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2003 OMIG, Abstract 17

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Ocular Surface Squamos Neoplasia: The Standard of Care Survey
Donald U. Stone, James Chodosh. Dean McGee Eye Institute, OKC, OK

Purpose: To determine current practice patterns for treatment of ocular surface squamous neoplasia (OSSN) in the era of topical chemotherapeutics.
Methods: An introductory letter, survey, and stamped return envelope were mailed to 345 physician members of the Ocular Microbiology and Immunology Group (OMIG). Members were queried with regards to their preferred form of therapy, their specific surgical technique, and the possible use of topically applied treatments including mitomycin C (MMC), interferon (IFN), and 5-fluorouracil (5-FU).
Results: 122 surveys were completed and returned. For initial treatment of OSSN, the majority of responders utilize excision alone or excision with adjunctive topical therapy. Surgical approach varied considerably, particularly with respect to ideal surgical margins (mean: 2.4 mm, range: 1-5 mm). The proportion of responders who felt there was sufficient evidence to support the use of MMC, lFN, or 5-FU as the sole form of therapy for OSSN was 54, 21, and 11%, respectively. Taken together, 58% of OMIG physician members felt the evidence was sufficient to support use of at least 1 of the 3 topical agents. Only half the responders (51%) always perform a biopsy before instituting topical therapy. While 82% of respondents replied that there should be a clinical trial of topical agents, 83% believed a placebo arm was unnecessary or inappropriate as part of such a study.
Conclusions: This survey demonstrates a wide disparity in practice patterns for treatment of OSSN. Topical chemotherapy appears to be used commonly, despite a lack of long term outcome data. A prospective clinical trial is indicated to delineate the optimal therapy for OSSN.

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