 0.033). Only mild adverse events such as ocular discomfort, ocular burning and tearing were observed along the treatment in 8 patients. CONCLUSIONS Topical 5-FU 0.5% is an effective therapeutic option in the treatment of OSSN, with an 80% therapeutic success rate, showing good tolerability. The size of the lesion was identified as a factor influencing treatment success, therefore it should be taken into consideration when defining treatment approaches.
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Affiliation(s)
| | | | - Melina Correia Morales
- Department of Visual Sciences and Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Arthur Gustavo Fernandes
- Department of Visual Sciences and Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil
- Department of Anthropology and Archaeology, University of Calgary, Calgary, AB, Canada
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2
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Carlà MM, Sammarco MG, Giannuzzi F, Savino G, Blasi MA, Fionda B, Tagliaferri L, Pagliara MM. Exclusive Ru-106 brachytherapy for the management of a recurrent corneo: Conjunctival squamous cell carcinoma. Brachytherapy 2024:S1538-4721(24)00018-7. [PMID: 38556408 DOI: 10.1016/j.brachy.2024.02.002] [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: 07/21/2023] [Revised: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND We report a case of personalized exclusive brachytherapy treatment for the management of a highly recurrent squamous cell conjunctival carcinoma with corneal invasion. CASE DESCRIPTION This is a case of a Caucasian 81-years-old man who presented 10 years ago to our clinic with a pink-white para-limbal mass with dilated feeder arteries and mild leukoplakia. Excisional biopsy confirmed the presence of conjunctival intraepithelial neoplasia (CIN). Successively, he underwent two 4-weeks cycles of Mytomicin C topical therapy and a second excisional surgery, due to several recurrences of the lesion. At the last relapse, the pink-white peri-limbic mass which invaded the corneal limbus, determining corneal opacification from 5- to 7-clock hours, was confirmed by anterior segment optical coherence tomography (AS-OCT). Due to resistance to MMC therapy and chronic epitheliopathy, an AS-OCT guided exclusive radiotherapy plan was set: a Rhutenium-106 CCD plaque was applied directly over the afflicted corneal surface, the corneal limbus and the neighboring sclera for 24 hours. The remission of both conjunctival and corneal malignancy was complete 2 months after surgery and no signs of recurrence were highlighted at AS-OCT analysis at the 2-year follow up. CONCLUSION Brachytherapy treatment showed optimal management of both corneal and conjunctival involvement, with a free-of-disease follow-up of 24-months. This result suggests that, in specific conditions, Ru-106 brachytherapy could be an effective option of treatment even if not associated with surgical excision.
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Affiliation(s)
- Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy.
| | - Maria Grazia Sammarco
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Gustavo Savino
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Maria Antonietta Blasi
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
| | - Bruno Fionda
- Catholic University "Sacro Cuore", Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center (IOC), Rome, Italy
| | - Luca Tagliaferri
- Catholic University "Sacro Cuore", Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center (IOC), Rome, Italy
| | - Monica Maria Pagliara
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Catholic University "Sacro Cuore", Rome, Italy
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3
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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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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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Baheran SS, Alany RG, Schwikkard S, Muen W, Salman LN, Freestone N, Al-Kinani AA. Pharmacological treatment strategies of pterygium: Drugs, biologics, and novel natural products. Drug Discov Today 2023; 28:103416. [PMID: 36280041 DOI: 10.1016/j.drudis.2022.103416] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 02/02/2023]
Abstract
Pterygium is a fibrovascular tissue growth invading the cornea. Adjunctive treatment post-surgery includes conventional immunosuppressants as well as antiviral drugs. The use of large- and small-molecule antivascular endothelial growth factor (VEGF) agents remains an integral part of pterygium treatment as well as other neovascular conditions of the eye. Naturally occurring polyphenolic compounds have favorable characteristics for treating neovascular and inflammatory eye conditions, including good efficacy, stability, cost-effectiveness, and the versatility of their chemical synthesis. In this review, we discuss pharmacological treatments of pterygium. Natural products, such curcumin, ellagic acid, and chalcones, are reviewed, with emphasis on their potential as future pterygium treatments.
