Topical 1% 5-fluorouracil eye drops as primary treatment for ocular surface squamous neoplasia: Long-term follow-up study

Differential diagnostic importance of swept-source optical coherence tomography in ocular surface lesions : Swept-source OCT in ocular surface lesions

BACKGROUND

The purpose of this retrospective study was to analyze the features of different ocular surface lesions using high resolution swept-source optical coherence tomography (OCT) and to correlate those characteristics with histopathologic alterations.

METHODS

Thirty-eight eyes of 37 patients (19 males and 18 females) were included in this study with a mean age of 60.36 ± 17.29 years years. Anterior segment imaging was performed with a swept-light source OCT system (ANTERION, Heidelberg Engineering, Germany) using the Imaging App. Clinical diagnosis based on the slit-lamp findings was compared with the OCT features of the lesion and the histopathology result.

RESULTS

Based on the OCT features, 11 lesions were in the epithelium, of which 5 had only epithelial component. Six growths had both epithelial and subepithelial components and 27 lesions were confined to the substantia propria. The OCT finding and histopathology result correlated in 57% (6/11) for epithelial involvement and in 84% (28/33) for subepithelial involvement. In 25 cases (65%), the clinical and histopathology diagnosis agreed. In 13 cases (35%), the clinical suspicion was different from the final histopathology diagnosis. Out of those 13 cases, high-resolution OCT findings were suggestive of the histopathology results in 8 cases.

CONCLUSIONS

High-resolution swept-source OCT provided valuable information of the structure, topographic location and extent of an ocular surface lesion and was helpful in assisting the diagnosis.

Iatrogenic Ocular Surface Complications After Surgery for Ocular and Adnexal Tumors

Background/Objectives: The management of ocular tumors often necessitates surgery, either alone or in combination with radiotherapy, chemotherapy, or other modalities. While crucial for tumor control, these treatments can significantly impact the ocular surface, leading to both acute and chronic complications. This review examines iatrogenic ocular surface diseases resulting from oncologic interventions, emphasizing their pathophysiology, diagnostic challenges, and management strategies. Methods: A literature review was conducted to identify studies on iatrogenic ocular surface complications associated with ocular tumor treatments. Results: Ocular surface complications include direct damage from surgical manipulation, leading to corneal opacities and persistent epithelial defects, as well as dry eye disease secondary to postoperative chemosis. These disruptions may progress to more severe conditions such as keratopathy, corneal ulcers, limbal stem cell deficiency, and stromal scarring, further impairing visual function. Structural alterations contribute to eyelid malpositions-including ectropion, entropion, round eye, and lagophthalmos-which exacerbate exposure-related damage and ocular surface instability. In cases of uveal melanomas, the exposure of episcleral brachytherapy plaques can induce chronic conjunctival irritation, promoting adhesion formation and symblepharon. Surgical interventions disrupt ocular surface homeostasis, while radiotherapy and chemotherapy exacerbate these effects through cytotoxic and inflammatory mechanisms. Conclusions: Preventing and managing iatrogenic ocular surface complications require a multidisciplinary approach involving early diagnosis, personalized treatment strategies, and targeted postoperative care. Comprehensive pre- and postoperative planning is essential to optimize both visual function and long-term ocular surface integrity, ultimately ensuring a balance between oncologic control with functional and aesthetic preservation.

Interferon alpha-2b versus 5-fluorouracil as primary treatment modalities for ocular surface squamous neoplasia: a study of 116 eyes

PURPOSE

To compare the efficacy and side-effect profile of interferon alpha-2b (IFNα2B) and topical 5-fluorouracil (5-FU) as primary treatment modalities for ocular surface squamous neoplasia (OSSN).

METHODS

Retrospective comparative study of 116 OSSN eyes treated with topical 1 MIU IFNα2B with/without 5 MIU/cc subconjunctival injection (group 1) or topical 1% 5-FU (group 2) in mutually exclusive time periods of treatment.

RESULTS

Of the 116 eyes with OSSN, 64 eyes belonged to group 1 and 52 eyes to group 2. The mean tumor basal conjunctival diameter for groups 1 and 2 was 10 mm (median, 10 mm; range 0-28 mm) and 5 mm (median, 4 mm; range, 0-24 mm) respectively (p < 0.0001). Complete tumor regression with medical management alone was achieved in 51 (80%) eyes in group 1 and 43 (83%) eyes in group 2 (p = 0.6814). The mean number of sessions/cycles of treatment for complete tumor regression was 3 (median, 3; range, 1-6) for group 1 versus 2 (median, 2; range, 1-6) for group 2 (p < 0.0001). Tumor recurrence was noted in 3 (5%) eyes in group 1 over a mean follow-up period (months) of 11 (median, 7; range, 3-41) versus 1 (2%) in group 2 (p = 0.25) over a mean follow-up period (months) of 6 (median, 5; range, 1-25). Side-effects included transient conjunctival hyperemia (9%), and flu-like symptoms (3%) in group 1 versus transient conjunctival hyperemia (2%), punctal stenosis (2%), and partial limbal stem cell deficiency (2%) in group 2.

