Long term study of topical interferon α-2b eye drops as primary treatment of ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) is an umbrella term for a spectrum of disease on the cornea and conjunctiva ranging from mild dysplasia to invasive squamous cell carcinoma [[1], [2], [3]]. It is the most common tumor affecting the ocular surface [4]. OSSN is typically seen in elderly, white males [[5], [6], [7]]. The strongest risk factors for OSSN include a prolonged history of sun exposure and an immune-compromised state (e.g. human immunodeficiency virus (HIV), use of immunosuppressive medication) [4]. Human papilloma virus (HPV) has also been implicated in the pathogenesis of OSSN [8].

Surgical excision with a no-touch technique and adjuvant cryotherapy has traditionally been the mainstay of treatment for OSSN, providing immediate resolution [9]. Surgical treatment however comes with the risk of recurrence, symblepharon and scar formation, limbal stem cell deficiency (LSCD) and failure to treat subclinical disease [10]. Over the last two decades, medical therapy in the form of topical chemotherapeutics have grown in popularity and use [11,12]. Topical chemotherapy has the advantage of treating the entire ocular surface, thus treating sub-clinical disease, with a lower risk of scarring and LSCD compared to surgery [13]. Three commonly used medications include interferon α-2b (IFN), mitomycin C (MMC), and 5-fluorouracil (5FU).14-17.

IFN α is a glycoprotein that confers anti-neoplastic and anti-viral properties.18 IFN α-2β is a recombinant form of IFN α that has been used in the treatment of OSSN since the early 1990s.[19] IFN α-2β has been shown to be highly effective in the treatment of OSSN with a high frequency of resolution and a favorable side effect profile [16,[20], [21], [22]] compared to topical 5FU and MMC. Several studies have demonstrated the efficacy of topical IFN with respect to tumor resolution, tumor recurrence and adverse effects [15,23,24]. However, follow up times have been short (9–23 months [15,16,23,[25], [26], [27], [28], [29], [30]]) and as such more data are needed on long term outcomes of topical IFN, specifically with respect to tumor recurrence. The primary aim of this study was to assess treatment outcomes and factors related to resolution and recurrence in a large cohort of individuals with OSSN patients treated solely with topical IFN eye drops only as well as treatment related side effects.

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