EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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May 2012 EW CORNEA 49 months, her first line of medical treatment is interferon, 1 million IU/ml four times daily. It usually needs to be used for at least 3 months. "I like it because it is well tolerated, effective in most cases, and gentle," Dr. Karp said. If this does not work, she also uses MMC 0.02% or 0.04% four times daily for 1 week, then off until the eye recov- ers. MMC is very toxic and needs to be cycled. 5-FU 1% is another option she utilizes. This is also cycled, and she uses it four times daily for a week, like MMC, and then gives the eye the rest of the month to recover. MMC and 5-FU usually require three or more cycles and can be quite unpleasant. Dr. Mian prefers to excise the lesion, using a double cryosurgery freeze-thaw technique to prevent recurrence, and opts for adjunctive therapy including topical chemo, MMC, and interferon. "Interferon alpha drops are much better tolerated in the eye [than MMC]," he said. MMC can cause epithelial toxicity, reactive conjunctivitis, and photophobia, which is why Dr. Karp has dubbed it the "devil drop." She notes that 5- FU is another topical drop option and calls it the "assistant devil drop." Interferon alpha 2b? "That's the angel drop," she said, but its downside is that it has to be used continuously for 3-4 months. In some cases, however, interferon can be injected anywhere from once to three times weekly. Intralesion interferon "doesn't need to be com- pounded and ensures patient com- pliance," she said. It does, however, give side effects of a "flu-like" feeling for several hours after the injection. Local chemotherapy of MMC or 5-FU involves 1 week on, 1 week off, to give the conjunctiva time to heal, Dr. Mian noted. "If patients can tolerate the combination, the one on/one off schedule will let the tumor resolve faster, but if patients can't tolerate the drops, we'll give them a longer break in between dosing," he said. For ophthalmologists who don't often see these kinds of lesions, "don't ignore these when you see them," Dr. Mian said. "If we diag- nose and treat these lesions early, we can achieve a complete cure rate in most patients." EW References 1. Lee GA and Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995;39(6):429-50. 2. Yousef YA, Finger PT. Squamous carcinoma and dysplasia of the conjunctiva and cornea: an analysis of 101 cases. Ophthalmology. 2012;119(2): 233-40. Epub 2011 Dec 20. Editors' note: Drs. Karp and Mian have no financial interests related to this article. Contact information Karp: 305-326-6156, ckarp@med.miami.edu Mian: 734-615-5476, smian@med.umich.edu Right On Target... The New A-Scan Plus®4.20 Meeting the Needs of Your Premium IOL Patient • Industry Leading Resolution • 100% Measurement Capability including dense cataracts • Automatic Alignment Detection • Simplified Personalization of Lens Constants • Unlimited patient data storage, recall, and transfer via USB Memory Stick Every purchase of an A-Scan Plus 4.20 comes with an on-site training program. Product #24-4200 Receive a Free Toric Marker with Purchase Visit us at ARVO Booth #425 3222 Phoenixville Pike, Malvern, PA 19355 • USA 800-979-2020 • 610-889-0200 • FAX 610-889-3233 • www.accutome.com