Topical 5-fluorouracil 1% for moderate to extensive ocular surface squamous neoplasia in 73 consecutive patients: Primary versus secondary treatment.

IMPORTANCE: Ocular surface squamous neoplasia (OSSN) is a spectrum of malignancies that generally includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). OSSN can be treated with topical therapies including interferon α-2b (IFN), mitomycin C (MMC), or 5-fluorouracil 1% (5FU). Recently, due to unavailability of IFN and toxicity associated with MMC, therapy has shifted towards 5FU. OBJECTIVE: Herein, we compare the use of 5FU 1% as a primary versus (vs) secondary treatment regimen in eyes with moderate to extensive OSSN. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study of 73 consecutive patients with unilateral moderate to extensive OSSN treated at a single tertiary ocular oncology center from 2016 to 2023. Mean follow up time was 478.2 days overall, with 283.0 days for primary 5FU group and 860.3 days for secondary 5FU group. INTERVENTION: Topical 5FU 1% 4 times daily for 2 weeks with option for 2-weekly extension until tumor control, either as primary treatment or as secondary treatment to surgical resection, topical IFN or topical MMC, or cryotherapy. MAIN OUTCOMES: Outcome measures included tumor response, need for additional surgery, complications, and visual outcomes. RESULTS: A comparison (primary vs secondary treatment) revealed no difference in mean tumor basal dimension (19.6 vs 17.2 mm, P = 0.46), thickness (3.7 vs 3.4 mm, P = 0.64), or tumor extent (4.4 vs 4.5 clock hours, P = 0.92). The primary treatment group showed greater complete tumor control (77% vs 38%, P = 0.04). Multivariable analysis comparison (primary vs secondary treatment) showed primary treatment more likely to achieve complete tumor control (P = 0.01). There was no difference in the complication rate from 5FU treatment between the groups. There was no difference in visual outcome, and no tumor-related metastasis (0%) or death (0%). CONCLUSION AND RELEVANCE: Topical 5FU 1% is efficacious and safe as a primary or secondary treatment for moderate to extensive OSSN. Tumors treated with primary 5FU 1% demonstrated more complete resolution. In patients with moderate to extensive OSSN, primary treatment with topical 5FU 1% may be warranted.

Patient perspectives on ocular oncology care at hybrid telehealth satellite offices.

OBJECTIVE: To assess patient satisfaction with the hybrid telehealth model in patients undergoing follow-up care in ocular oncology. DESIGN: Retrospective survey study. PARTICIPANTS: All patients who visited 1 of 2 satellite telehealth offices between July 2021 and October 2022 for their follow-up ocular oncology appointment. METHODS: A 13-question online survey was completed for outcome measures of patient demographics, patient satisfaction with the satellite offices, and overall patient experience with telehealth. RESULTS: The survey response rate was 32% (203 of 632). The mean patient age was 65 years (median, 65 years), and 119 patients (58%) were female. A comparison (suburban satellite vs urban in-person office) revealed that the suburban satellite office had less difficulty in travel (3% vs 47%; p < 0.001) and less time commitment (<1 hour) for travel to the office (58% vs 23%; p < 0.001). On a scale (i.e., poor, fair, good, or excellent), the percentage of patients reported the following parameters as good or excellent: ease of finding satellite office (95%), check-in (94%), and time spent waiting for the doctor (72%). On a scale (i.e., extremely dissatisfied to extremely satisfied), the percentage of patients reported being extremely satisfied to the following parameters: the staff (81%) and the office overall (65%). Most patients (90%) would use this telehealth model for future visits (p < 0.0001), and 86% would recommend it to a friend (p < 0.0001). CONCLUSION: In this study on a hybrid telehealth satellite office model for ocular oncology follow-up examinations, patient satisfaction was high, most patients would use this form of examination in the future.