Topical Mitomycin C Research Articles

Early topical mitomycin-C prevents stricture formation in children with caustic ingestion.

Stricture formation is the most common remote complication of caustic ingestion. The aim of this study was evaluation of the efficacy of early topical endoscopic application of mitomycin C (MMC) in prevention of stricture formation after corrosive ingestion in children. We enrolled 78 children with a history of caustic ingestion within 48 h in a prospective, randomised-controlled study. Only 61 children completed the study and were classified into two groups: group A and B. After initial stabilisation, patients in group A (n = 30) received topical application of MMC within the initial 48 h while patients in group B (n = 31) only received conventional management. Follow-up endoscopic dilatation was done every 2 weeks to patients in either group until no need for further dilatation. The barium study, which was done on the third week, revealed that all the patients (100%) on conservative management (group B) had strictures while only nine patients (30%) in group A had strictures (P < 0.001). The median number of dilatations required for patients in group B was 26 (min. = 23 and max. = 32) while in group A, it was 0 (min. = 0 and max. = 7) (P < 0.001). The success of early MMC application was complete response in 26 patients (86.7%), partial response in 3 patients (10%) and no response in 1 patient (3.3%). On the other side, conventional therapy with endoscopic dilatation achieved complete response in 11 patients (35.5%). Early topical MMC application proved its efficacy and safety in prevention of scar and stricture formation in children following caustic ingestion.

A comparative study between amniotic membrane transplantation and topical mitomycin-C in recurrent pterygium management

Aim The aim of this study was to compare the outcome of amniotic membrane transplantation (AMT) and topical mitomycin-C (MMC) in the management of recurrent pterygia. Patients and methods This is a retrospective study that included 40 cases of recurrent pterygia. They were subjected to surgical excision of the pterygium with bare sclera technique. The cases were categorized into two groups, 20 cases in each group. Group 1 was managed with intraoperative topical MMC, while group 2 was managed with AMT at the time of surgery. The patients were followed-up for at least 6 months postoperatively. The outcome measures were visual acuity (VA), corneal astigmatism, recurrence, and postoperative complications. Results The duration of postoperative pain was significantly shorter in the AMT group (6.8±1.0 days) than in the MMC group (10.45±1.5 days, P&lt;0.0001). In addition, postoperative photophobia and lacrimation persisted for a significantly longer period in the MMC group (mean=10.0±1.03 days) compared to the AMT group (mean=7.85±0.81 days, P&lt;0.0001). At the end of follow-up period, VA improvement occurred in 60% of group 1 and in 70% of group 2 patients. However, the preoperative and postoperative decimal VA were not significantly different between the two study groups (P=0.6684 and 0.7302, respectively). In group 1, there was a significant difference between the preoperative corneal astigmatism [−3.74±2.19 diopter (D)] and the postoperative astigmatism (−2.31±1.46 D) after 6 months (P&lt;0.01). Similarly, in group 2, there was also a significant difference between the preoperative corneal astigmatism (−3.83±2.32 D) and the postoperative astigmatism (−2.12±1.60 D) after 6 months (P&lt;0.01). However, the difference between the two groups was statistically insignificant. In the first postoperative 2 weeks, there was a statistically insignificant higher incidence of delayed wound healing and superficial punctate keratitis in the MMC group. The corneal wound healing was faster in the AMT group (mean=4.2±0.69 days) than in the MMC group (mean=4.6±o.6 days). However, the difference was not statistically significant (P=0.0578). At 2 weeks postoperatively, there were two cases of conjunctival defect and one case of scleral thinning in the MMC group only. At the end of the follow-up period, another case, in the MMC group, developed scleral thinning; however, the cornea was clear. Conclusion AMT and MMC could be used in the management of recurrent pterygia. The AMT group showed better visual outcome without postoperative complications. However, the difference between the two groups was statistically insignificant.

