Recurrent Intraepithelial Neoplasia Treatment

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We congratulate Drs Boehm and Huang on their publication reporting “the largest collection of cases of recurrent corneal and conjunctival intraepithelial neoplasia” (CIN) treated with topical interferon alfa 2b (IFNα2b). 1Boehm M.D. Huang A.J. Treatment of recurrent corneal and conjunctival intraepithelial neoplasia with topical interferon alfa 2b.Ophthalmology. 2004; 111: 1755-1761Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar They have confirmed what we and others have found, that CIN lesions, both primary and recurrent, respond very well to topical recombinant alfa-interferon, although the treatment period may be prolonged. 2Schechter B.A. Conjunctival intraepithelial neoplasia.Ophthalmology. 1999; 106 ([letter]): 1642-1643Abstract Full Text Full Text PDF PubMed Google Scholar, 3Schechter B.A. Schrier A. Nagler R.S. et al.Regression of presumed primary conjunctival and corneal intraepithelial neoplasia with topical interferon alfa-2b.Cornea. 2002; 21: 6-11Crossref PubMed Scopus (73) Google Scholar A diagnosis of CIN can usually be made clinically, and Drs Boehm and Huang felt that, given the original histological diagnoses of CIN, a biopsy was not necessary to ascertain the diagnosis of recurrent lesions. With that in mind, 2 of their patients (cases 4 and 6) displayed “papillomatous growths” that were not histologically identified but were assumed to be recurrent CIN lesions. Conjunctival papillomata share many features with CIN lesions. Either may be associated with the presence of human papillomavirus. 4Schechter B.A. Rand W.J. Velázquez G.E. et al.Treatment of conjunctival papillomata with topical interferon alfa-2b.Am J Ophthalmol. 2002; 134: 268-270Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 5Chen H.C. Chang S.W. Huang S.F. Adjunctive treatment with interferon alfa-2b may decrease the risk of papilloma-associated conjunctival intraepithelial neoplasm recurrence.Cornea. 2004; 23: 726-729Crossref PubMed Scopus (25) Google Scholar Depending on their location, they may exhibit the typical gelatinous appearance that characterizes CIN, but more likely, when they are present at the limbus, papillomata appear vascular, raised, and sessile. Fortunately, conjunctival papillomata also respond well to IFNα2b. 4Schechter B.A. Rand W.J. Velázquez G.E. et al.Treatment of conjunctival papillomata with topical interferon alfa-2b.Am J Ophthalmol. 2002; 134: 268-270Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar As Drs Boehm and Huang rightfully conclude, most recurrent CIN lesions occur within 2 years, but may display a highly variable recurrence rate. Future studies should consider histologically identifying potential recurrences to distinguish them from potential papillomata because CIN can progress to carcinoma. Human papillomavirus testing might also establish a further link in phenotypic expression, because papillomata and CIN may represent different positions along the clinical spectrum of disease. Treatment of recurrent corneal and conjunctival intraepithelial neoplasia with topical interferon alfa 2bOphthalmologyVol. 111Issue 9PreviewTo evaluate topical interferon alfa 2b (IFNα2b) as a single therapeutic agent in the treatment of presumed recurrent corneal and conjunctival intraepithelial neoplasia. Full-Text PDF Treatment of Intraepithelial Neoplasia with Topical Interferon: ReplyOphthalmologyVol. 112Issue 7PreviewWe concur with Drs Schechter, Nagler, and Schrier that topical interferon alfa 2b is effective in the management of corneal and conjunctival intraepithelial neoplasia (CIN), as well as conjunctival papillomas. It has been known that CIN is often associated with human papillomaviruses 16 and 18. 1,2 The association of conjunctival papilloma with a specific type of human papillomavirus, however, remains to be established. Nonetheless, given the antiviral effects of interferon, it is not surprising that both CIN and conjunctival papilloma respond well to it. Full-Text PDF