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Affiliation(s)
- Sanaz Sadig Baheran
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Raid G Alany
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK; School of Pharmacy, The University of Auckland, Auckland 1023, New Zealand
| | - Sianne Schwikkard
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Wisam Muen
- Royal Eye Unit, Kingston NHS Foundation Trust, Kingston upon Thames KT2 7BE, UK
| | - Lena Namaan Salman
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Nicholas Freestone
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK
| | - Ali A Al-Kinani
- Drug Discovery, Delivery and Patient Care Research Group, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
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6
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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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7
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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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8
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Auw-Hädrich C, Gasser L, Reinhard T. Bindehautdegenerationen und -neoplasien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1488-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungErhabenheiten der Bindehaut entstehen durch Gewebevermehrung, die entweder degenerativ oder neoplastisch, aber auch entzündlich sein können. In diesem Artikel werden degenerative (Pterygium
und Pinguecula) sowie benigne und maligne neoplastische Bindehautveränderungen (epitheliale, melanozytäre und vaskuläre Tumoren, Choristome sowie Metastasen) bezüglich der Pathogenese,
Symptome, Diagnostik und aktuellem Stand der Behandlung dargestellt.
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9
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Auw-Hädrich C, Gasser L, Reinhard T. [Conjunctival Degeneration and Neoplasia]. Klin Monbl Augenheilkd 2022; 239:823-845. [PMID: 35609810 DOI: 10.1055/a-1831-2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Conjunctival tumors result from gain of tissue, which can be either degenerative or neoplastic, but also inflammatory. In this article, degenerative (pterygium and pinguecula) as well as benign and malignant neoplastic conjunctival changes (epithelial, melanocytic and vascular tumors, choristomas as well as metastases) are discussed with regard to pathogenesis, symptoms, diagnostics and current status of treatment.
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10
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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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Offer KS, Marchesi F, Sutton DGM. Topical 5‐fluorouracil as an adjunct treatment in equine corneolimbal squamous cell carcinoma. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K. S. Offer
- School of Veterinary Medicine College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - F. Marchesi
- School of Veterinary Medicine College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - D. G. M. Sutton
- School of Veterinary Medicine College of Medical Veterinary and Life Sciences University of Glasgow Glasgow UK
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12
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Kounatidou NE, Palioura S. An update in the management of ocular surface squamous neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1932465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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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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14
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Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa. PLoS One 2020; 15:e0237453. [PMID: 32780766 PMCID: PMC7418961 DOI: 10.1371/journal.pone.0237453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests. METHODS This observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy. DISCUSSION There is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.
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Biofabrication of Chitosan-Based Nanomedicines and Its Potential Use for Translational Ophthalmic Applications. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10124189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Drug delivery to the anterior and posterior segment of eye remains a challenge. Nanoparticle-mediated drug delivery has indicated some promise. The presented review aims to summarize recent advancements in chitosan-based nanotherapies for ocular drug delivery and the challenges encountered during the process. Significant research using chitosan, a cationic linear polymer, is being conducted for ocular drug delivery. A vast number of publications exploit the mucoadhesive properties of the polymer, which arise due to interactions between the amino acids of chitosan and the sialic acid residues in mucous. The high degree of crosslinking in chitosan nanoparticles facilitates a dramatic increase in ocular drug retention of the desired drug, which subsequently helps in ocular penetration and improving the bioavailability of the drugs. A noted decrease in the initial burst of the drug is the basis for developing sustained drug release formulation using biodegradable and biocompatible chitosan polymer. In vitro as well as in vivo studies have indicated enhancement in the uptake, accumulation, and removal of chitosan nanoparticles from the site of delivery. In summary, chitosan- or modified-chitosan-based nanoparticles are being widely tested as drug carriers for treatment of bacterial and viral infections, glaucoma, age-related macular degeneration, and diabetic retinopathy.
