Tran Ann Q, Venkateswaran Nandini, Galor Anat, Karp Carol L
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL 33136 USA.
Eye Vis (Lond). 2019 Aug 27;6:27. doi: 10.1186/s40662-019-0152-3. eCollection 2019.
To evaluate the frequency and characteristics of sub-clinical ocular surface squamous neoplasia (OSSN) detected by high-resolution anterior segment tomography (HR- OCT) in patients with clinically unapparent disease following topical treatment.
A retrospective chart review of patients with OSSN identified through a pharmacy database at the Bascom Palmer Eye Institute from January 2013 to December 2018 was conducted. Patients undergoing primary therapy with topical 5-fluorouracil 1% (5-FU) (4 times a day for 7 days with a 21-day break) or interferon-alpha-2b (IFN) (4 times a day) were reviewed. Patients were separated into two groups. Group 1 included individuals whose clinical resolution of OSSN aligned with complete resolution on HR-OCT. Group 2 (sub-clinical OSSN group) included individuals with clinical OSSN resolution but with features of persistent disease on HR- OCT. Patients excluded included those treated at an outside institution and those who used topical therapy as a surgical adjunct.
A total of 95 patients (95 eyes) were reviewed. Sub-clinical OSSN was detected at a frequency of 17% in our study patients ( = 16 patients, 9 treated with 5-FU and 7 treated with IFN). In the 16 individuals, the mean time to clinical resolution was 3.6 ± 1.0 cycles for 5-FU and 4.0 ± 0.0 months for IFN. An additional 2.1 ± 0.8 cycles for 5-FU and 1.2 ± 0.4 months for IFN were needed to achieve HR-OCT resolution of OSSN. Recurrence in Group 1 was noted in 10 patients (12%) while no recurrences occurred in Group 2, the cohort with subclinical disease that received the extended medical therapy. The mean follow-up was 24.0 ± 17.9 months.
We found that at least 17% of individuals with apparent clinical resolution of OSSN have sub-clinical disease detected on HR-OCT. This information can be used to optimize treatment and extend therapy past the point of clinical resolution.
评估经局部治疗后临床症状不明显的患者中，通过高分辨率眼前节断层扫描（HR-OCT）检测到的亚临床眼表鳞状上皮肿瘤（OSSN）的频率及特征。
对2013年1月至2018年12月期间在巴斯科姆·帕尔默眼科研究所通过药房数据库识别出的OSSN患者进行回顾性病历审查。对接受1% 5-氟尿嘧啶（5-FU）（每日4次，共7天，休息21天）或α-2b干扰素（IFN）（每日4次）一线治疗的患者进行审查。患者分为两组。第1组包括OSSN临床症状消退且HR-OCT显示完全消退的个体。第2组（亚临床OSSN组）包括临床OSSN症状消退但HR-OCT显示有疾病持续特征的个体。排除的患者包括在外部机构接受治疗的患者以及将局部治疗用作手术辅助治疗的患者。
共审查了95例患者（95只眼）。在我们的研究患者中，亚临床OSSN的检出频率为17%（n = 16例患者，9例接受5-FU治疗，7例接受IFN治疗）。在这16例个体中，5-FU治疗达到临床症状消退的平均时间为3.6±1.0个周期，IFN治疗为4.0±0.0个月。5-FU还需要额外2.1±0.8个周期、IFN需要额外1.2±0.4个月才能使OSSN在HR-OCT上消退。第1组有10例患者（12%）出现复发，而接受延长药物治疗的亚临床疾病队列第2组未出现复发。平均随访时间为24.0±17.9个月。
我们发现，至少17%临床症状明显消退的OSSN个体在HR-OCT上检测到有亚临床疾病。该信息可用于优化治疗并将治疗延长至临床症状消退之后。
