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

Im Gyu Kim; Yu Sung; Gwang Ja Lee; Kyoo Won Lee; Young Jeung Park

doi:10.3341/jkos.2017.58.2.147

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Kim, Sung, Lee, Lee, and Park: The Effectiveness of Topical Chemotherapy for the Primary Treatment of Ocular Surface Squamous Neoplasia

Original Article

J Korean Ophthalmol Soc 2017;58(2):147-155.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.147

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

Im Gyu Kim, M.D., Yu Sung, M.D., Gwang Ja Lee, M.D., Kyoo Won Lee, M.D., PhD, Young Jeung Park, M.D., PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, PhD Cheil Eye Hospital, #1 Ayang-ro, Dong-gu, Daegu 41196, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758 E-mail: eyepark9@naver.com

Received 20 October 201613 December 2016 Accepted 26 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 imag-ing 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 dura-tion 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 μ m (pretreatment) to 105.3 μ m (after complete re-mission). Additionally, the epithelial lesion appeared normal after treatment. The most common side effect was conjunctival hy-peremia (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.

Keywords: 5-fluorouracil, Mitomycin C, Ocular surface squamous neoplasia, Optical coherence tomography

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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’.

Table 1.

Demographics of 10 patients with ocular surface squ-amous neoplasia

Parameter	Values
Patient information
Patients (n)	10
Sex (n)
Male	8
Female	2
Age (years)
Mean ± SD	76.7 ± 10.1
Range	55-88
Clinical information
OD	6
OS	4
MMC treatment (n, %)	80.0 (8)
5-FU combine treatment (n, %)	20.0 (2)
Resolution time (weeks)
Mean ± SD	4.3 ± 1.8
Range	2-7
Pre-treatment thickness (μ m)
Mean ± SD	315.0 ± 142.3
Range	174-617
Post-treatment thickness (μ m)
Mean ± SD	105.3 ± 14.2
Range	68-118
From resolution to last F/U time (months)
Mean ± SD	17.5 ± 6.9
Range	12-33

Values are presented as mean ± SD unless otherwise indicated. OD = oculus dexter; OS = oculus sinister; MMC = mitomycin C; 5-FU =5-Fluorouracil; F/U = follow-up.

Table 2.

Demographics of 10 patients with ocular surface squamous neoplasia

No.	Age/gender	Affected eye	0.02% MMC duration (weeks)	5-FU duration (weeks)	Total regression	Pre-treatment thickness (μ m)	Post-treatment thickness (μ m)	Follow-up (months)
1	M/77	R	2	None	Yes	180	103	26
2	F/88	R	7	None	Yes	617	118	12
3	M/85	L	5	None	Yes	174	68	33
4	M/88	L	5	None	Yes	505	103	13
5	F/55	L	2	None	Yes	324	106	18
6	M/80	L	7	None	Yes	294	110	13
7	M/75	R	4	1	Yes	203	111	18
8	M/69	R	3	2	Yes	299	106	16
9	M/80	R	5	None	Yes	294	118	12
10	M/70	R	3	None	Yes	260	110	14

MMC = mitomycin C; FU = fluorouracil; M = male; F = female; R = right; L = left.

Table 3.

Complications in patient with ocular surface squ-amous neoplasia treated by topical chemotherapy

Complications	Values
Conjunctival hyperemia	60.0 (6)
Ocular allergy (Lid swelling, eczema)	30.0 (3)
Superficial punctate keratitis.	30.0 (3)
Corneal erosion	20.0 (2)
Ectropion	0 (0)
Blepharospasm	0 (0)
Uveitis	0 (0)
Punctal stenosis	0 (0)
Limbal stem cell deficiency	0 (0)
Symblepharon	0 (0)

Values are presented as n (%).

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