W e would like to thank Yadav, Yadav, and Rastogi for highlighting the strengths of our study, which showed a lasting complete response when treating conjunctival primary acquired melanosis (PAM) with atypia with topical interferon (IFN) alfa-2a. We also want to thank them for pointing out that our study offers clinicians facing a shortage in one type of IFN-α2 with evidence-based treatment options.
Although Yadav et al are from a school of pharmacy, they made no comment on our dosing selection of 2 drops a day vs the previous publications of 4 drops a day for IFN-α2b. Because our study showed a high and lasting response rate, we suggest maintaining that dosing, especially because fewer drops per day increase patients’ compliance.
We agree that the variability in treatment duration limits the formation of a unified treatment protocol and would like to address this issue. The aim was to treat patients in 3-month cycles to monitor response and continue treatment until all pigmentation disappeared from the conjunctiva. Variable disease extent and response rates dictated a nonuniform treatment duration. New companies are starting to manufacture IFN-α2 for eye use, and we are calling interested clinicians to join us in a future prospective multicenter study once the supply chain stabilizes worldwide.
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