Decoding Ocular Surface Squamous Neoplasia: Comparative Therapeutic Outcomes Of 5-Fluorouracil And Interferon Alpha-2B With Clinical, Cytological, And As-Oct Correlation

To compare the efficacy, recurrence risk, and tolerability of topical 5-Fluorouracil versus Interferon alpha-2b in the management of ocular surface squamous neoplasia, with integrated evaluation of clinical morphology, impression cytology, and anterior segment optical coherence tomography findings.

Retrospective observational study conducted at a tertiary eye care referral centre specializing in ocular surface disorders.

Fifty three OSSN cases were analyzed. Patients received topical 5-Fluorouracil (n = 25) or Interferon alpha-2b (n = 28) as primary therapy. Lesions were categorized morphologically using slit lamp biomicroscopy. Baseline AS-OCT assessed epithelial thickness and subepithelial reflectivity. Impression cytology was performed for diagnostic confirmation and post treatment evaluation. Clinical response, need for surgery, compliance, and adverse effects were recorded.

Complete resolution occurred in 50% of 5-Fluorouracil cases versus 10% with Interferon alpha-2b. Partial response was seen in 25% and 10% respectively. Surgical excision was required in three Interferon cases and one 5-Fluorouracil case. No recurrences were noted within six months among medically managed eyes. Mild irritation occurred in one 5-Fluorouracil case; none in the Interferon group. Nearly 46% of Interferon patients were non compliant. AS-OCT and impression cytology correlated with treatment response.

Topical 5-Fluorouracil demonstrates superior resolution rates compared to Interferon alpha-2b in OSSN, particularly in keratinized and gelatinous lesions. AS-OCT and impression cytology provide valuable non invasive biomarkers for monitoring response and detecting subclinical disease, facilitating individualized management in high volume clinical settings.