Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL.
Cornea. 2024 Aug 1;43(8):942-949. doi: 10.1097/ICO.0000000000003461. Epub 2024 Jan 18.
The aim of this review was to elucidate treatment preferences for ocular surface squamous neoplasia and to examine the changes in treatment modalities over the past 2 decades.
An electronic survey was distributed to members of The Cornea Society, Ocular Microbiology and Immunology Group, and 4 international corneal specialist listservs. Questions examined medical and surgical treatment preferences, and results were compared with surveys administered in 2003 and 2012.
A total of 285 individuals responded to the survey; 90% of respondents were self-classified as corneal specialists. Seventy-three percent reported using primary topical monotherapy to treat ocular surface squamous neoplasia as compared with 58% in 2012 ( P = 0.008). Compared with 2003, the percentage use of topical interferon significantly increased ( P < 0.0001) from 14% to 55%, 5-fluorouracil increased ( P < 0.0001) from 5% to 23%, and mitomycin C decreased ( P < 0.0001) from 76% to 19% as a primary monotherapy. The frequency of performing excision without the use of postoperative adjunctive medical therapy decreased significantly ( P < 0.0001), from 66% to 26% for lesions <2 mm, 64% to 12% for lesions between 2 and 8 mm, and 47% to 5% for lesions >8 mm from 2003 to 2022. More clinicians initiated topical immuno/chemotherapy without performing a biopsy as compared to 2003 (31% vs. 11%, P < 0.0001).
These results demonstrate a paradigm shift in the management of ocular surface squamous neoplasia. The use of primary medical therapy as a first approach has significantly increased, with a reduction in the frequency of performing surgical excision alone.
本综述旨在阐明眼表鳞状细胞癌的治疗偏好,并检查过去 20 年治疗方式的变化。
向角膜学会、眼微生物学和免疫学组以及 4 个国际角膜专家名录组的成员分发了一份电子调查。调查询问了医学和手术治疗偏好,结果与 2003 年和 2012 年进行的调查进行了比较。
共有 285 人对调查做出了回应;90%的应答者自我归类为角膜专家。与 2012 年的 58%相比,73%的人报告使用主要局部单一疗法治疗眼表鳞状细胞癌(P=0.008)。与 2003 年相比,局部干扰素的使用比例显著增加(P<0.0001),从 14%增加到 55%,5-氟尿嘧啶增加(P<0.0001),从 5%增加到 23%,丝裂霉素 C 减少(P<0.0001),从 76%减少到 19%,作为单一主要疗法。不使用术后辅助药物治疗而进行切除术的频率显著下降(P<0.0001),对于<2mm 的病变,从 2003 年的 66%降至 2022 年的 26%,对于 2-8mm 的病变,从 64%降至 12%,对于>8mm 的病变,从 47%降至 5%。与 2003 年相比,更多的临床医生在未进行活检的情况下开始进行局部免疫/化学疗法(31%对 11%,P<0.0001)。
这些结果表明眼表鳞状细胞癌的治疗模式发生了转变。作为初始方法的主要药物治疗的使用显著增加,单独进行手术切除的频率降低。