Blasi Maria Antonietta, Maceroni Martina, Sammarco Maria Grazia, Pagliara Monica M
Ocular Oncology Unit, Catholic University, Rome - Italy.
Eur J Ophthalmol. 2018 Mar;28(2):204-209. doi: 10.5301/ejo.5001035. Epub 2017 Nov 9.
Traditionally, surgical excision has been the treatment of choice for ocular surface squamous neoplasia (OSSN). Recurrences after surgery are high. To reduce the risk of recurrence, adjuvant therapies have been increasingly used.
We compared recurrences and complications of 3 forms of treatment for OSSN: surgical excision (group A), surgical excision plus adjuvant topical mitomycin C (MMC) (group B), and surgical excision plus subconjunctival interferon-α-2b (IFN-α-2b) (group C).
A retrospective comparative study was conducted between January 2006 and March 2016 at the Ocular Oncology Service of the Catholic University of Rome. Seventy-nine patients with a confirmed histological diagnosis of OSSN were included: 43 were treated with surgical excision (group A), 16 underwent surgical excision plus topical MMC (group B), and 20 underwent surgical excision plus adjuvant subconjunctival IFN-α-2b (group C).
The recurrences were different in the 3 groups. Thirty-one recurrences (72%) were seen in group A, 5 (31%) were found in group B, and 3 (15%) were seen in group C. Eight (50%) patients who received MMC 0.02% complained of ocular discomfort, 10 (62.5%) presented conjunctival hyperemia, while conjunctival chemosis and corneal epitheliopathy were noticed in 2 (13%) and 2 (13%) patients, respectively. All patients treated with subconjunctival IFN-α-2b reported flu-like symptoms. Two patients (10%) complained of ocular discomfort.
Our study revealed that OSSN is not always manageable with simple excision. Adjuvant chemotherapy is strongly advisable after surgery to reduce recurrences. Interferon injections and MMC drops are effective in preventing recurrences and should be administered after surgery.
传统上，手术切除一直是眼表鳞状上皮肿瘤（OSSN）的首选治疗方法。手术后复发率很高。为降低复发风险，辅助治疗的应用越来越广泛。
我们比较了OSSN的三种治疗方式的复发情况和并发症：手术切除（A组）、手术切除联合辅助局部丝裂霉素C（MMC）（B组）以及手术切除联合结膜下注射干扰素-α-2b（IFN-α-2b）（C组）。
2006年1月至2016年3月在罗马天主教大学眼科肿瘤服务中心进行了一项回顾性比较研究。纳入79例经组织学确诊为OSSN的患者：43例接受手术切除（A组），16例接受手术切除联合局部MMC（B组），20例接受手术切除联合辅助结膜下注射IFN-α-2b（C组）。
三组的复发情况不同。A组出现31例复发（72%），B组发现5例（31%），C组出现3例（15%）。接受0.02%MMC治疗的8例（50%）患者抱怨眼部不适，10例（62.5%）出现结膜充血，而分别有2例（13%）患者出现结膜水肿和角膜上皮病变。所有接受结膜下注射IFN-α-2b治疗的患者均报告有流感样症状。2例（10%）患者抱怨眼部不适。
我们的研究表明，单纯切除并不总能有效治疗OSSN。强烈建议术后进行辅助化疗以降低复发率。干扰素注射和MMC滴眼液在预防复发方面有效，应在术后使用。