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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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Tran AQ, Venkateswaran N, Galor A, Karp CL. Utility of high-resolution anterior segment optical coherence tomography in the diagnosis and management of sub-clinical ocular surface squamous neoplasia. EYE AND VISION 2019; 6:27. [PMID: 31463333 PMCID: PMC6710864 DOI: 10.1186/s40662-019-0152-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Abstract
Background To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia (OSSN) detected by high-resolution anterior segment tomography (HR- OCT) in patients with clinically unapparent disease following topical treatment. Methods A retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted. Patients undergoing primary therapy with topical 5-fluorouracil 1% (5-FU) (4 times a day for 7 days with a 21-day break) or interferon-alpha-2b (IFN) (4 times a day) were reviewed. Patients were separated into two groups. Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT. Group 2 (sub-clinical OSSN group) included individuals with clinical OSSN resolution but with features of persistent disease on HR- OCT. Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct. Results A total of 95 patients (95 eyes) were reviewed. Sub-clinical OSSN was detected at a frequency of 17% in our study patients (n = 16 patients, 9 treated with 5-FU and 7 treated with IFN). In the 16 individuals, the mean time to clinical resolution was 3.6 ± 1.0 cycles for 5-FU and 4.0 ± 0.0 months for IFN. An additional 2.1 ± 0.8 cycles for 5-FU and 1.2 ± 0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN. Recurrence in Group 1 was noted in 10 patients (12%) while no recurrences occurred in Group 2, the cohort with subclinical disease that received the extended medical therapy. The mean follow-up was 24.0 ± 17.9 months. Conclusion We found that at least 17% of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT. This information can be used to optimize treatment and extend therapy past the point of clinical resolution.
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Affiliation(s)
- Ann Q Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA
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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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Santoni A, Thariat J, Maschi C, Herault J, Baillif S, Lassalle S, Peyrichon ML, Salleron J, Caujolle JP. Management of Invasive Squamous Cell Carcinomas of the Conjunctiva. Am J Ophthalmol 2019; 200:1-9. [PMID: 30552889 DOI: 10.1016/j.ajo.2018.11.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Ocular surface squamous neoplasia includes a spectrum of diseases from dysplasia to invasive squamous cell carcinoma (SCC) of the conjunctiva. Whether the degree of invasion influences outcomes is debated. We evaluated the outcomes and management of conjunctival carcinomas defined as ≤0.2 mm invasion of the chorion (microinvasive; miSCC) or over (SCC). DESIGN Retrospective case series. METHODS Clinical, tumor, and therapeutic characteristics and outcomes were collected for consecutive patients with histology-proven invasive conjunctival miSCC/SCC treated between 2002 and 2017. RESULTS Patients were 70% men, ≥70 years old (56%), with carcinomas of the bulbar conjunctiva (83.0%). Limbal, corneal, and/or scleral involvement were present in 70.4%, 42.6%, and 27.8%, respectively. Patient characteristics, tumor characteristics, and no-touch surgery rates were similar between the 39 SCC and 15 miSCC. However, mitomycin was performed in 93.3% and 20.5% of miSCC and SCC, respectively (P < .001). Proton therapy was performed in 0% and 92.0% of miSCC and SCC, respectively (P < .001). SCC received mitomycin in case of tumoral resection margins, respectively (P = .018). The 24-month incidence of local relapse was 14.8%, including 20% and 12% for miSCC and SCC, respectively (P = .079). Irradiation was the only prognostic factor associated with a lower risk for local relapse (hazard ratio [0.25]; P = .045). There were 2 cancer-related deaths (2%). Mild/moderate anterior segment complications occurred in one third of the patients. CONCLUSIONS miSCC had slightly worse relapse rates compared with SCC. Postoperative proton therapy, performed in SCC only, was associated with a lower risk for relapse.
