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2025 OMIG Abstract
Chemo-Immunotherapy Resistant Ocular Surface Squamous Neoplasia Managed with I-125 Brachytherapy
Pragat J. Muthu1, William Herskowitz1, Michael Antonietti1, Nathan L Scott1, Basil K Williams Jr.2,3,
Maura Di Nicola2, Kavitha R Sivaraman3, Noah K. Cohen1, Wisam Najdawi1, Wendy Li1, Diego E Alba1, Carol L Karp1
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; 2Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio; 3Cincinnati Eye Institute, Cincinnati, Ohio
Purpose: To report the management of chemo-immunotherapy resistant ocular surface squamous neoplasia (OSSN) managed with iodine-125 (I-125) brachytherapy.
Methods: A 36-year-old man presented to the clinic with biopsy proven OSSN that covered ~70% of the corneal surface and extended to 6 clock hours of the inferior limbus of the left eye (OS). The visual acuity was 20/20 in the right eye (OD) and 20/40 in the affected OS. He was treated with topical interferon alpha-2b 1MIU/mL (four times daily (QID) for 6 weeks), then four 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 25mg (0.5mL of a 50mg/mL solution) of 5-fluorouracil. The tumor persisted. The patient was ultimately cured with placement of an 18mm I-125 brachytherapy plaque for 97 hours (50 Gray).
Results: Due to extensive corneal involvement and risks associated with surgery, an 18mm I-125 brachytherapy plaque was placed over the cornea and limbus. The treatment led to full resolution of the tumor within one month of treatment and recovery of 20/20 vision in the affected eye. Thirty-two months post-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 68 months.
Conclusions: This case highlights the efficacy and safety of I-125 brachytherapy as an alternative for intraepithelial OSSN unresponsive to conventional chemo/immunotherapy, particularly when extensive surgical excision poses significant risks.
Disclosure:
P (CLP, patents PCT/US2022/029842, 63/627,578; and 63/435,503 with the University of Miami)
C (CLP, Glaukos Medical Advisory Board)
Support:
NIH Center Core Grant P30EY014801, The RPB Unrestricted Award and Career Development Awards,
Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Grant and Diana
Stanton-Thornbrough, The Robert Baer Family Grant, The Emilyn Page and Mark Feldberg Grant,
The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, Mr. and Mrs. Irwin Friedman Grant,
The Roberto and Antonia Menendez Family Grant, The Calvin and Flavia Oak Foundation,
The Dr. Tim and Cammy Ioannides Grant, The Stephen Takach Grant, The Richard and Kathy Lesser Grant,
The Ragheb Family Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant,
The Zvi Levin Grant, The Christian Kathke Grant, The Carol Soffer Grant,
and the Richard Azar Family Grant
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