Interferon alpha-2b(Hanmi Pharmaceutical Co., Ltd.)

Melanocytic conjunctival tumors including conjunctival melanoma and primary acquired melanosis with atypia, are rare but aggressive, capable of local invasion, systemic spread, and recurrence despite treatment. While surgery remains the standard approach, topical chemotherapy using mitomycin C and interferon alpha-2b has emerged as an alternative. This systematic review, analyzed 22 studies encompassing 116 cases. Among these, 28 cases were treated with mitomycin C as a primary therapy achieving a 60.7% remission rate, and 48 were treated with mitomycin C as adjuvant therapy yielding a 68.8% remission rate. Interferon alpha-2b achieved 87.5% remission across primary and adjuvant applications. Overall, remission was achieved in 74.1% of cases (86 patients). Topical chemotherapy provides a non-surgical approach that treats the entire conjunctival surface eliminating reliance on precise tumor margin identification. Primary mitomycin C demonstrated efficacy in managing diffuse, superficial, and intraepithelial disease whereas adjuvant was more effective for nodular and invasive lesions. Interferon alpha-2b, associated with fewer adverse effects, is a valuable alternative, particularly in cases intolerant to mitomycin C. These findings underscore the potential of topical chemotherapy as both a primary and adjuvant option, highlighting the need for further studies to refine treatment protocols and assess long-term outcomes.

The purpose of this study was to report the management of chemoimmunotherapy-resistant ocular surface squamous neoplasia (OSSN) with iodine-125 (I-125) brachytherapy.

A 36-year-old man presented to the clinic with biopsy-proven OSSN that covered ∼70% of the corneal surface and extended to the 6 o'clock position of the inferior limbus of the OS. The visual acuity was 20/20 in the OD and 20/40 in the affected OS. He was treated with topical interferon alpha-2b 1 MIU/mL (4 times daily [QID] for 6 weeks) and then 4 cycles of topical 5-fluorouracil 1% (QID, 1 week on, 3 weeks off) with an incomplete response. He switched to topical mitomycin C 0.04% (QID, 1 week on, 2 weeks off) for 2 cycles and received a subconjunctival injection 25 mg (0.5 mL of a 50-mg/mL solution) of 5-fluorouracil. The tumor persisted. The patient was ultimately cured with placement of an 18-mm I-125 brachytherapy plaque for 97 hours (50 Gy).

Because of extensive corneal involvement and risks associated with surgery, an 18-mm I-125 brachytherapy plaque was placed over the cornea and limbus. The treatment led to full resolution of the tumor within 1 month of treatment and recovery of 20/20 vision in the affected eye. Thirty-two months after treatment, the patient developed a visually significant posterior subcapsular cataract OS and underwent successful phacoemulsification surgery, returning to 20/20 vision. He has remained tumor-free for over 55 months.

This case highlights the efficacy and safety of I-125 brachytherapy as an alternative for intraepithelial OSSN unresponsive to conventional chemoimmunotherapy, particularly when extensive surgical excision poses significant risks.