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Primary chemotherapy as the emerging management paradigm for diffuse ocular surface squamous neoplasia (OSSN)

Poster Details

First Author: C.Malhotra INDIA

Co Author(s):    D. Dhingra   A. Jain                 

Abstract Details

Purpose:

To photographically document the variable clinical response of 2 cases of diffuse OSSN to primary chemotherapy with Mitomycin C and to highlight the need for use of more than one chemotherapeutic agents in unresponsive cases.

Setting:

Cornea Services of the Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Methods:

Two cases of diffuse OSSN (defined as limbal lesions with greater than 5 clock hours of conjunctival and corneal involvement or by extensive central/ paracentral corneal spread) were treated with 3 cycles of topical mitomycin C 0.04%, instilled 4 times/day.One cycle consisted of one week of instillation of MMC (On week) 1 week of no MMC instillation (off week). Lack of clinical response to 3 cycles, which was seen in the second patient was considered as treatment failure and the patient was switched to treatment with topical and subconjunctival interferon �Î�±2�Î�². The clinical course of both patients was documented photographically.

Results:

Case 1, a 76 year old male had OSSN left eye involving 2 clock hours of the temporal limbus and almost the entire cornea. He responded completely to 3 cycles of Mitomycin C, which was serially documented on confocal microscopy and anterior segment optical coherence tomography. Case 2, a 45 year female had diffuse OSSN involving five clock hours of limbus and extending upto the pupil. Lack of response to MMC, necessitated the combined use of weekly subconjunctival (3milion IU/0.5ml) and daily topical interferon �Î�±2�Î�² (1 million IU/ml 4 times/day) following which complete resolution was seen over 3months.

Conclusions:

Chemotherapy is fast replacing surgery as the primary modality for treatment of OSSN, especially for diffuse lesions.Though effective in a large majority of cases, variabililty of response to different chemotherapeutic agents is not uncommon as is documented by the above 2 cases. Addition or switch over to another drug is often successful in eliciting the desired response. Interferon �Î�±2�Î�² because of its favourable safety profile is especially useful as a �â�€�˜rescue therapy�â�€�™ in such cases.

Financial Disclosure:

NONE

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