J Korean Ophthalmol Soc.  2017 Feb;58(2):147-155. 10.3341/jkos.2017.58.2.147.

The Effectiveness of Topical Chemotherapy for the Primary Treatment of Ocular Surface Squamous Neoplasia

• Kim IG
• Yu S
• Lee GJ
• Lee KW
• Park YJ

• KMID: 2369461
• DOI: http://doi.org/10.3341/jkos.2017.58.2.147

Abstract

PURPOSE
In the present study, the effectiveness of topical chemotherapy for the primary treatment of ocular surface squamous neoplasia (OSSN) was evaluated.
METHODS
We enrolled 10 patients (10 eyes) diagnosed with OSSN who received both clinical examination and anterior segment optical coherence tomography (AS-OCT) imaging. The patients were administered topical 0.02% mitomycin-C (MMC) 4 times/day in the affected eye. The patients with MMC-resistant OSSN received topical 1% 5-fluorouracil (5-FU) 4 times/day. AS-OCT imaging was performed before and after the treatment. Clinical examination and AS-OCT were used to monitor the efficacy of topical chemotherapy, recurrence and side effects.
RESULTS
The mean age of the 10 patients (8 males, 2 females) was 76.7 years. The proportion of complete remission resulting from topical treatment with MMC was 80.0% (8 eyes) and 20.0% (2 eyes) when 5-FU was changed to MMC. The average duration of complete remission was 4.3 weeks and the average duration of no recurrence was 17.5 months. The epithelial thickness of the lesions, measured using AS-OCT, significantly decreased from 315.0 µm (pretreatment) to 105.3 µm (after complete remission). Additionally, the epithelial lesion appeared normal after treatment. The most common side effect was conjunctival hyperemia (60.0%, 6 eyes), followed by ocular allergy (30.0%, 3 eyes), superficial punctate keratitis (30.0%, 3 eyes) and corneal erosion (20%, 2 eyes). No serious complications were reported.
CONCLUSIONS
Topical chemotherapy is as effective and well tolerated as a primary treatment for OSSN. Additionally, AS-OCT is a useful noninvasive adjunctive tool in the diagnosis and management of OSSN.

Keyword

5-fluorouracil; Mitomycin C; Ocular surface squamous neoplasia; Optical coherence tomography

MeSH Terms

Diagnosis
Drug Therapy*
Fluorouracil
Humans
Hyperemia
Hypersensitivity
Keratitis
Male
Mitomycin
Recurrence
Tomography, Optical Coherence
Fluorouracil
Mitomycin

Figure

• 

  Figure 1. An 88-year-old female (Patient no. 2 in Table 2) with Ocular surface squamous neoplasia (OSSN) of the right eye. (A) Slit-lamp photograph of the right eye demonstrates a smooth, gelatin-like mass lesion suspicious for OSSN at the temporal (9-O'clock) and inferior (6-O'clock) limbus. (B) Initial Anterior segment optical coherence tomography (AS-OCT) imaging demo-strates a thickened hyper-reflective epithelium and an abrupt transition zone from normal to abnormal epithelium. (C) Slit-lamp pho-tograph after 7 weeks of topical 0.02% Mitomycin C (MMC) for OSSN, showing clinical resolution of the lesion. (D) Follow up AS-OCT image of the same eye after 0.02% MMC for OSSN, showing a return of normal-appearing, thin epithelium after reso-lution of the OSSN.

• 

  Figure 2. An 80-year-old male (Patient no. 9 in Table 2) with ocular surface squamous neoplasia (OSSN) of the right eye. (A) Slit-lamp photographs showed a raised gelatinous diffuse conjunctival lesion extending from 12-O'clock to 6-O'clock position abut-ting, which appeared highly vascular with numerous feeder vessels. (B) Slit-lamp photographs showing decreased OSSN at 2 weeks with 0.02% Mitomycin C (MMC). (C) Slit-lamp photographs showing resolved OSSN at 1 month with 0.02% MMC. (D) Slit-lamp photographs at 7 months after treatment showing normal ocular surface and no recurrence. (E) Initial anterior segment optical coher-ence tomography (AS-OCT) imaging demostrates a thickened hyper-reflective epithelium and an abrupt transition zone from normal to abnormal epithelium. (F) Follow up AS-OCT image of the same eye after 0.02% MMC for OSSN, showing a return of nor-mal-appearing, thin epithelium overlying a dense subepithelial lesion after resolution of the OSSN.

• 

  Figure 3. Before and after treatment slit-lamp photographs of ocular surface squamous neoplasia (OSSN). A 77-year-old male pa-tient with OSSN, before (A) and after treatment (B) slit-lamp photographs. A 85-year-old male patient with OSSN, before (C) and after treatment (D) slit-lamp photographs. A 88-year-old male patient with OSSN, before (E) and after treatment (F) slit-lamp photographs. A 55-year-old female patient with OSSN, before (G) and after treatment (H) slit-lamp photographs. A 80-year-old male patient with OSSN, before (I) and after treatment (J) slit-lamp photographs. A 75-year-old male patient with OSSN, before (K) and after treatment (L) slit-lamp photographs. A 69-year-old male patient with OSSN, before (M) and after treatment (N) slit-lamp photographs. A 70-year-old male patient with OSSN, before (O) and after treatment (P) slit-lamp photographs. Arrows indicates ‘Pre-treatment ocular surface squamous neoplasia lesion’.

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