2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T790,Postoperative complications such as dry eye, ocular surface pain, and abnormal wound healing responses, including fibrosis or ectasia, remain a significant concern in corneal, refractive, and cataract surgeries as they occur even in those patients without the classical clinical risk factors. Persistent low-grade or subclinical ocular surface inflammation in these patients may have contributed to these suboptimal outcomes. Inflammatory factors such as IL-1β, IL-6, IL-17A, TNFα, IFNγ, and/or MMP-9 are reported to be higher on the ocular surface of patients with either overt or subclinical inflammation. These inflammatory factors disrupt tissue homeostasis and wound healing response as they (i) sensitize nociceptive (pain) pathways, (ii) destabilize cell-cell adhesion, (iii) increase TGFβ-dependent or independent extracellular matrix (ECM) deposition leading to scarring, and/or (iv) cause ectasia by decreasing ECM deposition and natural collagen cross-linking. These effects of molecular risk factors can be mitigated by preoperative BIOLOGICAL CLEANSING strategies designed to reduce the load of these inflammatory factors on the ocular surface. Depending on the clinical presentation and inflammatory load status, biological cleansing using (i) lubricants; (ii) eyelid hygiene; (iii) ocular surface washes; (iv) topical or oral nutraceuticals; (v) nonpharmacological treatments, such as thermal pulsation therapy and intense light therapy; (vi) topical immunomodulators, such as cyclosporine, tacrolimus, steroids, and Lifitegrast; and (vii) lifestyle modifications, such as diet and probiotics, can be followed. We and others have shown a reduction in these inflammatory factors on the ocular surface using one or more of these strategies. Incorporating biological cleansing protocols into presurgical preparation is a vital step toward modulating ocular surface biology to improve postoperative outcomes for patients.31:T7a3,Postoperative complications such as dry eye, ocular surface pain, and abnormal wound healing responses, including fibrosis or ectasia, remain a significant concern in corneal, refractive, and cataract surgeries as they occur even in those patients without the classical clinical risk factors. Persistent low-grade or subclinical ocular surface inflammation in these patients may have contributed to these suboptimal outcomes. Inflammatory factors such as IL-1β, IL-6, IL-17A, TNFα, IFNγ, and/or MMP-9 are reported to be higher on the ocular surface of patients with either overt or subclinical inflammation. These inflammatory factors disrupt tissue homeostasis and wound healing response as they (i) sensitize nociceptive (pain) pathways, (ii) destabilize cell–cell adhesion, (iii) increase TGFβ-dependent or independent extracellular matrix (ECM) deposition leading to scarring, and/or (iv) cause ectasia by decreasing ECM deposition and natural collagen cross-linking. These effects of molecular risk factors can be mitigated by preoperative BIOLOGICAL CLEANSING strategies designed to reduce the load of these inflammatory factors on the ocular surface. Depending on the clinical presentation and inflammatory load status, biological cleansing using (i) lubricants; (ii) eyelid hygiene; (iii) ocular surface washes; (iv) topical or oral nutraceuticals; (v) nonpharmacological treatments, such as thermal pulsation therapy and intense light therapy; (vi) topical immunomodulators, such as cyclosporine, tacrolimus, steroids, and Lifitegrast; and (vii) lifestyle modifications, such as diet and probiotics, can be followed. We and others have shown a reduction in these inflammatory factors on the ocular surface using one or more of these strategies. Incorporating biological cleansing protocols into presurgical preparation is a vital step toward modulating ocular surface biology to improve postoperative outcomes for patients.32:T8f1,There are limited effective treatment options for diffuse conjunctival melanoma in situ (MIS), diffuse conjunctival intraepithelial neoplasia, and squamous cell carcinoma. There is a need for a more effective treatment with less ocular adverse effects than mitomycin C for MIS and 5-fluorouracil for ocular surface squamous neoplasia (OSSN). To evaluate the outcomes of compounded imiquimod 5% in ophthalmic petrolatum-based ointment for diffuse conjunctival MIS or OSSN. This was an interventional case series study at a tertiary referral center conducted from June 2024 to March 2025. Patients with a histological diagnosis of either conjunctival intraepithelial neoplasia (CIN), conjunctival squamous cell carcinoma, conjunctival MIS, or conjunctival melanoma with adjacent clinical primary acquired melanosis (PAM) were included in the study. Compounded imiquimod 5% ointment applied to the conjunctival surface 5 days per week for 12 weeks at a minimum (range, 12-15 weeks) along with a topical antibiotic. Histological resolution of MIS or OSSN. This case series included 5 patients (mean [SD] age, 77.4 [6] years; 4 female [80%]). At 12 weeks of treatment, there was complete clinical and histological response of CIN with moderate dysplasia, partial histological response (downgrade from squamous cell carcinoma to CIN with moderate dysplasia), and no histological recurrence of positive margins of squamous cell carcinoma excision. At 12 weeks of treatment, there was partial clinical response of diffuse MIS with mild persistence of epithelial pigmentation at the corneal limbus at the 7-o'clock position; however, there was complete histological response in the areas of initial map biopsy. At 15 weeks of treatment, there was complete clinical and histological response of PAM. Of the 5 patients, all experienced ophthalmic adverse events only affecting the ocular surface and eyelids. All ocular surface adverse events resolved within 1 to 2 weeks of drug holiday or completing treatment. Study results suggest that, although definitive safety and efficacy cannot be determined across only 5 cases, compounded imiquimod 5% ointment may be a safe and effective approach to manage diffuse conjunctival MIS or OSSN. Longer-term follow-up with larger number of cases is warranted.33:Tdc7, Importance There are limited effective treatment options for diffuse conjunctival melanoma in situ (MIS), diffuse conjunctival intraepithelial neoplasia, and squamous cell carcinoma. There is a need for a more effective treatment with less ocular adverse effects than mitomycin C for MIS and 5-fluorouracil for ocular surface squamous neoplasia (OSSN). Objective To evaluate the outcomes of compounded imiquimod 5% in ophthalmic petrolatum-based ointment for diffuse conjunctival MIS or OSSN. Design, Setting, and Participants This was an interventional case series study at a tertiary referral center conducted from June 2024 to March 2025. Patients with a histological diagnosis of either conjunctival intraepithelial neoplasia (CIN), conjunctival squamous cell carcinoma, conjunctival MIS, or conjunctival melanoma with adjacent clinical primary acquired melanosis (PAM) were included in the study. Exposures Compounded imiquimod 5% ointment applied to the conjunctival surface 5 days per week for 12 weeks at a minimum (range, 12-15 weeks) along with a topical antibiotic. Main Outcomes and Measures Histological resolution of MIS or OSSN. Results This case series included 5 patients (mean [SD] age, 77.4 [6] years; 4 female [80%]). At 12 weeks of treatment, there was complete clinical and histological response of CIN with moderate dysplasia, partial histological response (downgrade from squamous cell carcinoma to CIN with moderate dysplasia), and no histological recurrence of positive margins of squamous cell carcinoma excision. At 12 weeks of treatment, there was partial clinical response of diffuse MIS with mild persistence of epithelial pigmentation at the corneal limbus at the 7-o’clock position; however, there was complete histological response in the areas of initial map biopsy. At 15 weeks of treatment, there was complete clinical and histological response of PAM. Of the 5 patients, all experienced ophthalmic adverse events only affecting the ocular surface and eyelids. All ocular surface adverse events resolved within 1 to 2 weeks of drug holiday or completing treatment. Conclusions and Relevance Study results suggest that, although definitive safety and efficacy cannot be determined across only 5 cases, compounded imiquimod 5% ointment may be a safe and effective approach to manage diffuse conjunctival MIS or OSSN. Longer-term follow-up with larger number of cases is warranted. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Topical Immunomodulator: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Topical Immunomodulator (modality). Clinician-written summaries and actionable practice insights. 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interpret extended CRRs with caution.