The Management of Diffuse Ocular Surface Squamous Neoplasia with Topical 5-Fluorouracil or Mitomycin-C: A Retrospective Study

1. Adam K Rudkin^1,2
2. James S Muecke^1,2

¹South Australian Institute of Ophthalmology, Adelaide, South Australia.
²Discipline of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, South Australia

Purpose: To report the outcome of treatment of diffuse ocular surface squamous neoplasia (OSSN) where either topical 5-flurourocil (5FU) or Mitomycin-C (MMC) has been used as primary treatment.

Methods: Study was a retrospective interventional case series. 30 cases of diffuse OSSN were treated with primary chemotherapy, either 5-flurourocil 1% or Mitomycin-C 0.04%.

Results: 23 cases of diffuse disease were treated with MMC, of these, recurrence was seen in three and persistent disease in one case. Seven cases of diffuse disease were treated with 5FU, of these, recurrence was observed in two cases and persistent disease in one case. Epitheliopathy or corneal epithelial defects were the most common side effect of MMC. Lid toxicity was the most common side effect of 5FU. 5FU was also associated with one episode of focal stromal melt.

Conclusions: Compared to the treatment of localised disease, diffuse OSSN is associated with a high rate of recurrence or persistence. Of the two treatment protocols studied, MMC 0.04% appears to be more effective than 5FU 1%. While the side effect profile of 5FU 1% is relatively benign, it is notable that, in the treatment of diffuse disease 5FU was associated with an episode of focal stromal melt.