Conjunctival-corneal Intraepithelial Neoplasia Research Articles

Safety and efficacy of topical interferon alpha 2B and mitomycin C for localized conjunctival intraepithelial neoplasia: long-term report of their pharmacological safety and efficacy

PurposeOcular surface squamous neoplasia (OSSN) comprises a wide spectrum of squamous tumors, from which corneal/conjunctival intraepithelial neoplasia (CIN) is the most common one. The classic treatment is complete excision, but recurrence rates are high. Antineoplastic drugs such as mitomycin C (MMC) and interferon alpha 2b (IFNα2b) have been used as adjuvants or as primary treatment. To evaluate the efficacy and safety of topical IFNα2b and MMC in patients with CIN, a phase IIb double-blind clinical trial was performed.MethodsPatients diagnosed with localized CIN were evaluated by slit lamp and impression cytology and were randomly given MMC 0.04% or INF2b (1 million IU/mL) 4 times daily until neoplasia resolution. Time of resolution and frequency of adverse effects were analyzed to determine the pharmacological efficacy and safety of both medications.ResultsSeventeen patients were included. Nine patients were treated with MMC and 8 with IFNα2b. All patients responded to treatment. The resolution time in days was 59.11 ± 24.02 in patients treated with MMC and 143.50 ± 47.181 in those treated with IFNα2b (p < 0.001). In the MMC group, one recurrence was reported (11%). There were no recurrences at 2 years of follow-up in the IFNα2b group. Regarding adverse effects, one or more mild adverse reaction occurred in 77% of patients managed with MMC and in 50% of patients managed with IFNα2b (p > 0.05). No serious adverse effects were reported.ConclusionsTopical chemotherapy with MMC and IFNα2b demonstrate pharmacological safety and efficacy. Therefore, these drugs could be considered as primary therapies for localized CIN .

Ocular surface squamous neoplasia in Northern Thailand: a 16-year review

PurposeTo evaluate clinical characteristics, treatments, and outcomes in patients with ocular surface squamous neoplasia (OSSN) at a tertiary center in Northern Thailand.MethodsPatients diagnosed with either corneal-conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from May 2000 to December 2015, were recruited. The patients’ demographics, symptoms, clinical characteristics, cytopathology, treatments, and outcomes were reviewed.ResultsOverall 171 eyes from 168 patients, 92 eyes were CIN and 79 eyes were SCC. Males were affected in 65.5%. The mean age was 58.8 ± 16.8 (29–99) years. In most cases (60.3%), the tumors were located at the limbus. The most common clinical characteristic was papilliform appearance (46.2%). Human immunodeficiency virus (HIV) infection was found in 37 (22.0%) patients with a mean age of 40.5 ± 7.7 years. The treatments and outcomes were evaluated in 136 eyes whose main initial treatment was wide excision with adjunctive cryotherapy (47.8%), followed by topical mitomycin C (30.9%). The mean follow-up time after treatment was 20.8 ± 2.2 (3–110) months and the recurrence occurred in 18 eyes (13.2%) during the follow-up period. The mean recurrence-free time (months) for CIN was significantly longer than that of SCC (81.3 ± 10.0 [95%CI 61.5 – 101.1] vs 33.2 ± 4.6 [95%CI 24.0 – 42.3], p = 0.030). SCC was the only significant risk factor that influences the recurrence of the tumors with the adjusted hazard ratio of 5.69 (p = 0.005).ConclusionOSSN in Northern Thailand usually involved a limbal area and presented as a papilliform mass. HIV infection should be suspected in young patients. CIN had better outcomes after treatments than invasive SCC.

Impression Cytology's Reliability as an Effective Method for Ophthalmic Neoplasm Detection.