Topical 5-fluorouracil 1% for moderate to extensive ocular surface squamous neoplasia in 73 consecutive patients: Primary versus secondary treatment

ImportanceOcular surface squamous neoplasia (OSSN) is a spectrum of malignancies that generally includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). OSSN can be treated with topical therapies including interferon α-2b (IFN), mitomycin C (MMC), or 5-fluorouracil 1% (5FU). Recently, due to unavailability of IFN and toxicity associated with MMC, therapy has shifted towards 5FU. ObjectiveHerein, we compare the use of 5FU 1% as a primary versus (vs) secondary treatment regimen in eyes with moderate to extensive OSSN. Design Setting and ParticipantsRetrospective cohort study of 73 consecutive patients with unilateral moderate to extensive OSSN treated at a single tertiary ocular oncology center from 2016 to 2023. Mean follow up time was 478.2 days overall, with 283.0 days for primary 5FU group and 860.3 days for secondary 5FU group. InterventionTopical 5FU 1% 4 times daily for 2 weeks with option for 2-weekly extension until tumor control, either as primary treatment or as secondary treatment to surgical resection, topical IFN or topical MMC, or cryotherapy. Main OutcomesOutcome measures included tumor response, need for additional surgery, complications, and visual outcomes. ResultsA comparison (primary vs secondary treatment) revealed no difference in mean tumor basal dimension (19.6 vs 17.2 mm, P = 0.46), thickness (3.7 vs 3.4 mm, P = 0.64), or tumor extent (4.4 vs 4.5 clock hours, P = 0.92). The primary treatment group showed greater complete tumor control (77% vs 38%, P = 0.04). Multivariable analysis comparison (primary vs secondary treatment) showed primary treatment more likely to achieve complete tumor control (P = 0.01). There was no difference in the complication rate from 5FU treatment between the groups. There was no difference in visual outcome, and no tumor-related metastasis (0%) or death (0%). Conclusion and RelevanceTopical 5FU 1% is efficacious and safe as a primary or secondary treatment for moderate to extensive OSSN. Tumors treated with primary 5FU 1% demonstrated more complete resolution. In patients with moderate to extensive OSSN, primary treatment with topical 5FU 1% may be warranted.

Factors affecting recurrence and metastasis in conjunctival melanoma.

To evaluate clinical and demographic characteristics and factors affecting recurrence, metastasis, and survival in conjunctival melanoma (CM). The clinical records of 45 patients who were treated for CM between October 1998 and June 2022 were retrospectively evaluated. Age, gender, presence of underlying conjunctival nevus-primary acquired melanosis (PAM), tumor stage according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system, tumor basal diameter, tumor thickness, lymph node (LN) involvement, metastasis, presence of tumor at the surgical margin, treatment method, need for adjuvant therapy, local tumor control, recurrence, and survival were recorded. Twenty-one (46.7%) patients were female and 24 (53.3%) patients were male. The mean age at diagnosis was 53.2 ± 16.1years. Median follow up time was 12 (1-300) months. Fifteen (33.3%) patients had conjunctival PAM; 2 (4.4%) patients had conjunctival nevus. The tumor stage was T1 in 24 (55.8%), T2 in 13 (30.2%), and T3 in 6 (14.0%) of the cases. The T stage in 2cases could not be determined.For stage T1 and T2 CM, in addition to excisional biopsy (EB) and cryotherapy, alcohol epitheliectomy (AE) was performed in 17 cases (37.8%), superficial sclerectomy (SS) was performed in 7 (15.6%), and amnion membrane transplantation (AMT) due to a large conjunctival defect in 9 (20.0%). Six (14.0%) T3 cases underwent primary exenteration. Positive surgical margins were observed in 23 (51.1%) of the excised tumors at histopathologic examination. Adjuvant topical mitomycin-C (MMC) was used in 7 (30.4%) and strontium-90 episcleral brachytherapy in 4 (17.4%) of the 23 cases with tumor-positive borders. During the follow-up, recurrence was seen in 14 (31.1%) cases. According to Kaplan Meier analysis, the mean time to recurrence development was 90.5 ± 16.1months and the 5-year recurrence free rate was 52.0%. Fourteen of the recurrent cases underwent EB + cryotherapy, 3 underwent AE + SS, and 3 underwent secondary exenteration. Metastasis and LN involvement occurred in 11 (24.4%) and 8 (17.8%) of the cases, respectively. Four (8.9%) cases expired during follow-up. According to Kaplan-Meier analysis, the mean time to metastasis was 106.2 ± 17.3months and the 5-year metastasis free rate was 52.0%. While recurrence was more frequent in CM developing from PAM/nevus, metastasis was more frequent in men and those with LN involvement. Conjunctival melanoma was a malignant tumor with high recurrence and metastasis rates. Precursor nevus/PAM is a risk factor for recurrence, while male gender and regional LN involvement were risk factors for metastasisin this study.

