Ocular surface squamous neoplasia: angiographic characteristics and response to subconjunctival/perilesional 5-fluorouracil injections

Abstract

Introduction:

To investigate the angiographic characteristics of ocular surface squamous neoplasia (OSSN) and to evaluate the efficacy of subconjunctival/perilesional 5-fluorouracil injections in OSSN cases.

Materials and methods:

Six eyes of six patients with primary OSSN, received perilesional, subconjunctival, 25-mg/mL 5-fluorouracil injections at certain intervals. Anterior segment digital photography images, anterior segment optical coherence tomography (AS-OCT), and conjunctival indocyanine green angiography (ICGA) were obtained simultaneously with fluorescein angiography.

Results:

The mean best-corrected vision acuity significantly improved after treatment. At baseline, the median of the largest thickness of OSSN was 905.0 (interquartile range: 492.0–1592.5) μm based on AS-OCT data. There was an abrupt transition between normal and abnormal epithelium, a thickened hyper-reflective epithelium, and a sharp plane of cleavage between the lesion and underlying tissue, all indicative of OSSN. The angiographic characteristics of OSSN included focal or seafan-shaped intratumoral and conjunctival feeding vessels visible via ICGA, and abnormal vascular leakage visible with fluorescein angiography. The median time to tumor regression after treatment was 35.0 (interquartile range: 32.0–45.5) days in five eyes without recurrence, and OSSN in one eye regressed partially 40 days after treatment.

Conclusion:

This is the first report of the angiographic characteristics of OSSN and its response to subconjunctival/perilesional 5-fluorouracil injections by simultaneous conjunctival angiography and AS-OCT. The improved subconjunctival/perilesional 5-fluorouracil injection was an effective therapy for OSSN in both best-corrected vision acuity gain and anatomic outcomes.

Keywords:

• ocular surface squamous neoplasia
• subconjunctival 5-flourouracil injection
• conjunctival angiography
• anterior segment optical coherence tomography

Acknowledgments

We thank Prof. Guangping Wu, PhD (Department of Pathology, The First Affiliated Hospital of China Medical University) for the exfoliative cytology in this study. This study was funded by the Natural Science Foundation of Liaoning Province (No.20170541041), Fund for Scientific Research of The First Hospital of China Medical University (No. FSFH201712), and Clinical Genetics (Ophthalmology) Subject construction project of China Medical University (No.3110118049).

Role of the funding source

The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Abbreviation list

AS-OCT, anterior segment optical coherence tomography; BCVA, best-corrected vision acuity; DNA, deoxyribonucleic acid; FA, fluorescein angiography; ICGA, conjunctival indocyanine green angiography; LSCD, limbal stem cell deficiency; LogMAR, logarithm of the minimum angle of resolution, OCT, optical coherence tomography; OSSN, ocular surface squamous neoplasia; PEE, punctuate epithelial erosion; RNA, ribonucleic acid.

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report  no conflicts of interest in this work.