Background:The current investigation was intended to evaluate the precision of impression cytology and tissue histology in the detection of ocular surface neoplasia.Materials and Methods:We examined the histories of patients detected with ocular surface neoplasia at the Department of Ophthalmology, Kalinga Institute of Medical Sciences, Bhubaneswar. All the patients had their impressions cytology and tissue samples taken. The outcomes of both strategies were compared.Results:There were a total of 55 patients (33 males and 22 females) aged 12–99 years (average age, 51 years). Twenty patients had injuries to the right eye and 35 had injuries to the left eye. Conjunctival–corneal intraepithelial neoplasia (38.2%), squamous cell carcinoma (34.5%), squamous epithelium (10.9%), squamous papilloma (7.3%), conjunctival nevi (7.3%), Along with the most common histological research, malignant melanoma (1.8%). Compared with the histological results, impression cytology showed positive and negative assessment accuracies of 97.4% and 52.9%, respectively. In squamous neoplasms, squamous cell carcinoma exhibited a strong link with histology. The occurrence of dysplastic cells raised suspicion of malignancy.Conclusion:Because of its increased accuracy in detecting lesions, along with tissue histology, impression cytology exhibits enormous potential in identifying ocular surface neoplasia. However, impression cytology has an undesirable prognostic accuracy, indicating that it is a useful screening tool but cannot be considered as a “gold standard.”

Interferón alfa-2B tópico como primera opción terapéutica en un caso clínico de neoplasia intraepitelial córneo-conjuntival

IntroductionConjunctival intraepithelial neoplasia is a pre-malignant lesion of the ocular surface. It can be treated with topical interferon alpha-2b (INF α-2b) as first choice. Clinical caseA 71-year-old man referred for corneal-conjunctival, gelatinous lesion in the left eye (LE) with an area of almost 270°. The clinical diagnosis was compatible with a corneal-conjunctival intraepithelial neoplasia. Topical treatment was started with INF α-2b at a dose of one million international units (IU)/ml, 4 times/day for 4 months, with remission being achieved. ConclusionThe isolated use of topical INF α-2b is an effective treatment as a first option in the case of corneal-conjunctival intraepithelial neoplasia, positioning itself as a form of effective and safe treatment compared to other therapeutic options. Surgical excision and use of other chemotherapy agents could lead to severe limbic deficits and other side effects.

Excision, cryotherapy and mitomycin c for the treatment of conjunctival-corneal intraepithelial neoplasia

Purpose: To evaluate the safety and efficacy of three different techniques for the treatment of conjunctival-corneal intraepithelial neoplasia. Methods: Twenty-six eyes of 26 patients, 11 women and 15 men were included in a nonrandomized, retrospective, observational case series. Mean patient age was 64 years (range, 32-88 years).All patients were treated from 1999 to 2014. Mean postoperative follow-up was 4 years (range, 3 months to 14 years). All patients underwent excision of the lesion with a 4-mm safety margin and a 2-mm from the limbus cryotherapy. As further treatment the patients were divided into three groups: Group 1 (8 eyes): conjunctival autograft and 2 cycles of mitomycin C 0.02% (MMC) eye drops, four times daily for 10 days with an interval of 30 days between cycles. Group 2 (9 eyes): amniotic membrane (AM) graft and 3 cycles of MMC eye drops, three times daily for 10 days with an interval of 10 days between the 1st and 2nd cycle and 30 days between the 2nd and 3rd cycle. Group 3 (9 eyes): AM graft without MMC eye drops. Results: After a single treatment, the lesions were eradicated in twenty-three patients. Recurrence was noted in three patients from Group 3 at 3 months, 6 months and 1 year after treatment. Two of them were retreated by the technique used in Group 1 without further recurrence; the other patient underwent enucleation. No adverse effects related to the use of mitomycin C were observed during. There were no side effects related to the use of mitomycin C during follow-up. Conclusion: After surgical excision and cryotherapy, patients treated with conjunctival or amniotic membrane graft associated with mitomycin C, showed a tendency to more effective results.

Conjunctival-corneal intraepithelial neoplasia: Presenting as a pterygium

Ocular surface squamous neoplasia (OSSN) comprises a wide spectrum of dysplastic alterations of the squamous epithelium of the surface of the eye, for example, the cornea and the conjunctiva ranging from precancerous lesions to bona fide invasive carcinoma. The epithelial infiltration can range from mild to severe dysplasia (i.e. mild, moderate, or severe corneal intraepithelial neoplasia) to full thickness epithelial dysplasia. We are presenting a case of a 55-year-old male patient who presented with a sudden increase in the size of her pterygium for the last 3 months, which were finally diagnosed to be carcinoma in situ .