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 .

Unilateral ocular surface squamous neoplasia in a case of laryngeal carcinoma: A case report

We discuss a unique case, where a patient is suffering from both laryngeal carcinoma and ocular surface neoplasia with a strong family history of multiple malignancies of various organs. The patient is a 65-year-old male suffering from unilateral left-sided ocular surface neoplasia involving the inferotemporal quadrant of limbus and sclera. The lesion was excised surgically with double freeze-thaw cryotherapy and was started on topical mitomycin-c (0.02%) for 3 1-week cycles over 6 weeks.

Bilateral ocular surface squamous neoplasia in xeroderma pigmentosum patient - A case report

A rare case of a 13yr old male patient presented with photophobia in both eyes and gradually progressive painless mass with watering, itching, and redness in the right eye for 2 months. Best-corrected visual acuity in Right eye 20/200 and Left eye 20/120. On examination, Right eye has a 6 x 6 mm fleshy pink oval pedunculated mass lesion arising from the temporal limbus and a 2mm hyperpigmented lesion in the nasal limbus. Left eye has a gelatinous white flat diffuse lesion with the pigmentation of 3mm both in the nasal and temporal limbus. Both eyes' Anterior segment, ocular motility, and fundus are normal. The patient had multiple hyperpigmented spots (freckles) and scaly skin on the face and trunk suggestive of Xeroderma pigmentosum for which he was on irregular treatment. Right eye tumor mass was excised with intraoperative control of surgical margins with adjunctive cryotherapy and sent for histopathology examination, which was confirmed as squamous neoplasia. Postoperatively, Both eyes started on Topical Mitomycin-c 0.02% 4 cycles, and the patient was carefully followed for any recurrence.

Esophageal Dilation in Children: A State of the Art Review.

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.

Safety profile and efficacy of high-dose topical mitomycin-C for choanal atresia repair: A prospective cohort study

ObjectivesTo study the effect of dose-adjusted mitomycin-c (MMC) on the recurrence rate of choanal atresia (CA), and the complication rate associated with this concentration. MethodsThis prospective cohort study was conducted between May 2012 and March 2020 at a tertiary referral center. It included patients of all ages who were diagnosed with CA and scheduled to undergo surgical repair. The MMC group received 4.0 mg/mL of topical MMC. Both groups were followed up for the surgical outcomes and complication rates. ResultsTwenty-one patients (15 females) underwent 25 CA repair procedures. The mean age was 44.85 months (standard deviation = 72.85). MMC was used in 12 (57.1%) of 21 patients. Revision CA repair was warranted in three of the nine patients who did not receive topical MMC compared to one of the 12 patients who received topical MMC. The MMC group required 1.08 ± 0.29 surgeries (range, 1–2), whereas the non-MMC group required 1.44 ± 0.73 surgeries (range, 1–3). Functional success was achieved in 17 (81%) patients who remained symptom-free until their last follow-up visit. ConclusionHigh-concentration MMC was considered safe in the pediatric and adult populations. Although high-concentration MMC could reduce the need for revision surgery, further studies are required to determine whether the effect is significant in a larger sample population.