CONCLUSION

Primary treatment of OSSN with IFNα2b or 5-FU offers comparable and good tumor control with minimal side-effects.

Update in the Diagnosis and Management of Ocular Surface Squamous Neoplasia (OSSN)

Ocular surface squamous neoplasia (OSSN) includes a variety of ocular surface tumors ranging from mild epithelial dysplasia to invasive squamous cell carcinoma. OSSN is one of the most frequent non-pigmented malignancies of the ocular surface. Debate persists between surgical excision and medical management concerning the optimal regimen for OSSN treatment, with surgical excision continuing to be the recognized standard of care in contemporary medicine. Medical and conservative therapy techniques have advanced significantly in recent years, leading to widespread use in everyday ophthalmology practice. This study aims to look into the efficacy of current treatment options for conjunctival squamous cell carcinoma and to evaluate the available evidence for the most up-to-date approach for the management of the disease.

Topical 5-fluorouracil 1% as first-line therapy for giant ocular surface squamous neoplasia

PURPOSE

To evaluate the clinical outcomes of topical 5-fluorouracil (5-FU) 1% as first-line therapy for giant ocular surface squamous neoplasia (OSSN).

MATERIALS AND METHODS

This was a non-comparative cohort study. We included patients with biopsy-proven giant OSSN in a tertiary-care setting. Giant OSSN was defined as a single lesion≥15mm in the largest basal dimension or an extent of≥6 clock hours of limbal involvement. Topical 5-FU 1% was administered QID for one week, followed by a three-week drug holiday. This treatment cycle was repeated until resolution. Resolution rate was the primary outcome measure, where complete resolution was defined clinically and by tomography. Secondary outcomes were time to resolution and frequency of recurrence and side effects.

RESULTS

Twenty-seven eyes (27 patients) were included; the majority (19, 70%) were men, with a mean age of 69.2±15.7 years. Corneal/conjunctival intraepithelial neoplasia was diagnosed in 88%, and squamous cell carcinoma (SCC) in the remaining 12% of cases. The rate of complete resolution was 77.8% (21/27) after a mean of 5.1±2.1 cycles. The median time to complete resolution was 5 months (CI95% 4-6 months). During a mean follow-up of 10.2±2.9 months, recurrence was observed in one patient (4.8%) and four (14.8%) reported side effects. Patients with partial resolution were older and had a higher frequency of SCC diagnosis than those with complete resolution.

CONCLUSION

Topical 5-FU 1% appears to be useful as first-line therapy for giant OSSN, with good tolerance and a low frequency of recurrence. More studies with larger sample sizes and longer follow-up are needed.

Topical 5-Fluorouracil 0.5% as primary treatment for Ocular Surface Squamous Neoplasia

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.

Chemoimmunotherapy-Resistant Ocular Surface Squamous Neoplasia Managed With I-125 Brachytherapy

PURPOSE

The purpose of this study was to report the management of chemoimmunotherapy-resistant ocular surface squamous neoplasia (OSSN) with iodine-125 (I-125) brachytherapy.

METHODS

A 36-year-old man presented to the clinic with biopsy-proven OSSN that covered ∼70% of the corneal surface and extended to the 6 o'clock position of the inferior limbus of the OS. The visual acuity was 20/20 in the OD and 20/40 in the affected OS. He was treated with topical interferon alpha-2b 1 MIU/mL (4 times daily [QID] for 6 weeks) and then 4 cycles of topical 5-fluorouracil 1% (QID, 1 week on, 3 weeks off) with an incomplete response. He switched to topical mitomycin C 0.04% (QID, 1 week on, 2 weeks off) for 2 cycles and received a subconjunctival injection 25 mg (0.5 mL of a 50-mg/mL solution) of 5-fluorouracil. The tumor persisted. The patient was ultimately cured with placement of an 18-mm I-125 brachytherapy plaque for 97 hours (50 Gy).

RESULTS

Because of extensive corneal involvement and risks associated with surgery, an 18-mm I-125 brachytherapy plaque was placed over the cornea and limbus. The treatment led to full resolution of the tumor within 1 month of treatment and recovery of 20/20 vision in the affected eye. Thirty-two months after treatment, the patient developed a visually significant posterior subcapsular cataract OS and underwent successful phacoemulsification surgery, returning to 20/20 vision. He has remained tumor-free for over 55 months.

CONCLUSIONS

This case highlights the efficacy and safety of I-125 brachytherapy as an alternative for intraepithelial OSSN unresponsive to conventional chemoimmunotherapy, particularly when extensive surgical excision poses significant risks.