Successful Treatment of Bilateral Conjunctival-Corneal Intraepithelial Neoplasia: Case Report and Review of the Literature

Successful Treatment of Bilateral Conjunctival-Corneal Intraepithelial Neoplasia: Case Report and Review of the Literature

Mitomycin C: An effective adjuvant in the management of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) forms a spectrum of dysplasia from conjunctival-corneal intraepithelial neoplasia to an invasive squamous cell carcinoma (SCC). Management of OSSN is surgical excision; however, with a high reported recurrence rates (33 to 56%). Hence, Mitomycin C, a tumor-targeted deoxyribonucleic acid (DNA) synthesis inhibitor is considered as an adjuvant following excision of primary OSSN. Aim: To report the cure and recurrence rate with excision of primary OSSN with Mitomycin C as an adjunctive ina single ocular center over 1 year period. Materials and Methods: Twelve eyes of 12 patients with histologically proven primary were included in the study between 1 st Jan 2009 and 31 st Dec. 2009. Protocol for the management comprised of surgical excision of the lesion with a 3 mm of healthy rim with cryotherapy followed by topical Mitomycin C 0.04% four times a day to all postoperative patients in 3-4 cycles of alternate on and off weekly courses. At each visit, looked for recurrence of tumor and corneal alterations like keratitis or erosions. Efficacy of Mitomycin C as an adjuvant therapy was measured in terms of clinical cure and recurrence of the tumor. Results: Average age 45.25 years with 42% below 40 years with 83% male preponderance. With a follow up period of 44.5 months, 91.7% success rate found despite late stage presentation in our study. Conclusion: Hence, we conclude that, Mitomycin C treatment following surgical excision decreases the recurrencerate of primary ocular surface neoplasia and should be considered as adjunctive therapy in primary treatment.

Long-term results of topical mitomycin C 0.02% for primary and recurrent conjunctival-corneal intraepithelial neoplasia

Long-term results of topical mitomycin C 0.02% for primary and recurrent conjunctival-corneal intraepithelial neoplasia

Conjunctival–Corneal Intraepithelial Neoplasia (Bowen Disease) Treated With Orthovoltage

To report an exceptionally large conjunctival-corneal intraepithelial neoplasia (CCIN) (Bowen disease), for which the size of the tumor made classical treatment difficult, and to highlight the role of orthovoltage as an alternative treatment mode with good results. Observational case report of a healthy 61-year-old man with CCIN. Given its extension, alternative treatment was performed with orthovoltage, thus avoiding surgery, with adjuvant cryotherapy and mitomycin C, and potential complications. After administering topical anesthetic, a therapeutic contact lens was placed on the cornea; then, the eyelids were held open with a blepharostat. A 1-mm lead plate with a window was placed over the blepharostat. The shape of the window reproduced the shape of the tumor to protect the rest of the eye structures from radiation. Orthovoltage was administered with direct field radiation that was focused on the tumor through the window. The patient received 500 cGy in 2 sessions/week for 2 weeks (2000 cGy) and then 7 sessions 300 cGy daily (2100 cGy). Evolution was good without side effects. After one-year follow-up, the patient was asymptomatic, without alterations of ocular surface or deep structures. Safely administered orthovoltage may be a good therapeutic option for the treatment of CCIN when complete surgical resection is complicated by the extension of the tumor. Compared with topical treatment, radiation is easier to administer, shortens and simplifies the treatment, and is independent of patient compliance.

Corneal Intraepithelial Neoplasia: In Vivo Confocal Microscopic Study With Histopathologic Correlation

To ascertain in vivo confocal microscopic features of corneal/conjunctival intraepithelial neoplasia (CIN) and correlate these with histology of the same lesions. Observational case series with evaluation of diagnostic technology. Four patients with unilateral CIN (3 men and 1 woman) were examined with the Heidelberg Retina Tomograph II (HRT II) Rostock Cornea Module (RCM) confocal microscope before, during, and after treatment. Corneal epithelial samples were taken by alcohol delamination technique in 2 patients, while impression cytology (IC) samples were obtained in the other 2 patients. Morphometric analysis of confocal and histologic images was carried out and the findings correlated. Four controls (all men, 2 with limbal stem cell deficiency, 1 with a limbal lesion, and 1 with diffuse keratoconjunctival proliferation) were similarly examined. Two of these had biopsy for histologic examination. Main outcome measures comprised the degree of correlation between histology and confocal microscopic features of CIN. Dysplastic cellular changes were noticed on histopathology and correlated well with confocal microscopy, corresponding to the different corneal epithelial layers. Bright nucleoli within huge nuclei and ill-defined cell borders were a feature of the basal epithelium on histopathology and confocal microscopy. Subbasal corneal nerves were not visualized on confocal microscopy in areas affected by CIN. These features disappeared in response to treatment cycles as the basal epithelium reverted to its normal pattern, as seen by confocal microscopy. Confocal microscopy findings highly correlate with histologic features in CIN. Confocal microscopic features of CIN as defined in this study will enable a reliable diagnosis in a noninvasive manner. Confocal microscopy will also allow real-time monitoring of the condition during treatment.

Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications

IntroductionThe use of topical mitomycin C (MMC) has gained popularity in the management of ocular surface neoplasia. The aim of this study is to determine outcomes and complications following such...

Treatment of ocular surface squamous neoplasia with Mitomycin C

AimTo report the outcome of treatment of non-invasive ocular surface squamous neoplasia (or conjunctival-corneal intra-epithelial neoplasia (CCIN)) where topical mitomycin C (MMC) has been used in the treatment regimen.DesignProspective, non-comparative...

Long-Term Results of Topical Mitomycin C 0.02% for Primary and Recurrent Conjunctival-Corneal Intraepithelial Neoplasia

To evaluate the efficacy, recurrence rate, and long-term complications of topical mitomycin C (MMC) 0.02% for conjunctival-corneal intraepithelial neoplasia (CCIN). A prospective, nonrandomized, noncontrolled study was conducted of patients with primary or recurrent CCIN treated with topical MMC 0.02%, four times per day, for 28 consecutive days. The main outcome measures were complete resolution of the neoplasia by slit-lamp examination and cytology 1 month after treatment, tumor recurrence, and long-term complications. Between June 1999 and September 2005, 23 patients were included. Eighteen had primary CCIN (group 1) and 5 had recurrent CCIN (group 2). The mean follow-up was 46 months in group 1 and 54 months in group 2. All patients were treated with MMC 0.02% for 28 consecutive days. Complete resolution of the lesion was achieved in all patients after 1 month of treatment. Recurrence occurred in 1 patient (4.3%) after 24 months of treatment. Four patients developed corneal erosion (17.4%), 2 of them with primary CCIN and 2 with recurrent CCIN. Corneal erosion occurred 4 to 24 months after treatment and was treated successfully. The probability for corneal erosions by the log-rank test was equal for both groups (p = 0.1705). The use of topical MMC 0.02% for 28 consecutive days to treat primary or recurrent CCIN was effective and showed a low recurrence rate. Corneal erosion occurred in 17.4% of cases and can occur as late as 24 months after treatment.

Use of Interferon alpha b2 in Treatment of Corneal-Conjunctival Intraepithelial Neoplasia

Use of Interferon alpha b2 in Treatment of Corneal-Conjunctival Intraepithelial Neoplasia

Role of Impression Cytology in Diagnosis of Ocular Surface Neoplasia

To compare the accuracy of impression cytology in the diagnosis of ocular surface neoplasia with tissue histology. We reviewed the histories of patients diagnosed with ocular surface neoplasia at the Chiang Mai University Hospital. All patients underwent both impression cytology and tissue biopsy. We compared the results of both methods. There were 55 patients (33 men and 22 women), with an age range of 12-99 years (mean, 51 years). Twenty patients had lesions in the right eye and 35 had them in the left eye. The most common histologic report was conjunctival-corneal intraepithelial neoplasia (38.2%), followed by squamous cell carcinoma (34.5%), nonneoplastic changes of squamous epithelia (10.9%), squamous papilloma (7.3%), conjunctival nevi (7.3%), and malignant melanoma (1.8%). Compared with histologic findings, the positive and negative predictive accuracy of impression cytology was 97.4% and 52.9%, respectively. For squamous neoplasms, squamous cell carcinoma had the highest correlation with histology. The presence of dysplastic cells suggested malignancy. This study shows that impression cytology might have a promising role in diagnosing ocular surface neoplasia for its high positive predictive accuracy compared with tissue histology. However, a fair negative predictive accuracy indicates that impression cytology is a valuable screening technique, but it is not a "gold standard."

