• This large prospective study found that the long-term recurrence of localized ocular surface squamous neoplasia (OSSN) is rare when topical 5-fluorouracil (5-FU) or mitomycin (MMC) is used as adjunctive treatment to surgical excision.

    This is the largest reported series of patients with localized OSSN and the only large series examining long-term outcomes of adjuvant topical chemotherapy.

    These two prospective, noncomparative interventional case series included a combined total of 153 eyes (150 patients) with histologically confirmed localized, noninvasive OSSN that underwent surgical excision. Eighty-nine eyes were treated with adjuvant topical 5-FU 1% four times daily for two weeks, and 64 eyes received adjuvant topical MMC 0.04% four times daily for two to three one-week cycles. Median follow-up was 33.6 months in the 5-FU group and 57.9 months in the MMC group.

    There was one recurrence in the 5-FU group and no recurrences in the MMC group. Side effects occurred in 69% of 5-FU patients and 41% of MMC patients. Five patients (6%) required intervention for treatment-related side effects in the 5-FU group versus 11 patients (17%) in the MMC group. No vision-threatening complications were noted.

    The authors note that this study was not designed to prospectively compare 5-FU and MMC as adjuvant treatment and the results give no clear indication that one is superior to the other for eradicating localized OSSN. Nevertheless, in their experience and based on the data they have collected, they say the side effects of 5-FU are better tolerated than those of MMC and lead to fewer additional interventions.