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Affiliation(s)
- Alexandra Santoni
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer ARCHADE Center, Normandie Universite-Unicaen, Caen, France.
| | - Célia Maschi
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Joel Herault
- Department of Radiation Oncology, Antoine-Lacassagne Cancer Center, Nice, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Pasteur 2 Teaching Hospital, Nice, France
| | - Sandra Lassalle
- Department of Biopathology, Pasteur 2 Teaching Hospital, Nice, France
| | | | - Julia Salleron
- Department of Biostatistics, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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Comparison of Topical 5-Fluorouracil and Interferon Alfa-2b as Primary Treatment Modalities for Ocular Surface Squamous Neoplasia. Am J Ophthalmol 2019; 199:216-222. [PMID: 30471241 DOI: 10.1016/j.ajo.2018.11.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare the efficacy of topical 5-fluorouracil 1% (5FU) and interferon alfa-2b 1 MIU/mL (IFN) eye drops as primary treatment modalities for ocular surface squamous neoplasia (OSSN). DESIGN Retrospective, comparative, interventional case series. METHODS Fifty-four patients who received 5FU and 48 patients who received IFN as primary therapy for OSSN were included. Primary outcome measures were the frequency of clinical resolution and time to OSSN recurrence by treatment modality. Secondary outcome was the frequency of side effects with each therapy. RESULTS The mean age of patients was 68 years. More Hispanics were treated with 5FU. In a univariable analysis, frequency of OSSN resolution was higher with 5FU (96.3%, n = 52) than with IFN (81.3%, n = 39), P = .01. In a multivariable analysis, treatment modality did not remain a significant predictor of resolution. In patients whose OSSN resolved, time to resolution was similar with both agents, (5FU mean 6.6 months, standard deviation (SD) 4.5 vs IFN mean 5.5 months, SD 2.9, P = .17). Of the 52 eyes whose OSSN resolved with 5FU, 11.5% of lesions (n = 6) recurred, whereas of the 39 eyes whose OSSN resolved with IFN, 5.1% of lesions (n = 2) recurred, P = .46. Kaplan-Meier survival curves of OSSN recurrence were similar between groups (log-rank = 0.16). One-year recurrence rates were 11.4% with 5FU and 4.5% with IFN. Eyelid edema (P = .04) and tearing (P = .02) were more significant with 5FU. CONCLUSIONS This is the first direct comparison study between 5FU and IFN eye drops as primary treatment modalities for OSSN. Both modalities resulted in a high frequency of tumor resolution and low recurrence rates and are effective treatment options for OSSN.
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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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Gichuhi S, Macharia E, Kabiru J, Zindamoyen AM, Rono H, Ollando E, Wachira J, Munene R, Maina J, Onyuma T, Sagoo MS, Weiss HA, Burton MJ. Topical fluorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2016; 4:e378-85. [PMID: 27198842 PMCID: PMC5081398 DOI: 10.1016/s2214-109x(16)30052-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/23/2016] [Accepted: 04/02/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly affecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the effect of fluorouracil 1% eye drops after surgery on recurrence. METHODS We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fluorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratified by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). FINDINGS Between August, 2012, and July, 2014, we assigned 49 participants to fluorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in five (11%) of 47 patients in the fluorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07-0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little effect (odds ratio 0·23; 95% CI 0·07-0·75; p=0·02). Adverse effects occurred more commonly in the fluorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fluorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus five, and eyelid skin inflammation occurred in seven versus none. INTERPRETATION Topical fluorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended. FUNDING British Council for Prevention of Blindness and the Wellcome Trust.