Efficacy and safety of topical 0.5% 5-Fluorouracil as primary treatment of ocular surface squamous neoplasia

OBJECTIVE

To assess the efficacy and safety of topical 0.5% 5-Fluorouracil (5-FU) as a primary therapy of ocular surface squamous neoplasia (OSSN).

DESIGN

Retrospective study.

PARTICIPANTS

Patients with clinically suspected OSSN referred to a Brazilian tertiary health center between October 2015 and December 2022.

METHODS

After diagnostic confirmation of OSSN with exfoliative cytology, 0.5% 5-FU was administered topically 4 times daily for 2 weeks followed by a pause of 2 weeks.

RESULTS

A total of 54 patients were included in this study, 32 males (59.3%), mean age of 62.9 years old. Complete resolution of OSSN was achieved in 70.4%. The median number of cycles was 2 (range 1-5). Side effects were reported in 35.2%, which included eyelid erythema, conjunctival hyperemia, and punctal stenosis. None of the patients stopped treatment due to adverse effects. Patients who had partial response to 0.5% 5-FU had complementary treatment with surgery, Mitomycin-C and/or Interferon ⍺2b. Overall recurrence was 14.8%. Median follow-up was 14 months (range 2-92 months). In a multivariate Cox regression analysis, the risk of relapse was 84% lower in patients who had complete response to 0.5% 5-FU (p = 0.018).

CONCLUSION

Topical 0.5% 5-FU may be considered a safe and effective primary therapy for OSSN, with a low rate of side effects.

Treatment of ocular surface squamous neoplasia in an Indian rural facility: a study of 38 eyes

PURPOSE

To report the demographic profile, clinical presentation, and management outcomes of ocular surface squamous neoplasia (OSSN) treated with primary topical chemotherapy in a limited resource secondary eye care facility in rural parts of South India.

METHODS

Retrospective interventional study of 38 eyes of 37 patients with OSSN treated with topical 1% 5-Fluorouracil (5FU), over a period of two years.

RESULTS

The median age at presentation with OSSN was 44 years (mean, 46 years; range 13 to 74 years). Majority (76%) were males. The most common morphological variant was placoid OSSN (18, 47%). Limbus was the most common epicenter (31, 82%). Corneal OSSN was the most initially misdiagnosed variant (n = 3). Of the 38 eyes receiving one week on and 3-weeks off cycles of 5FU regimen, complete tumor resolution was achieved in 36 (95%) eyes. The median number of topical 5FU cycles for tumor resolution was 2 (mean, 2; range, 1 to 4). Over a median follow-up period of 5 months (mean, 6 months; range, 1 to 27 months), tumor recurrence was noted in 3 eyes (8%), of which one case had xeroderma pigmentosum with bilateral multifocal recurrence. Complication rate was 5% (n = 2), which included transient conjunctival hyperemia (n = 1), and bacterial keratitis (n = 1) which resolved with fortified antibiotics.

CONCLUSION

Primary chemotherapy with topical 1% 5FU is a safe and effective management modality for OSSN at limited resource settings in rural India.

Ocular Surface Squamous Neoplasia: Changes in the Standard of Care 2003 to 2022

PURPOSE

The aim of this review was to elucidate treatment preferences for ocular surface squamous neoplasia and to examine the changes in treatment modalities over the past 2 decades.

METHODS

An electronic survey was distributed to members of The Cornea Society, Ocular Microbiology and Immunology Group, and 4 international corneal specialist listservs. Questions examined medical and surgical treatment preferences, and results were compared with surveys administered in 2003 and 2012.

RESULTS

A total of 285 individuals responded to the survey; 90% of respondents were self-classified as corneal specialists. Seventy-three percent reported using primary topical monotherapy to treat ocular surface squamous neoplasia as compared with 58% in 2012 ( P = 0.008). Compared with 2003, the percentage use of topical interferon significantly increased ( P < 0.0001) from 14% to 55%, 5-fluorouracil increased ( P < 0.0001) from 5% to 23%, and mitomycin C decreased ( P < 0.0001) from 76% to 19% as a primary monotherapy. The frequency of performing excision without the use of postoperative adjunctive medical therapy decreased significantly ( P < 0.0001), from 66% to 26% for lesions <2 mm, 64% to 12% for lesions between 2 and 8 mm, and 47% to 5% for lesions >8 mm from 2003 to 2022. More clinicians initiated topical immuno/chemotherapy without performing a biopsy as compared to 2003 (31% vs. 11%, P < 0.0001).

CONCLUSIONS

These results demonstrate a paradigm shift in the management of ocular surface squamous neoplasia. The use of primary medical therapy as a first approach has significantly increased, with a reduction in the frequency of performing surgical excision alone.