A clinical study to evaluate recurrence of pterygium after primary surgery and its management

Recurrence is a significant problem after pterygium excision. Therefore in this study its risk factors and management is discussed. This study was conducted to observe recurrence after conjunctival limbal autograft (CLAU) &amp; to evaluate different factors related with recurrence of pterygium and assessing its different management methods. Hundred &amp; seven patients with primary pterygium were examined, excised by CLAU and histopathology sample sent. The outcomes were assessed in terms of clinically significant recurrence till 6 months follow-up. Early topical mitomycin-C (MMC) 0.02% QID for a week was given to avoid resurgence of clinically significant pterygium, however if developed then excised by CLAU (if &amp;#60;4mm) or AMG (Amniotic membrane grafting) (if &amp;#62; 4mm). Out of total cases, 57% were females. Histopathology findings includeEpithelial Hyperplasia (80.4%), vascularity overwhelms fibrosis (39.1%), vascularity similar to fibrosis (28.3%), fibrosis overwhelms vascularity (34.8%), perivascular stromal inflammation (54.3%), diffuse stromal inflammation (37.0%). The following variables were significantly associated (p&amp;#60;0.05) with the recurrence: age, redness &amp; thickness, higher vascularity, diffuse inflammation. Factors such as younger age group, higher redness and thickness of pterygium, more vascularity, and diffuse inflammation on histopathological examination can be considered as a risk factor for recurrence. However, occupation, location, and type of pterygium were found not to be related to recurrence. Although no clinically significant recurrence was seen after mitomycin c eyedrops, but no significant correlation can be made. Young patients having pre-operative features like red and fleshy pterygium, along with vascularity more than fibrosis and diffuse inflammation on histopathological examination should be followed strictly and managed intensely.

A randomized trial of topical mitomycin-C in the immediate post-operative period for the short and long-term prevention of granulation tissue in mastoid cavities

BackgroundGranulation tissue is a primary source of otorrhea in the ear, particularly after surgery, and may develop complications in patients. Hence, discovering an efficient treatment is crucial for this disorder. PurposeThis study aimed to evaluate the mitomycin drops efficacy for germination prevention during the recovery process after mastoidectomy. Our purpose was to introduce novel treatment options in some conditions in which we could not reconstitute the cavity to prevent the possible germination. Materials and methodsThis clinical trial was performed on 52 patients undergoing mastoidectomy. Patients were randomly divided into two groups (26 patients in the mitomycin group and 26 patients in the placebo group). After drug administration, the granulation tissue and complications were recorded. All statistical analysis was performed using SPSS version 21. ResultsThe results of our study showed that mitomycin administration in patients undergoing mastoidectomy significantly reduced the formation of the granulation tissue in the first and third months after surgery (P < 0.05), which is associated with increased patient satisfaction (P < 0.05). ConclusionThe germ formation after mastoidectomy is so common. Since mitomycin administration decreased the incidence of germ formation, it can be proposed as a suggestive treatment in all patients to increase surgical quality and decrease complications include granulation formation.

Evaluation of Topical Mitomycin-C Eye Drops After Reconstructive Surgery for Anophthalmic Contracted Socket.

PurposeTo report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment.Patients and MethodsThe medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis.ResultsThe mean preoperative IFD was 1.67±0.04 mm in group I and 1.58±0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ±0.27 mm and 5.12 ±0.25mm, respectively. The mean preoperative SFD in group I was 8.3±0.9 mm and 8.9±1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4±1.2 mm and 10.2±1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9±0.2 mL and 1.3±0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant.ConclusionPostoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG).

An obstructive tongue neurofibroma

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by multiple manifestations, including the presence of neurofibromas. These benign lesions can potentially affect every site of the body; its location in the head and neck region is not uncommon, but the oral cavity, and specially the tongue, are rarely affected. We aim to present a case of a giant recurrent neurofibroma of the tongue in a NF1 patient, conditiong obstructive symptoms, as well as to ouline its successful treatment with topical mitomycin-C as an adjuvant therapy to surgical ressection. Keywords: neurofibromatosis; neurofibroma; recurrence; airway obstruction.