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2025-0064","tag_type":"warning","value":"PDT results for nBCC were stratified by calendar year due to non-proportional hazards; the year-to-year HR range (1.10–1.91) reflects possible operator-dependent variation after 2019 guideline changes.","value_numeric":null},{"paper_doi":"10.2340/actadv.v106.adv-2025-0064","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied cautiously — the study is observational with inherent treatment selection bias, and results may not fully generalize outside Denmark given different training and guideline contexts.","value_numeric":null}],"summaries":{"what_studied":"Nationwide Danish registry study (2014–2024) comparing 8-year cumulative recurrence rates (CRRs) of nodular BCC (nBCC, n=100,221) and superficial BCC (sBCC, n=30,898) across five treatment modalities: standard excision (SE), curettage, cryotherapy, PDT, and imiquimod; a machine-learning (boosted decision tree) model also identified predictors of 2-year recurrence.","key_result":"For nBCC, SE had the lowest 8-year CRR (margin <4 mm: 16.5%; ≥4 mm: 13.0%) vs. curettage (25.3%), PDT (36.9%), cryotherapy (2-yr CRR 21.1%), and imiquimod (2-yr CRR 14.9%); SE showed 20% lower hazard than curettage (HR 0.80, 95% CI 0.76–0.84). For sBCC, SE and curettage had equivalent 8-year CRRs (both 16.3%), while PDT had the highest CRR (36.3%). Key ML predictors of 2-year recurrence were facial location, larger tumour size, high number of hospital-registered diagnoses, and short distance to a dermatology clinic (ROC AUC 0.68 for nBCC, 0.71 for sBCC).","limitations":"- One-third of BCCs (57,544) were excluded for missing follow-up, risking overestimation of recurrence rates.\n- Treatment selection bias is inherent (tumour traits and cosmetic considerations drive modality choice), and residual confounding cannot be ruled out despite multivariable adjustment.\n- ML models lacked tumour images, histological depth/thickness, and margin status, limiting predictive accuracy (AUC 0.68–0.71).","practice_takeaway":"For nBCC, SE—especially with ≥4 mm margins—offers meaningfully lower recurrence than curettage or PDT and should be preferred when feasible. For sBCC, curettage is a reasonable, less resource-intensive alternative to SE given equivalent 8-year recurrence rates; PDT, cryotherapy, and imiquimod carry higher recurrence hazard and warrant careful patient selection."}},{"doi":"10.4103/ijo.ijo_2316_25","pmid":"42080711","title":"Biological cleansing: Toward improving ocular surface surgical outcomes","journal_title":"Indian Journal of Ophthalmology","journal_issn":"0301-4738","published_at":"2026-05-04T00:00:00.000Z","url":"https://doi.org/10.4103/ijo.ijo_2316_25","source_score":18,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.4103/ijo.ijo_2316_25","days":"7","issn":"0301-4738","rank":"2","field":"Clinical Medicine","score":"18","category":"Ophthalmology","categories":["Ophthalmology"],"_categories":["Ophthalmology"]},"pubmed":{"doi":"10.4103/IJO.IJO_2316_25","title":"Biological cleansing: Toward improving ocular surface surgical outcomes.","journal":"Indian journal of 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Specific study populations, sample sizes, comparators, and cited evidence cannot be confirmed.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the concept of 'biological cleansing' — preoperative strategies to reduce ocular surface inflammatory factors (IL-1β, IL-6, IL-17A, TNFα, IFNγ, MMP-9) in patients undergoing corneal, refractive, or cataract surgery, with the goal of improving postoperative outcomes.","key_result":"Multiple biological cleansing approaches — including lubricants, eyelid hygiene, ocular surface washes, nutraceuticals, thermal pulsation, intense light therapy, topical immunomodulators (cyclosporine, tacrolimus, steroids, lifitegrast), and lifestyle changes — are reported to reduce ocular surface inflammatory markers and may lower risk of postoperative dry eye, pain, fibrosis, and ectasia.","limitations":"The full text could not be retrieved (PDF rendering failure), so specific study data, sample sizes, and cited evidence levels supporting each cleansing strategy cannot be verified from the source. 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All 5 experienced ocular surface/eyelid adverse events that resolved within 1–2 weeks after a drug holiday or completing therapy.","limitations":"Very small, single-center case series (n=5) with heterogeneous diagnoses and short treatment-window follow-up (12–15 weeks). Outcomes were reported per case without long-term recurrence data.","practice_takeaway":"Compounded imiquimod 5% achieved clinical or histologic responses across diffuse conjunctival MIS/OSSN in this small series, with reversible ocular surface reactions in all patients. 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