Yeatts R P, Engelbrecht N E, Curry C D, Ford J G, Walter K A
Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Ophthalmology. 2000 Dec;107(12):2190-5. doi: 10.1016/s0161-6420(00)00389-4.
To evaluate the efficacy of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of conjunctival and corneal intraepithelial neoplasia.
Prospective, noncomparative case series.
Seven patients with histologic evidence of intraepithelial neoplasia were identified by conjunctival biopsy or tumor excision.
Seven patients with a minimum of 7 months of follow-up were treated with pulsed dosing of 1% 5-FU. Topical 1% 5-FU was administered four times daily for 2 to 4 days for each cycle. The number of initial treatment cycles was two to six, with the time between cycles being 30 to 45 days.
The presence or absence of clinically evident intraepithelial neoplasia was evaluated after each treatment interval. Patients were also monitored for adverse reactions to the use of topical 5-FU.
Four patients remain disease free with a mean follow-up of 18.5 months (range, 7-36 months) with no additional treatment after the initial treatment cycles (mean, 3.75 cycles; range, 2-5 cycles). Three patients had recurrence of disease after the initial treatment cycles. Two patients were treated with additional cycles for recurrent disease (six cycles in one patient and five cycles in the other patient) and are free of disease at 20 and 21 months after treatment, respectively. One patient had persistent disease despite treatment with topical 5-FU and was treated with topical mitomycin C with resolution of the disease without recurrence for 16.5 months. No adverse reactions to pulse dose treatment with topical 5-FU were noted.
Pulsed dosing with 1% topical 5-FU for the treatment of conjunctival and corneal intraepithelial neoplasia, alone or as an adjunct to excision of bulky disease, is a well-tolerated and effective method of treatment.
评估脉冲给药局部应用5-氟尿嘧啶（5-FU）治疗结膜和角膜上皮内瘤变的疗效。
前瞻性、非对照病例系列。
通过结膜活检或肿瘤切除确定7例有上皮内瘤变组织学证据的患者。
7例至少随访7个月的患者接受1% 5-FU脉冲给药治疗。每个周期局部应用1% 5-FU，每日4次，持续2至4天。初始治疗周期数为2至6个，周期之间的时间间隔为30至45天。
在每个治疗间隔后评估临床明显上皮内瘤变的有无。还监测患者使用局部5-FU的不良反应。
4例患者疾病无复发，平均随访18.5个月（范围7 - 36个月），初始治疗周期后无需额外治疗（平均3.75个周期；范围2 - 5个周期）。3例患者在初始治疗周期后疾病复发。2例复发患者接受了额外周期的治疗（1例患者6个周期，另1例患者5个周期），分别在治疗后20和21个月疾病无复发。1例患者尽管接受局部5-FU治疗但疾病持续存在，接受局部丝裂霉素C治疗后疾病消退，16.5个月无复发。未观察到局部5-FU脉冲剂量治疗有不良反应。
1%局部5-FU脉冲给药治疗结膜和角膜上皮内瘤变，单独使用或作为大块病变切除的辅助治疗，是一种耐受性良好且有效的治疗方法。
