Eyeworld

74 | EYEWORLD | DECEMBER 2022 C HOT TOPICS IN OPHTHALMOLOGY ORNEA About the physicians Dan Gombos, MD, FACS Professor and Chief Section of Ophthalmology Department of Head and Neck Surgery University of Texas MD Anderson Cancer Center Houston, Texas Carol L. Shields, MD Chief of the Ocular Oncology Service Wills Eye Hospital Thomas Jefferson University Philadelphia, Pennsylvania by Liz Hillman Editorial Co-Director F or the last decade, interferon alpha-2b (IFNα-2b) was the preferred phar- macologic therapy for ocular surface squamous neoplasia (OSSN) in the U.S. It was an effective, non-toxic immuno- therapy that was comfortable for the patient, said Carol L. Shields, MD, one of the country's foremost ocular oncologists. IFNα-2b was not without its drawbacks. It took longer to resolve cases of OSSN, it was unstable, necessitating special handling to main- tain its efficacy, and it was expensive. But it was, Dr. Shields said, still "a wonderful drug to treat OSSN." Then, "in walks COVID-19," Dr. Shields continued. With the pandemic, the makers of in- terferon decided they would no longer manufac- ture it for ocular conditions, transitioning its use for treatment of COVID-19 patients instead. Now, IFNα-2b for treatment of OSSN is largely unavailable worldwide, though Dr. Shields noted that her colleagues in India say it is still being produced there. OSSN treatment options Dr. Shields gave EyeWorld an overview of the treatment options for OSSN. Generally, the first-line treatment for most cases of OSSN is surgical resection. "Number 1, it's quick. Number 2, it's cov- ered by insurance. Number 3, you don't have to rely on the patient putting a medication into the eye. Number 4, we get pathology. We're sent patients with all kinds of different diseases, and we want to be sure that OSSN is OSSN because there are other more serious conditions that can look like it," she said, noting that some of these more serious conditions wouldn't necessarily respond to pharmacotherapy. Dr. Shields said the tumor control rate with surgical resection is 95–98%. She mentioned a study that looked at recurrence rates after surgical resection or pharmacotherapy, finding recurrence rates were similar (about 5%). 1 The latest in the treatment of OSSN continued on page 76 Topical chemoreduction with 5-FU 1% for extensive ocular surface squamous neoplasia A. Before: The flat neoplastic tumor is extensive (arrows), occupying limbus to near eyelid margin, measuring 25 mm in base. B. After: Following 1 month of topical 5-FU, the mass has substantially reduced to a smaller basal dimension of 14 mm diameter. After a 1-month drug holiday, another month of 5-FU was planned. Source: Carol L. Shields, MD A B

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