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Affiliation(s)
- Stephen Gichuhi
- London School of Hygiene & Tropical Medicine, London, UK,Department of Ophthalmology, University of Nairobi, Nairobi, Kenya,Correspondence to: Dr Stephen Gichuhi, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UKCorrespondence to: Dr Stephen GichuhiInternational Centre for Eye HealthLondon School of Hygiene & Tropical MedicineLondonWC1E 7HTUK
| | | | | | | | | | | | | | | | | | - Timothy Onyuma
- Department of Pathology, MP Shah Hospital, Nairobi, Kenya
| | - Mandeep S Sagoo
- UCL Institute of Ophthalmology, University College London, London, UK,Moorfields Eye Hospital, London, UK,St Bartholomew's Hospital, London, London, UK
| | - Helen A Weiss
- London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- London School of Hygiene & Tropical Medicine, London, UK,Moorfields Eye Hospital, London, UK
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Ndlovu N, Ndarukwa S, Kadzatsa W, Rusakaniko S. Evaluation of the radiotherapy management of ocular surface squamous neoplasia in a high HIV prevalence setting- a retrospective review. Infect Agent Cancer 2016; 11:18. [PMID: 27099616 PMCID: PMC4837636 DOI: 10.1186/s13027-016-0064-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article evaluates a single institute's radiotherapy management of OSSN, a previously regarded as rare malignancy, for possible future development of strategies to clearly define the role of adjuvant radiotherapy in improving treatment outcomes. MATERIALS AND METHODS A retrospective review of 153 patients treated from January 2003 to December 2009. RESULTS There was no difference in OSSN prevalence by gender (male to female ratio 1.07). Of 80/153 patients tested 79 (98.8 %) were HIV positive. Most patients (62.9 %) had prior orbital exenteration. Moderately and poorly differentiated grade (82.3 %) was associated with significantly higher stage and incidence of positive regional lymph nodes. External beam therapy dose mostly used was 60Gy in 30 fractions at 200 cGy per fraction in 5 fractions per week (34.8 %). (90)Strontium therapy was given to 13.5 % (60Gy in 6 fractions at 10Gy per fraction weekly). Favourable response (complete and partial) was seen in about 80 % of patients associated with higher total doses. Regional lymph node positivity was associated with poorer outcome. CONCLUSION Adjuvant radiotherapy could have an important role in the management of patients presenting with locally advanced OSSN who are mostly HIV positive in developing countries. Prospective studies to evaluate the role of radiotherapy with or without chemotherapy in the management of OSSN in these settings are warranted.
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Affiliation(s)
- Ntokozo Ndlovu
- College of Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe
| | - Sandra Ndarukwa
- Radiotherapy Centre, Parirenyatwa Hospital, Mazowe Street, Harare, Zimbabwe
| | - Webster Kadzatsa
- College of Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe
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Desai SJ, Pruzan NL, Geske MJ, Jeng BH, Bloomer MM, Vagefi MR. Local and Regional Spread of Primary Conjunctival Squamous Cell Carcinoma. Eye Contact Lens 2016; 44 Suppl 1:S312-S315. [PMID: 27058828 DOI: 10.1097/icl.0000000000000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two cases of biopsy-proven conjunctival squamous cell carcinoma (SCC) that developed local and regional spread are described. The cases involved a 65-year-old woman and a 79-year-old man who were initially treated at outside institutions for SCC of the conjunctiva. The patients did not have a history of immune compromise. The female patient presented with direct extension into the lacrimal gland but deferred recommended exenteration. Despite eventual exenteration, she developed metastasis to a neck node 6 months later, which was treated with radiotherapy. The male patient presented with local recurrence and a parotid node metastasis treated with exenteration, parotidectomy, selective neck dissection, and postoperative radiotherapy. Review of the outside pathology of both cases revealed positive tumor margins at the time of original resection. Local control of conjunctival SCC is of critical importance to reduce the risk of orbital extension and regional spread.
