Long-Term Efficacy and Safety of Subconjunctival/Perilesional 5-Fluorouracil Injections for Ocular Surface Squamous Neoplasia

Abstract

Purpose To investigate the effectiveness and safety of subconjunctival/perilesional 5-fluorouracil injections on ocular surface squamous neoplasia (OSSN) during a 3-year follow-up period. Patients and Methods We followed up six patients with intraepithelial OSSN (in one eye each) that had regressed after subconjunctival/perilesional 5-fluorouracil injections. Conjunctival fluorescein angiography (FA) and indocyanine green angiography (ICGA), as well as anterior segment optical coherence tomography (AS-OCT), were performed to evaluate the OSSN status 3 years after initiation of treatment. Results The mean age of patients (five males, one female) at baseline was 62.3±11.6 years. The mean number of 5-fluorouracil injections was 17.0±8.6, with a mean treatment duration of 13.0±7.4 weeks. At the final visit, both intratumoral and conjunctival feeding vessels had disappeared on ICGA and FA, with no neovascularization-related leakage, in accordance with the results of AS-OCT. The period from complete tumor regression to final visit according to AS-OCT was 32.5±4.2 months, which was longer than that according to ICGA (31.3±3.2 months, p=0.034). The final best-corrected visual acuity was similar to that at baseline (p=0.128). No side effects were observed in any of the eyes. Conclusion Subconjunctival/perilesional 5-fluorouracil injections are an effective and safe treatment for OSSN. Future studies with a larger sample size are warranted for confirmation of our findings, as well as investigation into the reasons for residual areas of non-perfusion in the conjunctiva.

Squamous Cell Carcinoma of the Eyelid and Ocular Surface

“…Subconjunctival and perilesional injections to treat OSSN have also been proposed, however, the evidence is limited and requires more studies [52].…”

Management of ocular surface squamous neoplasia: Bowman Club Lecture 2021

“…[13][14][15][16] 5FU has also been used as subconjunctival and perilesional injections to treat OSSN; however, the evidence is limited and this requires further study. 17 Side effects of 5FU are generally mild and well tolerated. These may include pain, tearing, redness, eyelid oedema and keratopathy.…”

New Insights on the Diagnosis and Management of Malignant Tumors of the Ocular Surface

“…Alternative regimens include administration of topical 5-FU 4 times daily for 2 days to 4 weeks, with variable weeks off (16,(65)(66)(67)(68). Recently, subconjunctival/perilesional 5-FU injections for treatment of OSSN have shown to be effective and safe in the long term (69). IF-Nα-2b is a valid alternative to 5-FU for treatment of OSSN, however, it may have decreased efficacy compared to 5-FU in patients with underlying immunosuppression (65,67,68,70 (10,11,16,48).…”