Ocular surface squamous neoplasia (OSSN) comprises a range of dysplasia including corneal-conjunctival intraepithelial neoplasia and invasive squamous cell carcinoma. The traditional treatment for localised non-invasive OSSN has been surgical excision with or without intraoperative cryotherapy. Postoperative adjunctive topical chemotherapy significantly reduces the rate of recurrence. This paper presented a long-term follow-up of two prospective non-comparative interventional case series examining recurrence and side-effect rates in patients receiving 5-FU (fluorouracil) or mitomycin C (MMC) as adjuvants to surgical excision of localised OSSN. Eighty-nine eyes were included in the 5-FU group and 64 eyes were included in the MMC group. All patients underwent complete superficial dissection of the lesion with a 2mm margin. All lesions in the 5-FU group had cryotherapy applied intraoperatively, however, cryotherapy was not available in 18.7% of cases in the MMC arm. Median follow-up was 33.6 months in the 5-FU arm and 57.9 months in the MMC arm. There were no recurrences in the MMC arm and one recurrence in the 5-FU arm. This case of recurrence was in an incompletely excised CIN III lesion with an incomplete course of adjuvant 5-FU therapy. Overall, side-effects were encountered in 69% of 5-FU cases compared with 41% of MMC cases. Sixty-two percent of 5-FU cases experienced lid toxicity vs. 0% of MMC cases. No 5-FU cases experienced allergy vs. 28% of MMC cases. Ten percent of patients in the 5-FU group developed epiphora, compared with 17% in the MMC group. The authors concluded that recurrence is rare when adjuvant 5-FU or MMC is used in surgically excised localised OSSN and although side-effects are common, the majority are transient and rarely limit compliance. 

Long-term outcomes after adjunctive topical 5-fluorouracil or mitomycin C for the treatment of surgically excised, localised ocular surface squamous neoplasia.
Bahrami B, Greenwell T, Muecke S.
Share This
Anjali Gupta

Birmingham and Midland Eye Centre, Birmingham, UK.

View Full Profile