057 Notre expérience avec 5-fluoruracil et mitomycine-C dans le traitement des néoplasies de la conjonctive et de la cornée-conjonctive. Chémoréduction ou traitement définitif ?

Abstract

To present 11 cases with conjunctival and/or corneal intraepithelial neoplasia treated with local application of 5-FU and Mytomicin- C. The intervention, noncomparative case series was performed in the period between April 2005 and June 2007. Of 11 cases, 6 cases (Group I) were treated with local application with 5-FU 1% and 5 cases treated with Mitomycin C 0.04% (Group II). All patients had biomicroscopic appearance of conjunctival or corneo- conjunctival neoplasia. Initial treatment (first day of cycle) started with direct applications of antimetabolite on tumor tissue. Antimetabolite drops were applied 4 times per day the next four days. Complete cycle lasted 5 days with 10 days off. Third and four cycles if needed started one month after previous cycle. All cases received antibiotics, steroids and 20% autologous serum drops. Group I: In 3 cases (3 cycle) tumor regressed without recurrence, in 2 cases tumor decreased after 3 cycles and required surgery, in 1 case tumor enlarged (after 2 cycles). Group II : in 2 cases we noticed full resolution after 2 cycles; 2 cases showed decrease of tumor (3 cycles) and required surgery; in one case tumor decreased without surgery after 3 cycles. In 7 cases we didn’t notice any recurrence (4 – 16 months) after antimetabolite treatment with/without surgeries. In two cases (Group I, Group II) we noticed corneal epithelial defect after second cycle, one case had iridocyclitis (Group I), and one case experienced corneal melting after the third cycle. Pathohisthological examination confirmed neoplasia in 9 cases. There is a great number of modalities for treatment of conjunctival/ corneal neoplasia: Cidofovir, Interferon alpha-2b, finger-tip cryotherapy, photodynamic therapy, vitamin A, beta radiation, phototerapeutic keratectomy, topical urea, thiothepa, cryotherapy, surgical excision of lesion, antimetabolite etc. Antimetabolite, in selected cases, may be a therapeutic option for the treatment of conjunctival and/or corneal neoplasia as a permanent solution, or as chemoreduction.