Successful treatment with 5-fu

Abstract

We would like to share our experience with a case similar to that reported by Dr. Yamamoto et al in “Successful treatment with 5-Fluorouracil of Conjunctival Intraepithelial Neoplasia Refractive to Mitomycin-C” (Ophthalmology 2002;109(2):249–252). A 78-year-old gentleman presented with a gelatinous gray mass covering the limbus from 12 to 5 o’clock. There was central extension with a focal gray appearance to the epithelium. Visual acuity was reduced to 20/100 secondary to involvement of the visual axis. An excisional biopsy with superficial keratectomy was performed, followed by cryotherapy utilizing a double freeze thaw method to the involved limbal area. The pathology specimen revealed conjunctival/corneal intraepithelial neoplasia (CIN) with no deep extension. The patient did well initially but by 2 months post-operatively, 300 degrees of the limbus now displayed the same gray, gelatinous appearance leaving only 2 free clock hours. The central epithelium was diffusely involved dropping the vision to 20/200. Impression cytology revealed dysplastic epithelium with scattered metaplastic cells. The patient was started on topical interferon-α2b (Intron-A, Schering Plough, Kenilworth, NJ) 1 million units/cc, one drop four times daily. There was initial clearing of the central epithelium. The patient was then lost to follow up for 3 months but continued the topical interferon twice daily. When he eventually returned, the extensive lesion had completely resolved with improvement in vision to 20/30. He used the medication for an additional month. He was then followed for 3 years with no recurrence until his demise from cardiac causes. Topical interferon is a safe and effective treatment for CIN,1Schechter 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 (70) Google Scholar and avoids the significant toxicity associated with Mitomycin-C or 5-Fluorouracil. It should be considered for initial, recurrent or resistant CIN lesions. In the aforementioned patient and in a recently published series1Schechter 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 (70) Google Scholar 7 patients with primary CIN all resolved with topical interferon-α2b. Surgical debulking was not necessary in any of the cases. No recurrences have been seen after 1-2 years. This has been reported by other investigators with similar results.2Karp C.L. Moore J.K. Rosa Jr, R.H. Treatment of conjunctival and corneal intraepithelial neoplasia with topical interferon-α2b.Ophthalmology. 2001; 108: 1093-1098Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar No corneal melts or corneal epithelial sequelae have been reported from use of the medication. Dr. Yamamoto and his colleagues are to be commended for their work. We recommend topical interferon be considered in the armamentarium of treatment for CIN. Author replyOphthalmologyVol. 110Issue 6Preview Full-Text PDF