Efficacy, safety and cost-effectiveness of 5-fluorouracil versus interferon α-2b as adjuvant therapy after surgery in ocular surface squamous neoplasia in a southern European tertiary hospital.

PURPOSE: To analyze the efficacy, safety and cost-effectiveness of adjuvant therapy with 5-fluorouracil (5-FU) compared to interferon α-2b (IFNα-2b) after surgery in ocular surface squamous neoplasia (OSSN). METHODS: Retrospective study that included patients diagnosed with OSSN, who underwent surgical excision followed by adjuvant therapy with IFN α-2b (Group A) or 5-FU (Group B), in a tertial referral hospital. Clinical data collected included: demographics, risk factors, appearance, size and location of the lesions, slit-lamp examination, anterior segment optical coherence tomography, iconography and histological classification of subtypes of OSSN. Costs derived from surgery and adjuvant therapy were noted. Resolution of the lesion, recurrences and adverse events were studied. Cost-effectiveness analysis was performed with the incremental cost-effectiveness index (CEI). RESULTS: 54 cases of 54 patients were included, with a mean age of 74.4 years (range 28-109). 30 were male (55.6%), and predominantly Caucasian (79.6%). The main risk factor was prolonged sun exposure (79.6%). Leukoplakic appearance (48.1%), location in bulbar conjunctiva (48.2%) and T3 (46.3%) stage were the most common clinical features. Histologically, the percentage of CIN I, CIN II, CIN III and SCC were 25.9%, 29.6%, 40.7% and 3.7%, respectively. Complete resolution was obtained in 74.1% and tolerance was overall positive. The cost was significantly higher for IFNα (1025€ ± 130.68€) compared to 5-FU (165.57€ ± 45.85 €) (p 0.001). The CEI was - 247.14€. CONCLUSIONS: Both 5-FU and IFN α-2b are effective and present a good security profile as adjuvant therapies after surgery in OSSN. Although presenting slightly more ocular complications, 5-FU can be considered more cost-effective than IFN α-2b.

Pinhole amniotic membrane for peripheral corneal defects in patients with a single eye or low vision.

AIMS: To describe the efficacy of a new pinhole amniotic membrane placement technique in cases of peripheral epithelial defects in patients with a single eye or low vision in the contrye. METHODS: This technique is based on a small central hole done with a dermatological 3 to 4 mm punch (according to pupillary diameter in mesoscopic conditions) and a continuous suture in the perilimbal cornea to fix the amniotic membrane. We performed this technique in 6 patients. Patients were followed clinical and photographically. RESULTS: No changes in the visual acuity before and after the surgery were observed. During follow-up, a complete re-epithelialization was observed with no need for reinterventions. CONCLUSIONS: Amniotic membrane transplantation is a very useful option in patients with persistent epithelial defects; however, its use is limited by the subsequent visual acuity. The use of the pinhole amniotic membrane technique allows us to treat peripheral persistent corneal lesions without modifying patients' visual acuity. This new technique may become especially useful in patients with functional single eye of low vision in the contralateral eye.