Corneal Intraepithelial Neoplasia Research Articles

Case report: Clinical features and management outcomes of isolated corneal intraepithelial neoplasia

PurposeTo report clinical features and treatment outcome of three cases with isolated corneal intraepithelial neoplasia (CIN).MethodsThis case series presents 3 patients with isolated CIN. Data collected included, presenting signs and symptoms including vision, anterior segment examination, medical and surgical outcomes and signs and symptoms at lost post-treatment visit.ResultsCase 1 was a 45-year-old male who presented with an isolated grayish amoeboid corneal lesion which was excised with alcohol assisted epitheliectomy, he also received 6 cycles of topical mitomycin C (MMC) 0.02% and one injection of interferon alfa-2b with no recurrence during the 10-year follow-up period. Case 2 was 78-year-old male referred for a suspicious white corneal lesion which was completely excised, the patient also received 6 subconjunctival injections of interferon alpha-2b. However, the lesion recurred at 2.5-years post-treatment. Case 3 was a 63-year-old male patient who presented with an isolated corneal lesion that was excised using alcohol-assisted epitheliectomy, patient received four cycles of topical 5-fluorouracil with no recurrence at last follow-up visit at 6 months.ConclusionIsolated corneal intraepithelial neoplasia (CIN) is a rare entity with few reported cases in the literature. In this case series, we report long and short-term management outcomes of combined surgical and medical therapy for isolated CIN.

Corneal intraepithelial neoplasia as a cause of visual acuity decrease: a low-cost approach

Corneal intraepithelial neoplasia as a cause of visual acuity decrease: a low-cost approach

Corneal intraepithelial neoplasia as a cause of visual acuity decrease: a low-cost approach

Corneal intraepithelial neoplasia as a cause of visual acuity decrease: a low-cost approach

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.”

Topical mitomycin C treatment in corneal and conjunctival intraepithelial neoplasia: A case report

Corneal and conjunctival intraepithelial neoplasia is a slowly progressive ocular surface lesion with low malignant potential. Owing to the high recurrence rates, cryotherapy or topical chemotherapy is used with surgical treatment. In this paper, we report the histopathologic findings and treatment of a case of intraepithelial neoplasia that began in the conjunctiva and progressed to the cornea. A 75-year-old woman presented with complaints of redness, irritation and lacrimation in her left eye for around 1 month. Slit-lamp examination revealed a papilliform mass on the nasal conjunctiva along with involvement of the adjacent corneal epithelium. Conjunctival excisional biopsy showed a moderate epithelial dysplasia. Topical 0.04% mitomycin C was administered 4 times daily for 3 weeks. No recurrence was observed in the following 18 months.

An unusual presentation of corneal intraepithelial neoplasia

Introduction: Conjunctival/corneal intraepithelial neoplasms are premalignant lesions usually showing conjunctival or limbal involvement. We report the rare case of an isolated corneal intraepithelial lesion.Clinical case: An 80-year-old woman with an elevated, avascular, well-demarcated grey corneal plaque. After epitheliectomy and alcohol, the excised lesion was identified as a high-grade epithelial neoplasia. Treatment was topical interferon α-2b for 1 month without recurrences.Conclusions: A well-defined greyish corneal opacity should always raise suspicion of an intraepithelial neoplasia. In the present case, epitheliectomy and topical recombinant interferon proved successful.

The treatment of recurrent conjunctival and corneal intraepithelial neoplasia with interferon alfa-2b and retinoic acid: ~9 years’ follow-up on tumor control

PurposeTo evaluate the long-term follow-up of recurrent conjunctival and corneal intraepithelial neoplasia (CCIN) treated with combination topical interferon alfa-2b and retinoic acid (I/RA). MethodsOur study represents a retrospective observational interventional series of 82 eyes from 82 patients from a single institution, reviewed for CCIN. All were administered topical interferon alfa-2b 1 million IU/mL QID and retinoic acid 0.01% every other day. Patients had been diagnosed by biopsy. A Kaplan-Meier survival analysis, Wilcoxon signed-rank test and a multivariate logistic regression were statistical tests used to correlate recurrence with patient and tumor variables. Results79 eyes assessed for CCIN diagnoses and treated with I/RA achieved tumor resolution. The median tumor-free follow-up was ~109.1 months with a median time to resolution being ~2.8 months. Our median treatment duration was ~11.3 months. The greatest difference in the mean total residual tumor size was identified between Months 0–1 [-7.63 mm2]. The difference in mean total residual tumor size remained significant till 36-months. A statistically significant correlation with recurrence was identified for biopsy type [OR 0.138]. 6 patients experienced papillary conjunctivitis which resolved with dosage reduction. ConclusionsCombination I/RA was effective in treating CCIN lesions with few transient side effects. The combination of retinoids and interferons may represent a viable topical therapeutic agent with an extended tumor-free follow-up and a large proportion of our study's patients achieving >10 year's tumor-free follow-up. Our treatment duration is long, but by cost-comparing surgical against medical interventions, topical I/RA may serve as a safe and effective alternative.