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Affiliation(s)
- Shilpa J Desai
- Department of Ophthalmology (S.J.D., N.L.P., M.J.G., M.M.B., M.R.V.), University of California, San Francisco, CA; Department of Ophthalmology (S.J.D., N.L.P., M.J.G., M.M.B., M.R.V.), San Francisco General Hospital, San Francisco, CA; and Department of Ophthalmology and Visual Sciences (B.H.J.), University of Maryland School of Medicine, Baltimore, MD
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Dorbandt DM, Driskell EA, Hamor RE. Treatment of corneal squamous cell carcinoma using topical 1% 5-fluorouracil as monotherapy. Vet Ophthalmol 2015; 19:256-261. [DOI: 10.1111/vop.12290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel M. Dorbandt
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
| | - Elizabeth A. Driskell
- Department of Pathobiology; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 2001 S. Lincoln Avenue Urbana IL 61802 USA
| | - Ralph E. Hamor
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois Urbana-Champaign; 1008 W. Hazelwood Drive Urbana IL 61802 USA
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Kenawy N, Garrick A, Heimann H, Coupland SE, Damato BE. Conjunctival squamous cell neoplasia: the Liverpool Ocular Oncology Centre experience. Graefes Arch Clin Exp Ophthalmol 2014; 253:143-50. [PMID: 25398663 DOI: 10.1007/s00417-014-2860-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report the outcome of patients with conjunctival squamous cell neoplasia (CSCN)--including conjunctival squamous cell carcinoma (SCC), conjunctival squamous intraepithelial neoplasia (C-SIN) and carcinoma in situ (CIS)-treated at the Liverpool Ocular Oncology Centre (LOOC). METHODS Patients treated between January 1993 and September 2011 were identified and categorised as having 'primary' or 'salvage' treatment, according to whether they had undergone a surgical procedure before referral to our centre. Invasive SCC was treated by excision with adjunctive ruthenium plaque radiotherapy. C-SIN or CIS was treated with topical 5-fluorouracil (5-FU), and in a few cases, cryotherapy. RESULTS Primary treatment was administered to 20 patients (16 males, four females). Mean age was 62 years (range, 33-85). Histological examination revealed C-SIN/CIS in ten patients and invasive SCC in nine. Median follow-up was 69 months (range, 34-168). Three patients required further topical chemotherapy for persistent/recurrent C-SIN. Salvage therapy was administered to 21 patients (15 males, six females). Mean age was 63 years (range, 26-82). Histology showed C-SIN/CIS in 11 patients and invasive SCC in ten. Median follow-up was 54.5 months (range, 36-120). At the close of this audit, there was no recurrence of invasive or metastatic disease in either the primary or salvage groups. CONCLUSIONS Our established protocol for treatment of CSCN has proven successful in local tumour control, and avoids ocular complications. We advocate adjunctive radiotherapy in patients with invasive SCC and chemotherapy in C-SIN/CIS. For improved patient outcome, prompt referral to a specialist centre is encouraged.
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Affiliation(s)
- N Kenawy
- Liverpool Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK,
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Overton TL, Allbaugh RA, Whitley D, Ben-Shlomo G, Griggs A, Tofflemire KL, Whitley EM. A pulse-dose topical 1% 5-fluorouracil treatment regimen in a young dog with corneal squamous cell carcinoma. Vet Ophthalmol 2014; 18:350-4. [PMID: 25270617 DOI: 10.1111/vop.12220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the use of a pulse-dose topical 5-fluorouracil (5-FU) treatment regimen in a Pug dog with corneal squamous cell carcinoma (SCC). METHODS A 1-year-old, spayed female Pug was evaluated for a corneal perforation of the right eye, which was surgically stabilized with a conjunctival pedicle graft. At the time of medial canthoplasty 7 weeks later, two areas of gray-white discoloration had developed medial and lateral to the graft. Biopsy samples were obtained via superficial keratectomy while under general anesthesia. RESULTS Definitive diagnosis of corneal SCC was made through histopathological examination of the surgical biopsies. Thoracic radiography and submandibular lymph node cytology revealed no evidence of metastatic neoplasia. Following healing of the corneal biopsy sites, topical 1% 5-FU ointment was applied four times daily for four consecutive days once a month, for six treatment cycles. Twenty-three months after diagnosis, the patient remains visual and comfortable with no evidence of SCC recurrence. Long-term therapy with once daily topical 1% cyclosporine solution was used to manage corneal pigmentation bilaterally. CONCLUSIONS The pulse-therapy 1% 5-FU protocol was a successful, convenient, and cost-effective adjunctive treatment with few adverse effects.
