5-Fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea

Objective: To evaluate the efficacy of pulse dosing of topical 5-fluorourac il (5-FU) in the treatment of conjunctival and corneal intraepithelial neop lasia. Design: Prospective, noncomparative case series. Participants: Seven patients with histologic evidence of intraepithelial ne oplasia were identified by conjunctival biopsy or tumor excision. Methods: Seven patients with a minimum of 7 months of follow-up were treate d with pulsed dosing of 1% 5-FU. Topical 1% 5-FU was administered four time s daily for 2 to 4 days for each cycle. The number of initial treatment cyc les was two to six, with the time between cycles being 30 to 45 days. Main Outcome Measures: The presence or absence of clinically evident intrae pithelial neoplasia was evaluated after each treatment interval. Patients w ere also monitored for adverse reactions to the use of topical 5-FU. Results: Four patients remain disease free with a mean follow-up of 18.5 mo nths (range, 7-36 months) with no additional treatment after the initial tr eatment cycles (mean, 3.75 cycles; range, 2-5 cycles). Three patients had r ecurrence of disease after the initial treatment cycles. Two patients were treated with additional cycles for recurrent disease (six cycles in one pat ient and five cycles in the other patient) and are free of disease at 20 an d 21 months after treatment, respectively. One patient had persistent disea se despite treatment with topical 5-FU and was treated with topical mitomyc in C with resolution of the disease without recurrence for 16.5 months. No adverse reactions to pulse dose treatment with topical 5-FU were noted. Conclusions: Pulsed dosing with 1% topical 5-FU for the treatment of conjun ctival and corneal intraepithelial neoplasia, alone or as an adjunct to exc ision of bulky disease, is a well-tolerated and effective method of treatme nt. (C) 2000 by the American Academy of Ophthalmology.