Case report of a ‘relatively’ new corneal disease

Peripheral hypertrophic sub-epithelial corneal degeneration was first described in 2003 and involves bilateral, symmetrical, peripheral, hypertrophic and sub-epithelial corneal opacification. The disease affects mostly young white women with light-coloured eyes and must be differentiated from corneal intraepithelial neoplasia, bullous keratopathy, climatic droplet keratopathy, corneal amyloidosis, corneal keloid, hereditary hypertrophic scarring, pseudo-pterygia and Salzmann’s nodular degeneration. This case report serves to highlight the clinical findings.

Conjunctival Benign Fibrous Histiocytoma in a 57-year-old man

Purpose. To report a case of benign fibrous histiocytoma of the conjunctiva involving the cornea, an uncommon ocular surface tumor. Methods. A 57-year-old patient came in our service complaining of a progressively enlarging conjunctival mass temporally to the limbus and invading the adjacent cornea of the left eye. Results. The approach consisted in surgical excision followed by cryotherapy on the edges and on the base of the excision site and amniotic membrane patch reconstruction of the ocular surface defect. Pathologic examination and immunohistochemistry were performed in order to establish the diagnosis. No recurrences appeared in 8 months of follow up. Conclusions. Fibrous histiocytoma might be easily misdiagnosed as it is exceedingly rare. Complete resection with careful inspection of edges is advised. Cryotherapy at the base and borders of the resection site is recommended as both benign and malignant tumors can show recurrence. Amniotic membrane should always be regarded as an efficient option in reconstruction of broad surface defects after tumor resection. Abbreviations: FH = fibrous histiocytoma, CIN = corneal intraepithelial neoplasia, SSCA = squamous cell carcinoma, AM = amniotic membrane, MMC = topical mitomycin-C, 5-FU = 5-fluorouracil, BCVA = best corrected visual acuity.

Corneal intraepithelial neoplasia treated with topical mitomycin-C

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Clinicopathologic correlation of ocular surface squamous neoplasia from a university hospital in North Taiwan 1994 to 2014

To describe the clinical and histologic characteristics of ocular surface squamous neoplasia (OSSN) and evaluate factors significant in recurrence at a university hospital in North Taiwan. Patient charts, clinical features, and pathology records were retrospectively reviewed in patients with pathology-proved OSSN from January, 1994 to December, 2014. Clinicopathologic correlation was analyzed. Thirty-six patients were recruited. Mean age was 63.4±13.0 (ranging from 23 to 87) years old. OSSN was predominant in men (21/36). Clinical appearances included papilliform in 17 eyes, gelatinous in 11 eyes, leukoplakic in 3 eyes, and 5 eyes in corneal intraepithelial neoplasia (CIN). Of 31 conjunctival OSSN, there were 4 in CIN I, 11 in CIN II, 13 in CIN III, and 3 in squamous cell carcinoma. Superior location was associated with higher-grade OSSN. Although statistical analysis was not significant, papilliform and multifocal lesions showed a trend of high-grade OSSN. The stages of tumor were 4, 5, 26, and 1 eye(s) in T1 to T4, respectively. Recurrence of disease occurred in 9 cases (25%) with mean recurrence time of 20.6 (range: 4 to 65) months. Multifocal lesion has a higher tendency for recurrence. Superior location was associated with high-grade OSSN, and papilliform OSSN might have a tendency of severe and invasive lesions. Multifocal lesions might be associated with higher-grade OSSN and higher recurrence rates.