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Affiliation(s)
- Taryn L Overton
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - Rachel A Allbaugh
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - David Whitley
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - Gil Ben-Shlomo
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - Angel Griggs
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - Kyle L Tofflemire
- Department of Veterinary Clinical Sciences, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
| | - Elizabeth M Whitley
- Department of Veterinary Pathology, Iowa State University College of Veterinary Medicine, 1600 S. 16th St., Ames, IA, 50011, USA
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Bahrami B, Greenwell T, Muecke JS. Long-term outcomes after adjunctive topical 5-flurouracil or mitomycin C for the treatment of surgically excised, localized ocular surface squamous neoplasia. Clin Exp Ophthalmol 2013; 42:317-22. [DOI: 10.1111/ceo.12184] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/28/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Bobak Bahrami
- South Australian Institute of Ophthalmology; Adelaide Australia
- Discipline of Ophthalmology and Visual Sciences; University of Adelaide; North Terrace South Australia Australia
| | - Timothy Greenwell
- South Australian Institute of Ophthalmology; Adelaide Australia
- Discipline of Ophthalmology and Visual Sciences; University of Adelaide; North Terrace South Australia Australia
| | - James S Muecke
- South Australian Institute of Ophthalmology; Adelaide Australia
- Discipline of Ophthalmology and Visual Sciences; University of Adelaide; North Terrace South Australia Australia
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Nagarwal RC, Kumar R, Pandit JK. Chitosan coated sodium alginate-chitosan nanoparticles loaded with 5-FU for ocular delivery: in vitro characterization and in vivo study in rabbit eye. Eur J Pharm Sci 2012; 47:678-85. [PMID: 22922098 DOI: 10.1016/j.ejps.2012.08.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 07/18/2012] [Accepted: 08/09/2012] [Indexed: 12/16/2022]
Abstract
The objective of the study was to develop chitosan (CH) coated sodium alginate-chitosan (SA-CH) nanoparticles, i.e. CH-SA-CH NPs loaded with 5-FU for ophthalmic delivery. Drug loaded nanoparticles (DNPs) were prepared by ionic gelation technique using sodium alginate (SA) and chitosan (CH) and then suspended in chitosan solution. The mean size of nanoparticles and morphology were characterized by dynamic light scattering, scanning electron microscopy, atomic force microscopy and zeta potential. The in vitro release was studied by dialysis membrane technique. The size and drug encapsulation efficiency were dependent on molar ratio of SA and CH. The size of SA-CH nanoparticles was significantly increased with changed morphology after CH coating. SA-CH nanoparticles did not show any interaction with mucin while an enhanced viscosity was observed on coating of nanoparticles with CH. CH-SA-CH DNPs presented a sustained release of 5-FU compared to the 5-FU solution with high burst effect. In vivo study in rabbit eye showed significantly greater level of 5-FU in aqueous humor compared to 5-FU solution. The enhanced mucoadhesiveness of CH-SA-CH DNPs results in higher bioavailability as compared to the uncoated nanoparticles. Optimized formulation was found non-irritant and tolerable when tested by modified Draize test in rabbit eye.
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Affiliation(s)
- Ramesh C Nagarwal
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi 221 005, UP, India.
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Topical 5-Fluorouracil for the Treatment of Periocular Actinic Keratosis and Low-Grade Squamous Malignancy. Ophthalmic Plast Reconstr Surg 2012; 28:181-3. [DOI: 10.1097/iop.0b013e3182467c68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Refractory Squamous Cell Carcinoma of the Conjunctiva Treated With Subconjunctival Ranibizumab (Lucentis). Ophthalmic Plast Reconstr Surg 2012; 28:85-9. [DOI: 10.1097/iop.0b013e3182392f29] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Modified PLA nano in situ gel: A potential ophthalmic drug delivery system. Colloids Surf B Biointerfaces 2011; 86:28-34. [DOI: 10.1016/j.colsurfb.2011.03.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/05/2011] [Accepted: 03/14/2011] [Indexed: 11/16/2022]
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