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2014 Agenda and Abstracts | < Previous | Next >

2014 OMIG Abstract 21

Surgery versus Interferon Alpha 2b for Ocular Surface Squamous Neoplasia (OSSN); a Literature Based Decision Analysis
Andrew Siedlecki1, Stephanie Tapp2, Anna Tosteson2, Thomas Lietman3, Carol Karp4, Michael Zegans5

1Geisel School of Medicine at Dartmouth, 2The Dartmouth Institute, 3University of California, San Francisco Medical Center, 4Bascom Palmer Eye Institute, 5Dartmouth-Hitchcock Medical Center

Purpose: To compare surgical treatment of ocular surface squamous neoplasia (OSSN) to treatment with interferon alpha-2b.

Methods: A decision tree was constructed to compare four strategies: excision followed by a repeat excision for positive margins, excision followed by interferon alpha-2b for positive margins, incisional biopsy followed by interferon alpha-2b for positive biopsies, and empirical treatment with interferon. A decision analysis was performed to model these interventions using disease persistence/recurrence or complete resolution as the primary outcomes. Probabilities were estimated from literature published between 1983 and 2013. Sensitivity analyses were performed to address which variables influence the optimal decision.

Results: The strategy of excisional surgery followed by interferon minimizes the expected value of persistence/recurrence of OSSN. The optimal strategy was sensitive to the efficacy of topical interferon, recurrence following interferon, recurrence following negative surgical margins on excisional biopsy, and the accuracy of excisional biopsy.
Conclusions: Based on the current literature, our analysis suggests that expected value of disease persistence/recurrence is minimized through excisional surgery with topical interferon for cases with compromised surgical margins. If avoidance of a missed diagnosis is primary, then empiric treatment with interferon performs best. However, the power of this analysis is limited by the paucity of randomized prospective controlled clinical trials in the current literature. As noted above the model was sensitive to several factors, indicating that future prospective randomized studies could provide more accurate data regarding these variables and thus better inform the management of OSSN.

Disclosure: N

2014 Agenda and Abstracts | < Previous | Next >