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.

Purpose To determine the efficacy of topical 5-fluorouracil 1% (5FU) as a primary treatment of ocular surface squamous neoplasia (OSSN). Design Retrospective study. Participants Topical 5FU was used as primary therapy in 44 patients with OSSN. Methods 5FU 1% administered topically four times a day for a week followed by a drug holiday of 3 weeks. Patients were identified through pharmacy database. Patients were excluded if 5FU was used as adjuvant therapy, did not complete therapy, or were still in active treatment for their OSSN at the time of last follow up. Main outcome measure The primary outcome measures were the frequency of complete resolution with topical 5FU treatment and the rate of OSSN recurrence. Results Of the 44 patients identified, 32 were males and 12 were females. The mean age was 68 years. Complete resolution of OSSN was noted in 82% (36/44) patients; and, 18% (8/44) were considered treatment non-responders. Patients were treated a median of 4 cycles (range 2-9). Nasal location was the only risk factor identified for nonresponse to therapy (p=0.04). The median follow up after resolution was 10 months (range 2-77). In the 36 patients with complete resolution, 4 had tumor recurrence. Recurrence rates at 1 and 2 years were 6% and 15% respectively using Kaplan-Meier survival analysis. At least one side effect from the medication was reported by 61% (21/44) of patients, but only 1 patient discontinued the medication due to intolerance. The most common side effect was pain (n=17, 39%) followed by tearing (n=10, 23%), photophobia (n=6, 14%), itching (n=4, 9%), swelling (n=2, 5%), and infection (n=1, 2%). No long-term complications were reported. Conclusion 5-fluorouracil is efficacious and well tolerated as a primary treatment for OSSN, with 82% of tumors completely responding to therapy.

Drs. Yoo and Donaldson are speakers for and consultants to Alcon Surgical, Inc., and Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (≤ 6 mm) after FLACS pretreatment.