Correlation of impression cytology with histopathology in the diagnosis of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) includes a wide spectrum of conjunctival and corneal intraepithelial neoplasia which can manifest as dysplasia, carcinoma in situ, and invasive squamous cell carcinoma. OSSN can be diagnosed by certain noninvasive techniques as well as invasive histopathological examination. One of such noninvasive techniques is impression cytology which refers to the histological study of superficial layers of ocular surface epithelium. Aim: The aim of this study was to assess the accuracy of impression cytology in the diagnosis of OSSN using cellulose acetate paper by correlating with histopathology. Materials and Methods: This is a prospective observational and interventional study conducted at a tertiary referral center in Chennai. This study was conducted from January 2016 to July 2017 and included 43 eyes of 42 patients presenting with conjunctival mass at the limbus or over the conjunctiva. Hospital ethics committee approval was obtained. Results: A total of 43 excision biopsies of 42 patients suspected for OSSN were performed. There was correlation in 36 eyes (83.72%), and in 7 eyes, there was no correlation (16.27%). The cases having hyperkeratotic lesions were missed by the impression cytology. Conclusion: Impression cytology can be used as a screening tool in the diagnosis of OSSN and in the follow-up of patients with recurrence. However, histopathology always remains the gold standard in diagnosing OSSN.

Slitlamp Photography and Videography With High Magnifications.

To demonstrate the use of the slitlamp photography and videography with extremely high magnifications for visualizing structures of the anterior segment of the eye. A Canon 60D digital camera with Movie Crop Function was adapted into a Nikon FS-2 slitlamp to capture still images and video clips of the structures of the anterior segment of the eye. Images obtained using the slitlamp were tested for spatial resolution. The cornea of human eyes was imaged with the slitlamp, and the structures were compared with the pictures captured using the ultra-high-resolution optical coherence tomography (UHR-OCT). The central thickness of the corneal epithelium and total cornea was obtained using the slitlamp, and the results were compared with the thickness obtained using UHR-OCT. High-quality ocular images and higher spatial resolutions were obtained using the slitlamp with extremely high magnifications and Movie Crop Function, rather than the traditional slitlamp. The structures and characteristics of the cornea, such as the normal epithelium, abnormal epithelium of corneal intraepithelial neoplasia, laser in situ keratomileusis interface, and contact lenses, were clearly visualized using this device. These features were confirmed by comparing the obtained images with those acquired using UHR-OCT. Moreover, the tear film debris on the ocular surface and the corneal nerve in the anterior corneal stroma were also visualized. The thicknesses of the corneal epithelium and total cornea were similar to that measured using UHR-OCT (P<0.05). We demonstrated that the slitlamp photography and videography with extremely high magnifications allow better visualization of the anterior segment structures of the eye, especially of the epithelium, when compared with the traditional slitlamp.

Treatment of partial limbal stem cell deficiency with topical interferon α-2b and retinoic acid

BackgroundThe combination of topical interferon α-2b (IFN α-2b) and all-trans retinoic acid (ATRA) 0.01% has previously been shown to be effective in conjunctival and corneal intraepithelial neoplasia. This combination was...

Korneal ve Konjonktival İntraepitelyal Tümörün Topikal İnterferon Alfa-2b ile Başarılı Tedavisi

Corneal and conjunctival intraepithelial neoplasia (CCIN) is a premalignant lesion of the corneal epithelium and limbus and the most common tumor of the ocular surface. Management of these lesions includes wide local excision followed by supplemental cryotherapy, and topical chemotherapy with antineoplastic drugs. As shown by past research, CCIN has a high recurrence rate after excision alone. Consequently, new chemotherapeutic agents have begun to be used in recent years to reduce the risk of recurrence in recent years. In this case, after a clinical and histopathological diagnosis of CCIN, an interferon alfa-2b (IFN α 2b) eye drop was prepared and used four times daily and complete tumor resolution was noted at the first year. We aimed to present our successful treatment of a case of CCIN with topical IFN α 2b.

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 .

