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PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 460-461

Intralesional and topical interferon therapy following incomplete primary excision of ocular surface squamous neoplasia


1 Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, Tamil Nadu, India
2 Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA

Date of Submission04-Feb-2016
Date of Acceptance05-Apr-2016
Date of Web Publication3-Aug-2016

Correspondence Address:
Pukhraj Rishi
Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.187677

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Keywords: Chemotherpy, conjunctival squamous cell carcinoma, excision biopsy, eye tumor, ocular surface squamous neoplasia


How to cite this article:
Rishi P, Shields CL. Intralesional and topical interferon therapy following incomplete primary excision of ocular surface squamous neoplasia. Indian J Ophthalmol 2016;64:460-1

How to cite this URL:
Rishi P, Shields CL. Intralesional and topical interferon therapy following incomplete primary excision of ocular surface squamous neoplasia. Indian J Ophthalmol [serial online] 2016 [cited 2020 Feb 17];64:460-1. Available from: http://www.ijo.in/text.asp?2016/64/6/460/187677

Ocular surface squamous neoplasia includes a wide spectrum of premalignant and malignant tumors affecting the elderly, those with immunocompromised status, excessive sun exposure, xeroderma pigmentosa, and cigarette smokers. Management includes excision biopsy, combined with topical chemotherapy, antiviral therapy, and immunomodulation. [1],[2],[3],[4]

A 62-year-old male presented with pain and redness in the left eye of 4 months duration. He reported excision biopsy of conjunctival tumor with amniotic membrane transplant (AMT) in that eye 3 months previously, elsewhere. Histopathological report revealed conjunctival squamous carcinoma in situ with incomplete excision at lateral margins and tumor-free deeper margins.


  Discussion Top


At presentation to us, vision in both eyes was 20/20. The right eye was normal [Figure 1]a. Left eye showed bulbar conjunctival congestion, absorbing AMT with anchor sutures, an exuberant conjunctival nodule (2 mm × 2 mm), and suspicious of residual conjunctival tumor [Figure 1]b and c. There was no involvement of the cornea. The patient was treated with intralesional and subconjunctival injection of 10 million units of interferon (IFN) alpha-2b [Figure 2] followed by topical IFN (1 million units/1 ml) 3 times a day for 6 months. The patient was reviewed at 4 weeks follow-up with a significant reduction of tumor [Figure 1]d, and continued to improve at each monthly visit [Figure 1]d-h. Topical IFN treatment was stopped at 6 months follow-up. At the last follow-up 1 year from presentation, the left eye remained recurrence-free.
Figure 1: At presentation, the right eye was normal (a). The Left eye revealed residual ocular surface squamous neoplasia with exuberant conjunctival lesion (arrow) near the nasal limbus (b and c); 10 mIU/1 ml interferon was injected and topical interferon (1 mIU/ml) prescribed for 6 months. One month following injection (d), a significant reduction of the tumor was noted. Two months following injection (e), tumor was completely resolved. Regression was maintained at 4 months (f), 6 months (g), and 1 year following injection (h)

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Figure 2: Technique of interferon injection. Residual ocular surface squamous neoplasia was treated with intralesional and subconjunctival injection of interferon in inferior fornix (a), superior fornix (b), and medial fornix (c) with conjunctival ballooning (d)

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  Conclusion Top


Subconjunctival and topical IFN alpha-2b are a useful therapeutic approach to treat incompletely excised conjunctival intraepithelial neoplasia with complete tumor control and minor side effects. [5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shields JA, Shields CL. Eyelid, Conjunctival and Orbital Tumors. An Atlas and Textbook. 3 rd ed. Philadelphia, PA: Lippincott Wolters Kluwer; 2016. p. 283-305.  Back to cited text no. 1
    
2.
Karp CL, Galor A, Chhabra S, Barnes SD, Alfonso EC. Subconjunctival/perilesional recombinant interferon α2b for ocular surface squamous neoplasia: A 10-year review. Ophthalmology 2010;117:2241-6.  Back to cited text no. 2
[PUBMED]    
3.
Kim BH, Kim MK, Wee WR, Oh JY. Clinical and pathological characteristics of ocular surface squamous neoplasia in an Asian population. Graefes Arch Clin Exp Ophthalmol 2013;251:2569-73.  Back to cited text no. 3
[PUBMED]    
4.
Yin VT, Merritt HA, Sniegowski M, Esmaeli B. Eyelid and ocular surface carcinoma: Diagnosis and management. Clin Dermatol 2015;33:159-69.  Back to cited text no. 4
    
5.
Shields CL, Kaliki S, Kim HJ, Al-Dahmash S, Shah SU, Lally SE, et al. Interferon for ocular surface squamous neoplasia in 81 cases: Outcomes based on the American Joint Committee on Cancer classification. Cornea 2013;32:248-56.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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