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Matthew Hochuen Ip, Robert George, William Rawlinson, Minas T Coroneo; Successful treatment of recurrent ocular surface squamous neoplasia (OSSN) with topical cidofovir. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© 2017 Association for Research in Vision and Ophthalmology.
Despite the success of topical medical treatments, particularly with Interferon alpha-2b in treatment of OSSN, there is a failure rate of ~2%. A previous study2 showed OSSN responds to cidofovir (CDV), although our data showed no herpes viruses present in OSSN1. We have previously demonstrated that 6.5% of OSSN specimens are HPV-positive1, and considered the possibility that patients unresponsive to interferon may be HPV-positive and respond to antiviral therapy with CDV.
A single center retrospective observational case series was performed to evaluate the efficacy of topical CDV for treatment of recurrent OSSN in 7 eyes of 7 patients. Each patient had been previously diagnosed with OSSN utilizing slit-lamp examination confirmed with histopathology, and had failed other interventions including Interferon alpha-2b. Each patient was treated with 2.5mg/ml TDS topical CDV for a period of 4-6 weeks. Patients were then reviewed clinically with slit-lamp examination and photography to look for recurrence.
Topical CDV was effective in 6 out of 7 eyes treated, with improved clinical appearance. After 1-month of CDV treatment, each of the 6 eyes demonstrated a marked reduction in mass size. Furthermore, no residual scar tissue was visualized (Figure 1 and 2). The mean follow-up with no clinical relapse is currently 6.4 months, with a range of follow-up of 1-12 months. In 1/7 cases we detected high risk HPV in a biopsy specimen using a hybrid capture assay. A further 5/7 were negative for high risk HPV using PCR, and 1/7 remains untested.
Topical CDV appears to be effective for treatment-refractive OSSN in the short-medium term. The efficacy of CDV raises the possibility of a viral etiology of OSSN in cases resistant to treatment with Interferon Alfa-2b.1. Woods M et al. Cornea 2013;54:8069-8078.2. Sherman MD et al. Am J Ophthal 2002;134:432-3.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1. The initial slit-lamp photograph of the right nasal conjunctiva of one patient.
Figure 2. A comparative clinical photograph of the right nasal conjunctiva 12 months after biopsy and topical cidofovir administration for 6 weeks.
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