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. 2017;12(1):11-19.
doi: 10.1080/17469899.2017.1263567. Epub 2016 Dec 5.

Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia

Ibrahim O Sayed-Ahmed  1 , Sotiria Palioura  1 , Anat Galor  1 , Carol L Karp  1
Affiliations

Diagnosis and Medical Management of Ocular Surface Squamous Neoplasia

Ibrahim O Sayed-Ahmed et al. Expert Rev Ophthalmol. 2017.

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.

Keywords: 5-fluorouracil; conjunctival neoplasia; high resolution optical coherence tomography; interferon-α2b; mitomycin C; ocular surface squamous neoplasia; topical chemotherapy.

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Conflict of interest statement

Declaration of interest The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Figures

Figure 1
Figure 1
A: Slit-lamp photograph of a large OSSN with papillary appearance that involves at least 5 clock hours of the limbus in a 94 year-old woman. B: Slit-lamp photograph after 6 months of topical interferon treatment, at a dose of 1 MIU/ml four times daily. C: Slit-lamp photograph of an elevated OSSN lesion in a 70 year-old male, which recurred after 3 excisions. D: Slit-lamp photograph after 4 one week cycles of treatment with topical 1% 5-FU drops with complete resolution of the lesion (1 week on, 3 weeks off). Residual haze at the site of the lesion. E: Slit-lamp photograph of a fungating OSSN lesion in a 65 year-old female. F: Slit-lamp photograph showing resolution of the lesion after 4 weekly cycles of MMC. (1 week on, 2–3 weeks off)
Figure 2
Figure 2
Histopathological examination of an excised specimen discloses mucosal epithelium that displays faulty epithelial maturational sequencing extending up to full thickness, with no invasion of the underlying tissue. Diagnosis is conjunctival intraepithelial neoplasia, in situ. (stain, hematoxylin–eosin; original magnification, X20).
Figure 3
Figure 3
A: Slit lamp photograph of a raised leukoplakic lesion that stains with Rose Bengal. B: HR OCT shows thickened hyper-reflective epithelium (asterisk) with an abrupt transition (circle) from the adjacent normal epithelium (white arrow). Dashed line at base of epithelium C: Slit lamp photograph showing resolution of the lesion in A after 4 cycles (1 week on, 3 weeks off) of 5-fluorouracil 1% drops. D: HR OCT after 4 months of treatment with 5-FU confirms resolution of the OSSN lesion and restoration of normal thin epithelium in the same location. Dashed line at base of epithelium.
See this image and copyright information in PMC

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