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Giulia Midena, Raffaele Parrozzani, Luisa Frizziero, ilaria testi, Edoardo Midena; Topical 1% 5-Fluoruracil as a sole treatment of corneo-conjunctival ocular surface squamous neoplasia: long term results.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2413.
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© ARVO (1962-2015); The Authors (2016-present)
To report, on a very long term, the clinical outcome of topical 1% 5-Fluorouracil (5 FU) used as sole treatment of ocular surface squamous neoplasia (OSSN).
Forty-five eyes of 45 patients affected by OSSN were included in this prospective study. Each patient underwent at baseline: full ophthalmologic examination, cytologic/histologic confirmation of clinical diagnosis, corneal/conjunctival confocal microscopy. Patients were initially treated with topical 1% 5FU four times a day for four weeks (one course). Adjunctive courses were used after at least one month free of therapy. Clinical resolution was confirmed by scraping cytology. Follow-up was performed monthly during therapy, and then after 1,3 and 6 months, and every 6 months thereafter. Ocular side effects were prospectively recorded.
Cyto/histological diagnosis resulted in: low grade dysplasia in 20 cases (49%), high grade dysplasia in 13 cases (31%) and squamous cell carcinoma in 8 cases (19%). Mean follow-up was 105 ± 32 months (range 60 to 171 months). Complete tumor regression was achieved in 34 cases (83%), after a mean of 1.5 courses (range: 1-3 courses). Univariate analysis revealed that complete response was significantly related to: tumor thickness < 1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and 0.0002, respectively), and morphologic classification (p=0.028). Multivariate analysis showed that tumor thickness > 1.5 mm and multifocality were correlated with incomplete tumor response (p=0.045 and 0.023, respectively). Transient and reversible low to mild local side effects were documented in 19 (48%) treated eyes. All these side effects completely resolved in 4 weeks after treatment.
Topical 1% 5 FU eyedrops used as sole treatment of OSSN may be an effective and safe treatement, even on a very long term basis. Tumor thickness is the main limiting factor for complete success. This confirms that 1% topical 5 FU can be used at least as debulking procedure for all OSSN.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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