Topical pharmacotherapy for ocular surface squamous neoplasia: systematic review and meta-analysis

Abstract

Ocular surface squamous neoplasia (OSSN) has different treatment modalities. Although surgical excision has been the gold standard therapeutic option, topical pharmacotherapy agents such as 5-fluorouracil (5-FU), interferon alfa-2b (IFN) and mitomycin-C (MMC) are also commonly used. The protocol was registered (CRD42021224961). Comprehensive literature research was carried out to compare topical pharmacotherapy (5-FU or IFN or MMC) to surgical excision regarding clinical success (tumor resolution), recurrence and complications in patients undergoing treatment for OSSN. From 7859 records, 7 articles were included in the qualitative and 4 in the quantitative synthesis. The outcomes of surgical excision and topical pharmacotherapy were comparable in the included articles. There were no significant differences between surgical excision and topical pharmacotherapy regarding the clinical success [odds ratio (OR): 0.785; confidence interval (CI): 0.130–4.736, P = 0.792)] and tumor recurrence (OR: 0.746; CI: 0.213–2.609; P = 0.646). The most common side effect of the different therapeutic options was dry eye. The highest rate of dry eye symptoms was reported after surgical excision (in 59%). Topical pharmacotherapy with all the 3 agents is as effective and well-tolerable as surgical excision in terms of tumor resolution, recurrence rate and side effects in all OSSN patients suggesting similar long-term clinical benefits.

Use of Cemiplimab, an Immune Checkpoint Inhibitor for Conjunctival Intraepithelial Neoplasia

“…Topical chemotherapeutic agents of MMC, 5-FU, and IFNα-2b demonstrate no significant clinical benefit on tumor resolution (overall risk [OR]: 0.785; 95% confidence interval, 0.130–4.736, P = 0.792) or tumor recurrence (OR: 0.746; 95% confidence interval, 0.213–2.609, P = 0.646) over surgery alone. 4 Nanji et al 5 reported that the recurrence rate after IFNα-2b therapy (topical or intralesional injections) was 3% at 1 year and 25% at 5 years, while it was 5% at 1 year and 11% at 5 years after surgical excision. There was no statistical difference between 2 groups ( P = 0.8).…”

Variable presentations of six conjunctival/limbal ocular surface squamous neoplasia (OSSN) cases: How good is our clinical judgment evidenced by the correlation to the histopathological findings and diagnosis?

“…The variability in OSSN presentation can result in overlooked or misdiagnosed cases, emphasizing the need for meticulous evaluation of any unusual ocular surface abnormality [ 12 , 13 ]. Therefore, incorporating OSSN into the differential diagnosis of every conjunctival mass, especially when accompanied by supporting risk factors such as: smoking, ultraviolet light exposure, human papilloma virus, xeroderma pigmentosa, and immunosuppression, is crucial for early detection and prompt intervention.…”

The combination of IFNα2b/5-FU inhibits proliferation and cell cycle of tumor cells in treating Ocular Surface Squamous Neoplasia

“…In the past decade, the consensus regarding rst-line therapy for OSSN has transformed from surgical excision towards topical pharmacotherapy 7,8 . Topical medications focusing on interferon-α2b (IFNα2b) and 5uorouracil (5-FU) gain reputation as an effective alternative for treating microinvasive tumors diffusedly and promoting tumor resolution on target [9][10][11] .…”