'Interferon magic' in ocular surface squamous neoplasia
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Ocular surface squamous neoplasia (OSSN) includes the entire spectrum of dysplastic, preinvasive, and malignant squamous lesions of conjunctiva and cornea, presenting as slightly elevated growth straddling the limbus with tufts of feeder vessels. The present case appears in the Kerala Journal of Ophthalmology.

An 80-year-old man presented with a growth in the left eye of 3 months duration. On examination, best-corrected visual acuity OD was 6/12 and OS was 6/18. The left eye showed a pinkish fleshy mass (12 mm diameter) over superior limbus extending to surrounding sclera and cornea with tufts of feeder vessels.

Impression cytology of the lesion revealed epithelial hyperplasia, high nuclear-cytoplasmic ratio, nuclear hyperchromasia, prominent nucleoli, pleomorphism, and increased mitotic figures with hyperkeratosis suggestive of squamous cell carcinoma. Intraocular and distant metastasis was ruled out by oncology consultation and investigations including B scan, AS OCT and magnetic resonance imaging orbit and brain. Serological tests for HIV and HBs Ag were negative.

The stage of the tumor according to the American Joint Committee on Cancer Classification of OSSN was T 2 (tumor present with largest basal diameter ≥5 mm, no invasion), N 0 (Regional Lymph Node metastasis absent), and M 0 (Distant Metastasis absent).

After obtaining informed consent, the patient was put on IFN-α 2b drops (3 MIU/ml concentration) 1 drop four times daily and followed up weekly with clinical photographs taken at each visit. Impression cytology was repeated at 1 month, 6 weeks, and 3 months of treatment.

The lesion started reducing in size and vascularity by the end of 2 weeks of INF treatment and significantly melted at the end of 1 month. At the end of 6 weeks, there was gross disappearance of the tumor, and impression cytology was negative for atypical cells. However, the drug was continued for another 1 month.

The authors concluded that impression cytology and topical INF-α 2b drops are simple, powerful, and affordable tools to manage extensive OSSN.

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