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Ocular Surface Squamous Neoplasia: A Survey of Changes in the Standard of Care From 2003 to 2012

Adler, Eldad MD; Turner, Joseph R. MD; Stone, Donald U. MD

doi: 10.1097/ICO.0b013e3182a6ea6c
Clinical Science

Purpose: To evaluate the current standard of care of ophthalmologists who are likely to encounter ocular surface squamous neoplasia (OSSN) in their practices and to compare this with data gathered in 2003.

Methods: Invitations to a web-based survey were sent to members of the Ocular Microbiology and Immunology Group. In addition, the survey was posted to the Cornea Society Listserv, Keranet. The survey contained questions regarding the surgical and medical management of OSSN and postcare follow-up. The results of this survey were compared with the results of a 2003 survey, where possible, to identify the areas of change in the standard of care.

Results: Eighty-one ophthalmologists participated in the survey. Seventy-nine percent of the responders thought that there was enough evidence for topical monotherapy in OSSN, but only 58% reported ever using topical agents as monotherapy. First-line topical therapy was interferon α2b (56%) followed by mitomycin C (MMC) (37%). A shift from surgical excision alone to excision followed by topical therapy was seen when comparing the 2012 survey to the 2003 survey. The preferred postexcision topical agent was MMC. Seventy-five percent of responders evaluate their patients every 2 to 4 months during the first 2 years.

Conclusions: Topical agents were being used more in 2012, either in combination with surgical excision or as monotherapy, compared with those used in 2003. Interferon has replaced MMC as the agent most used for topical monotherapy, possibly because of a favorable safety and tolerance profile. Prospective randomized trials are needed to better define the ideal practice patterns.

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*Department of Ophthalmology, University of Oklahoma College of Medicine, Oklahoma City, OK; and

Department of Ophthalmology, University of Oklahoma College of Medicine, Dean A. McGee Eye Institute, Oklahoma City, OK.

Reprints: Donald U. Stone, Department of Ophthalmology, University of Oklahoma College of Medicine, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73106 (e-mail:

Supported in part by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology, University of Oklahoma, and the Dean A McGee Eye Institute.

No author has a financial interest in any technique or product mentioned in this article. The authors wish to thank the members of the Ocular Microbiology and Immunology Group and the Cornea Society for their participation.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received June 01, 2013

Accepted July 25, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.