Modern Management of Ocular Surface Squamous Neoplasia
OSSN is the most common nonpigmented ocular surface tumor. Excision with cryotherapy has been the traditional therapy with good results, especially when a wide excision is performed. The authors favor the 'no-touch' technique described above. Despite the surgeon's best effort for clear margins, there is often subclinical extension. and this results in residual disease and a higher chance for recurrences. Medical therapy has gained increasing popularity and many studies have demonstrated its efficacy. The agents used are interferon, 5-FU and MMC, all of which have generated excellent results. We use medical therapy as primary treatment in recurrences. The choice of surgical or medical therapy is decided based on the tumor and the patient's needs and compliances. A poorly compliant patient, for example, may not use the chemotherapy drops as prescribed, and would be best served by an excisional biopsy with cryotherapy. Patients with recurrence after prior excisions or those with large, annular lesions have a higher risk of limbal stem-cell deficiency and are ideal for medical therapy. Although histopathological assessment from incisional or excisional biopsy remains the gold standard in diagnosis of OSSN and recurrences, UHROCT is emerging as an exciting new adjuvant tool for the initial diagnosis of OSSN, monitoring therapy and management of recurrences.