Efficacy of topical 5-Fluorouracil in the management of ocular surface squamous neoplasia: a study of 101 eyes

OBJECTIVE

To study the efficacy and side-effect profile of topical 5-Fluorouracil (5-FU) in the treatment of ocular surface squamous neoplasia (OSSN).

METHODS

Retrospective study of 101 eyes of 100 patients treated with 5-FU with one week on and 3 weeks off regimen.

RESULTS

Of the 100 patients (101 eyes), the mean age at diagnosis of OSSN was 49 (median, 52 years; range, 11-87 years). History of prior intervention was noted in 6 (6%) eyes. Tumor epicenter included bulbar conjunctiva (n = 54; 53%), limbus (n = 27; 27%), and cornea (n = 20;20%). Mean number of cycles of topical 5-FU administered was 3 (median, 3; range, 1-8). Complete tumor regression was achieved with topical 5-FU in 89 (88%) eyes with a mean number of 2 cycles (median, 2; range, 1-6) of 5-FU. The remaining 12 (12%) lesions underwent additional treatment including excisional biopsy (n = 7), extended enucleation (n = 3), and topical Interferon alpha 2b (n = 2) for complete tumor control. Over a mean follow-up period of 6 months (median, 5 months; range, 1-36 months) following treatment, tumor recurrence was noted in 2 (2%) patients, and side-effects were noted in 7 (7%) eyes including conjunctival hyperemia (n = 1), punctal stenosis (n = 1), sterile keratitis (n = 4), and limbal stem cell deficiency (n = 1).

CONCLUSION

Topical 5-FU is an effective non-invasive therapy for OSSN with a minimal side-effect profile.

Topical 5-fluorouracil 1% for moderate to extensive ocular surface squamous neoplasia in 73 consecutive patients: Primary versus secondary treatment

IMPORTANCE

Ocular surface squamous neoplasia (OSSN) is a spectrum of malignancies that generally includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). OSSN can be treated with topical therapies including interferon α-2b (IFN), mitomycin C (MMC), or 5-fluorouracil 1% (5FU). Recently, due to unavailability of IFN and toxicity associated with MMC, therapy has shifted towards 5FU.

OBJECTIVE

Herein, we compare the use of 5FU 1% as a primary versus (vs) secondary treatment regimen in eyes with moderate to extensive OSSN.

DESIGN SETTING AND PARTICIPANTS

Retrospective cohort study of 73 consecutive patients with unilateral moderate to extensive OSSN treated at a single tertiary ocular oncology center from 2016 to 2023. Mean follow up time was 478.2 days overall, with 283.0 days for primary 5FU group and 860.3 days for secondary 5FU group.

INTERVENTION

Topical 5FU 1% 4 times daily for 2 weeks with option for 2-weekly extension until tumor control, either as primary treatment or as secondary treatment to surgical resection, topical IFN or topical MMC, or cryotherapy.

MAIN OUTCOMES

Outcome measures included tumor response, need for additional surgery, complications, and visual outcomes.

RESULTS

A comparison (primary vs secondary treatment) revealed no difference in mean tumor basal dimension (19.6 vs 17.2 mm, P = 0.46), thickness (3.7 vs 3.4 mm, P = 0.64), or tumor extent (4.4 vs 4.5 clock hours, P = 0.92). The primary treatment group showed greater complete tumor control (77% vs 38%, P = 0.04). Multivariable analysis comparison (primary vs secondary treatment) showed primary treatment more likely to achieve complete tumor control (P = 0.01). There was no difference in the complication rate from 5FU treatment between the groups. There was no difference in visual outcome, and no tumor-related metastasis (0%) or death (0%).

CONCLUSION AND RELEVANCE

Topical 5FU 1% is efficacious and safe as a primary or secondary treatment for moderate to extensive OSSN. Tumors treated with primary 5FU 1% demonstrated more complete resolution. In patients with moderate to extensive OSSN, primary treatment with topical 5FU 1% may be warranted.

Targeted therapy in ophthalmic oncology: The current status

There have been rapid advancements in the field of ocular oncology for the diagnosis and management of intraocular, adnexal, and orbital tumors. Targeted therapy is in the forefront of medical research in all fields including ocular oncology. Targeted therapy include drugs that target specific genetic mutations, pathways or proteins involved in the development of cancer. In contrast to traditionally used chemotherapy, drugs used in targeted therapy are highly specific for tumor cells and preserve the function of normal cells. This review aims to familiarize ophthalmologists with the drugs that are currently approved or undergoing clinical trials for use in ocular oncology. Targeted therapy is particularly useful for locally advanced or metastatic tumors, including but not limited to eyelid and periocular basal cell carcinoma, periocular cutaneous and conjunctival squamous cell carcinoma, ocular adnexal lymphoma, conjunctival melanoma, and uveal melanoma. The results are promising with improved survival outcomes and better tolerability than chemotherapeutic drugs.