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 Table of Contents  
PHOTO ESSAY
Year : 2018  |  Volume : 30  |  Issue : 3  |  Page : 206-208

“Interferon magic” in ocular surface squamous neoplasia


Department of Ophthalmology, Government Medical College, Thrissur, Kerala, India

Date of Web Publication17-Dec-2018

Correspondence Address:
Sinumol Sukumaran Thulaseedharan
Department of Ophthalmology, Government Medical College, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_81_18

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  Abstract 

An elderly patient with limbal growth in the left eye was diagnosed by impression cytology as ocular surface squamous neoplasia (OSSN) and subsequently treated with topical interferon α 2b (IFN-α 2b). Complete gross and histopathological resolution was seen by 3 months. Impression cytology and topical IFN-α 2b drops are simple, powerful, and affordable tools to manage OSSN. Flu-like syndrome in the first few days was the only adverse effect noted.

Keywords: Immunotherapy, interferon α 2b, ocular surface squamous neoplasia


How to cite this article:
Thulaseedharan SS, Sudha V, Sujatha N, Narayan S. “Interferon magic” in ocular surface squamous neoplasia. Kerala J Ophthalmol 2018;30:206-8

How to cite this URL:
Thulaseedharan SS, Sudha V, Sujatha N, Narayan S. “Interferon magic” in ocular surface squamous neoplasia. Kerala J Ophthalmol [serial online] 2018 [cited 2019 Mar 25];30:206-8. Available from: http://www.kjophthal.com/text.asp?2018/30/3/206/247595


  Introduction Top


Ocular surface squamous neoplasia (OSSN) includes the entire spectrum of dysplastic, preinvasive, and malignant squamous lesions of conjunctiva and cornea, presenting as slightly elevated growth straddling the limbus with tufts of feeder vessels.[1] Etiological factors are ultraviolet-B light, HPV-16, HIV seropositivity, and stem cell factors.[2],[3] Impression cytology is a quick, low cost, and noninvasive diagnostic modality which can be reliably used for the diagnosis of conjunctival neoplasms and OSSN.[4],[5],[6] Interferon α 2b (IFN-α 2b) has been used as off-label immunotherapy in OSSN.[7],[8] It is a naturally occurring glycoprotein which binds to cell surface receptors affecting intracellular events resulting in antitumor and antiviral properties.


  Case Report Top


An 80-year-old man presented to our outpatient department with a growth in the left eye of 3 months duration.

On examination, best-corrected visual acuity OD was 6/12 and OS was 6/18. The left eye showed a pinkish fleshy mass (12 mm diameter) over superior limbus extending to surrounding sclera and cornea with tufts of feeder vessels [Figure 1].
Figure 1: Ocular surface squamous neoplasia before treatment

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Impression cytology of the lesion showed epithelial hyperplasia, high nuclear-cytoplasmic ratio, nuclear hyperchromasia, prominent nucleoli, pleomorphism, and increased mitotic figures with hyperkeratosis suggestive of squamous cell carcinoma [Figure 2]. Intraocular and distant metastasis was ruled out by oncology consultation and investigations including B scan, AS OCT and magnetic resonance imaging orbit and brain. Serological tests for HIV and HBs Ag were negative.
Figure 2: Impression cytology before treatment

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The stage of the tumor according to the American Joint Committee on Cancer Classification of OSSN was T 2 (tumor present with largest basal diameter ≥5 mm, no invasion), N 0 (Regional Lymph Node metastasis absent), and M 0 (Distant Metastasis absent).

After obtaining informed consent, the patient was put on IFN-α 2b drops (3 MIU/ml concentration) 1 drop four times daily and followed up weekly with clinical photographs taken at each visit. Impression cytology was repeated at 1 month, 6 weeks, and 3 months of treatment.

The lesion started reducing in size and vascularity by the end of 2 weeks of INF treatment and significantly melted at the end of 1 month [Figure 3]. At the end of 6 weeks, there was gross disappearance of the tumor [Figure 4], and impression cytology was negative for atypical cells [Figure 5]. However, the drug was continued for another 1 month. [Figure 6] shows the normal ocular surface at the end of 3 months.
Figure 3: Melting lesion after 1 month of treatment

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Figure 4: Gross disappearance after 6 weeks of treatment

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Figure 5: Impression cytology at 6 weeks

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Figure 6: Normal ocular surface at 3 months

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  Discussion Top


For OSSN, many treatment options are available. Surgical excision of the tumor with wide margins by “No-touch” Technique, absolute alcohol epitheliectomy of the involved cornea and application of cryotherapy in a double freeze-thaw cycle was the standard method.[9]

Chemotherapy with topical MMC and 5 FU is another option, but complications are corneal epitheliopathy, scleral ulceration, uveitis, and cataract.[10]

Immunotherapy is the preferred treatment nowadays. The efficacy rate after topical IFNα 2b ranges from 80% to 100%.[7] Compared to surgery, it treats the entire ocular surface and all subclinical lesions. Compared to chemotherapy, surface toxicity, and stem cell damage are negligible. The standard concentration of topical IFN-α 2b drops is 1 or 3 MIU/ml. The mean duration for tumor resolution with 1 million IU/ml is approximately 3–6 months. In our experience, the 3 MIU/ml dose shortens the duration of treatment with marked resolution in 6 weeks. Flu-like syndrome in the first 2 days was the only adverse effect noted.


  Conclusion Top


Impression cytology and topical INF-α 2b drops are simple, powerful, and affordable tools to manage extensive OSSN.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol 1995;39:429-50.  Back to cited text no. 1
    
2.
Mahomed A, Chetty R. Human immunodeficiency virus infection, bcl-2, p53 protein, and ki-67 analysis in ocular surface squamous neoplasia. Arch Ophthalmol 2002;120:554-8.  Back to cited text no. 2
    
3.
Thomas JO. Acquired immunodeficiency syndrome-associated cancers in Sub-Saharan Africa. Semin Oncol 2001;28:198-206.  Back to cited text no. 3
    
4.
Nolan GR, Hirst LW, Wright RG, Bancroft BJ. Application of impression cytology to the diagnosis of conjunctival neoplasms. Diagn Cytopathol 1994;11:246-9.  Back to cited text no. 4
    
5.
Tole DM, Mc Kelvie PA, Daniell M. Reliability of impression cytology for the diagnosis of ocular surface squamous neoplasia employing the biopore membrane. Br J Ophthalmol 2001;85:154-8.  Back to cited text no. 5
    
6.
Tananuvat N, Lertprasertsuk N, Mahanupap P, Noppanakeepong P. Role of impression cytology in diagnosis of ocular surface neoplasia. Cornea 2008;27:269-74.  Back to cited text no. 6
    
7.
Galor A, Karp CL, Chhabra S, Barnes S, Alfonso EC. Topical interferon alpha 2b eye-drops for treatment of ocular surface squamous neoplasia: A dose comparison study. Br J Ophthalmol 2010;94:551-4.  Back to cited text no. 7
    
8.
Vann RR, Karp CL. Perilesional and topical interferon alfa-2b for conjunctival and corneal neoplasia. Ophthalmology 1999; 106:91-7.  Back to cited text no. 8
    
9.
Shields JA, Shields CL, De Potter P. Surgical management of conjunctival tumors. The 1994 Lynn B. McMahan lecture. Arch Ophthalmol 1997;115:808-15.  Back to cited text no. 9
    
10.
Kim JW, Abramson DH. Topical treatment options for conjunctival neoplasms. Clin Ophthalmol 2008;2:503-15.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
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