• Written By: Matthew W. Wilson, MD, FACS
    Ocular Pathology/Oncology

    This small retrospective case series published in the July/August issue of Ophthalmic Plastic & Reconstructive Surgery reports outcomes of three patients with extensive ocular surface squamous neoplasia (OSSN) of an anophthalmic socket who were treated with combined topical and injection interferon α2b. Two patients had a complete response to treatment, at one month and 20 months, while the third patient achieved partial regression at nine months. No patient required surgery or exenteration. The authors conclude that combined topical and injection interferon α2b is a potentially effective therapy for OSSN of the socket, and recommend monitoring of patients with ophthalmic prosthesis over a socket for the development of OSSN.

    The study includes all patients in the electronic records of one ocular oncology service who were diagnosed with OSSN and wore a cosmetic prosthesis over a socket or malformed eye. OSSN was detected in the socket at age 60, 43, and 20 years, after the patients had worn ophthalmic prostheses for 54, 26 and 13 years, respectively. One case occurred in a socket following enucleation; the others were in a microphthalmic orbit with conjunctivalization of the cornea and a phthisical eye covered with a Gunderson flap.

    Lesions involved the tarsal, bulbar and forniceal conjunctiva and were multifocal. The largest lesions or confluence of lesions for each patient measured 20 to 25 mm in maximal basal diameter.

    All patients had chronic discharge and irritation, which was managed with intermittent topical corticosteroids in two patients. There were no predisposing factors of cigarette exposure, radiation exposure, eczema, systemic immune suppression or organ transplantation, and all prostheses fit well, with nonirritative edges.

    The patients were given with a combination of topical interferon α2b (1 million units/cc) four times daily and sublesional interferon α2b injection (5 million units in 0.5 cc to 8 million units in 0.8 cc). They all continued on chronic maintenance interferon α2b, with no recurrences.

    The authors say that the development of OSSN in the three patients could have been multifactorial, with chronic localized corticosteroid-related immune suppression in an environment of chronic inflammation. However, the role of topical immune suppression with corticosteroid eye drops in the development of OSSN is speculative. They recommend additional study of combined topical and injection interferon α2b therapy in a larger number of OSSN patients for a longer period of time.