Anterior Segment OCT and Confocal Microscopy Findings in Atypical Corneal Intraepithelial Neoplasia

To report a case of biopsy-proven corneal intraepithelial neoplasia (CIN) diagnosed and followed clinically using high-resolution anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Observational case report. A 57-year-old man presented with decreased vision in the right eye for 2 months before presentation. His best-corrected visual acuity was 20/70 in the affected eye, and the slit-lamp examination revealed superficial opacification of the anterior cornea originating from the temporal limbus with a "leopard-spot" pattern more centrally. The lesion was excised at his 2-month follow-up, and the histological examination revealed squamous dysplasia consistent with CIN. Visual acuity improved, and the slit-lamp examination revealed barely visible residual disease at the temporal limbus. However, AS-OCT showed a thicker and highly reflective epithelial layer near the temporal limbus, similar to initial presentation, highlighting this residual disease. IVCM demonstrated dysplastic cells consistent with residual disease. Therefore, we treated the patient with topical interferon alpha-2b (1 million IU/mL) 4 times daily in the affected eye. At 3-month follow-up, the patient's best-corrected visual acuity was 20/20 in the affected eye with persistent but improved residual disease adjacent to the temporal limbus. In the mid-periphery of the inferonasal cornea, focal areas of iatrogenic linear scarring were confirmed to be limited to the anterior stroma by AS-OCT and IVCM at 6-month follow-up. AS-OCT and IVCM are noninvasive techniques that can be used to diagnose and aid in the management of CIN, which may present as subclinical disease through slit-lamp biomicroscopy alone.

Treatment of Conjunctival and Corneal Epithelial Neoplasia with Retinoic Acid and Topical Interferon Alfa-2b: Long-term Follow-up

To evaluate the long-term recurrence rate of conjunctival and corneal intraepithelial neoplasia (CIN) treated with retinoic acid and topical interferon alfa-2b. Retrospective, noncomparative, interventional case series. A total of 89 eyes of 89 patients from 1 institution who were treated between September 2003 and February 2010 for CIN lesions used topical interferon alfa 1 million IU/ml drops 4 times daily and retinoic acid 0.01% once every second day. Diagnosis was made by biopsy and impression cytology. Patients' notes and clinical photographs were reviewed, and data were analyzed. All eyes were monitored for the possibility of recurrence with a minimum of 1 year of follow-up from the time of documented clinical resolution. All eyes were monitored for the possibility of recurrence with a minimum of 1 year of follow-up from the time of documented clinical resolution. Complete clinical resolution of the CIN lesions was achieved in 87 of the 89 eyes treated (97.75%). Two of the 89 eyes treated (2.25%) had only a partial response to treatment; of these 2 patients, 1 was taking cyclosporine for keratitis sicca. For the 87 eyes with complete response, resolution occurred after a mean of 1.69 months (range, 19 days to 6.5 months). Mean follow-up after clinical resolution (tumor-free period) was 51.5 months (range, 11-84 months). Four of the 87 patients with complete response developed a mild allergic papillary conjunctivitis that settled on halving the interferon dose to 0.5 million IU drops and reducing the frequency to 3 times daily. Side effects were limited to 1 case of epithelial microcysts and 1 case of marginal keratitis. In this group of patients observed with CIN lesions, combination treatment of topical retinoic acid and interferon alfa-2b was effective in treating lesions with minimal self-limited side effects with faster and greater resolution and a longer tumor-free period compared with studies using interferon alfa-2b alone. We hypothesize that topical all-trans retinoic acid and interferon alfa-2b may act synergistically. We believe that combination treatment of interferon alfa-2b and retinoic acid may offer a superior alternative to interferon alfa-2b alone in treating CIN.

Interferón alfa-2b tópico como primera opción en las neoplasias intraepiteliales corneoconjuntivales

We describe two cases of conjunctival-cornea intraepithelial neoplasia (CIN), treated with topical IFN alfa 2b. The traditional treatment for CIN is surgical excision usually with adjunctive cryotherapy. However, residual tumour may remain, which can lead to recurrence rates of more than 50%. 5-Fluorouracil, mitomicyn C and interferon α 2b are new pharmacological agents that have proved their efficacy in the treatment of CIN. As side effects are common, we present IFN α 2b as a single therapeutic agent as an effective and optimal treatment for presumed recurrent corneal and conjunctival intraepithelial neoplasia. It offers the benefits of topical therapy and avoids the risks of surgical or other interventions - specifically, ocular surface toxicity, cicatricial conjunctival changes, and limbal stem cell deficiency.

Diagnosis and Management of Conjunctival and Corneal Intraepithelial Neoplasia Using Ultra High-Resolution Optical Coherence Tomography

Diagnosis and Management of Conjunctival and Corneal Intraepithelial Neoplasia Using Ultra High-Resolution Optical Coherence Tomography