P5 Impression cytology of ocular surface diseases of the bulbar conjunctiva as non-invasive technology for diagnostic and monitoring for cancer prevention

To report a case of conjunctival-corneal intraepithelial neoplasia (CCIN) in an elderly African American patient treated with topical mitomycin C and the subsequent complication of limbal stem cell deficiency.Interventional case report.A 92-year-old African American woman was diagnosed with CCIN in the right eye. Following incisional biopsy, the patient received five 1-week courses of 0.04% mitomycin C and was followed over a period of 10 months.The CCIN regressed completely following mitomycin C therapy. Three months later, the patient developed recurrent nonhealing epithelial defects in the right cornea.Conjunctival-corneal intraepithelial neoplasia may occur in the African American population. Although MMC is effective in eradicating CCIN, a limbal stem cell deficiency may complicate the treatment.

Surgical Excision, Cryotherapy, Autolimbal Transplantation and Mitomycin-C in Treatment of Conjunctival–corneal Intraepithelial Neoplasia

To report surgical excision, cryotherapy, autologous conjunctival-limbal transplantation and topical mitomycin C (MMC) in the patient with extensive conjunctival-corneal intraepithelial neoplasia. Case report and literature review. A 75-year-old woman was referred to our department with the diagnosis of conjunctival-corneal neoplasia. Slit-lamp microscopic examination revealed an extensive papilliform tumoral mass invading the limbus at 360-degrees, and bulbar conjunctiva and cornea. Visual acuity was finger counting from 2 m in the right eye and 20/20 in the left eye. We performed total surgical excision, cryotherapy and autologous conjunctival-limbal transplantation in the right eye. Mitomycin-C 0.02% eye drops four times a day were prescribed for 4 weeks after the surgery. After the treatment, the visual acuity increased to 0.7 in the right eye. Corneal epithelium completely healed within 1 week after the surgery. No corneal epithelium-related problem or neoplasia recurrence were noted during the 2-year follow-up period. This technique may be useful in reconstruction of eyes with extensive neoplastic involvement of the conjunctiva, limbus, and cornea. In addition, mitomycin C drops may be useful in preventing postoperative recurrence of conjunctival-corneal intraepithelial neoplasia.

Topical 0.002% mitomycin C for the treatment of conjunctival-corneal intraepithelial neoplasia and squamous cell carcinoma

This article describes a retrospective study to demonstrate the efficacy of topical 0.002% mitomycin C (MMC) as an adjunctive and alternative treatment in primary and recurrent conjunctival-corneal intraepithelial neoplasia (CCIN and squamous cell carcinoma (SCC). Six cases of pathologically confirmed, recurrent CCIN and one case of primary SCC were treated with topical MMC 0.002% eyedrops four times daily until the tumor regressed completely as observed clinically and proved by impression cytology.

Topical 0.002% Mitomycin C for the Treatment of Conjunctival-Corneal Intraepithelial Neoplasia and Squamous Cell Carcinoma

To demonstrate the efficacy of topical 0.002% mitomycin C (MMC) as an adjunctive and alternative treatment in primary and recurrent conjunctival-corneal intraepithelial neoplasia (CCIN) and squamous cell carcinoma (SCC). The medical records of 7 patients with histopathologically confirmed CCIN and conjunctival SCC were retrospectively reviewed. All cases were treated with topical 0.002% MMC 4 times daily. The tumor size pre- and post-treatment, clinical response, and ocular complications were evaluated. The mean age of the patients was 56 +/- 13.4 years. The most common presenting symptom was foreign body sensation (57.1%) with a mean duration of 2.3 +/- 3.8 months. Six patients had pathologically proven CCIN (85.7%) and 1 had SCC (14.3%). Before MMC treatment, 6 eyes (85.7%) had recurrences after surgical excision. The tumor-free period ranged from 2 to 19 months. Two patients had multiple recurrences. MMC 0.002% 4 times daily was applied for a period of 5.4 +/- 4.4 weeks (range, 2-14). All had complete tumor regression as observed clinically and confirmed by impression cytology. Side effects of MMC therapy included ocular irritation, mild conjunctival hyperemia, and punctate keratopathy. There were no serious complications detected. The mean follow-up time was 30.7 +/- 15 months (range, 2-52) with no evidence of clinical recurrence in any case. Topical 0.002% MMC showed a favorable outcome as an adjunctive and alternative treatment of CCIN and SCC with regression of primary and recurrent tumors.