Abstract 2987: Comparison of the anticancer effects of Mitomycin-C and 5-Fluorouracil on novel periocular sebaceous carcinoma cell lines

Abstract Background: Sebaceous carcinoma (SC) is a highly malignant and potentially lethal neoplasm that most commonly arises from the ocular adnexa. Surgical management is the current mainstay of treatment; however, globe sparing tumor control is often complicated by pagetoid (or intraepithelial) invasion. Topical mitomycin-c (MMC) or 5-fluorouracil (5-FU) have been used as adjunctive medical therapy on the basis of their success in treating other ocular neoplasms. Yet, little is known of their effects on SC tumorgenicity. Here, we characterized effects of MMC and 5-FU in SC in vitro. Methods: Periocular SC tissue samples were collected from two patients with histologically confirmed disease. This study was approved by the University of Miami Institutional Review Board and was conducted in a Health Insurance Portability and Accountability Act of 1996—compliant manner. Molecular characterization of the SC cells was done by immunocytochemistry and whole exome sequencing. SC cells were treated with MMC and 5-FU. The cytotoxic effects were evaluated using a viability assay and the kinetics of these effects were investigated by measuring cell proliferation over time. Migration capability of SC cells after drug treatment was examined by wound healing assays. Results: Two SC cell lines, called Bascom Palmer 50 and 52 (BP50 and BP52), were established. Both cell lines retain the immunophenotypic and molecular features of SC. MMC reduced cell viability in both cell lines in a dose-dependent manner. MMC decreased SC cell proliferation and reduced overall cell number significantly compared to the untreated controls in a dose-dependent manner. MMC also inhibited SC migration capacity significantly. Conversely, 5-FU treatment did not affect cell viability or migration capacity in a dose-dependent fashion. While treatment with high-dose 5-FU inhibited SC proliferation, it did not reduce cell number below baseline. Conclusions: We successfully generated SC cell lines and characterized the effects of MMC and 5-FU on these lines. Clinical medical management of periocular SC has been based of empirical data. Our findings suggest that MMC possess superior cytotoxic and cytostatic activity against SC compared to 5-FU in vitro. Taken together, these preliminary findings indicate that MMC may be more efficacious than 5-FU in the treatment of periocular SC. Currently, investigations are underway to identify novel therapeutic targets and test their efficacy in our cell lines. Citation Format: Steven H. Lang, Ryan A. Gallo, Michelle G. Zhang, David T. Tse, Daniel Pelaez, Andrew J. Rong. Comparison of the anticancer effects of Mitomycin-C and 5-Fluorouracil on novel periocular sebaceous carcinoma cell lines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2987.

Effects of topical mitomycin-C on the tracheal epithelia of rabbits following tracheostomy

Background/aim We aimed to investigate the topical application of mitomycin-C (MMC) after the conventional tracheostomy in a rabbit model.Materials and methodsTwenty-four male New Zealand White rabbits were randomly divided among 3 equal groups (n: 8). Tracheostomies were performed on 16 subjects. Group 1 which served as a control for all tracheal measurements. After tracheostomy, we applied sterile saline (group 2) or MMC at 0.8 mg/mL (group 3) around the tracheotomy site for 5 min. At the 3rd week after surgery, all tracheas were subjected to morphometric and histopathological examinations, including tracheal lumen diameter (LD), number of capillary vessels (CV), subepithelial tissue thickness (SETT), fibroblasts, and inflammatory cells (IC).Results There was a statistically significant difference between the two tracheostomy groups themselves and the control group for LD (p = 0.035), CV (p = 0.006), SETT, fibroblasts, and IC (p < 0.001). Histopathological analysis showed the decreased LD, CV, SETT, IC, and fibroblasts compared to MMC with tracheostomy groups. MMC was more effective than saline for LD, CV, SETT, IC, and fibroblasts.Conclusion Wound healing modulation may prevent scar formation. Fibrosis decreased following tracheostomy in the group treated with MMC. Fibroblasts appear to be key cells mediating these effects.

DEMOGRAPHIC CLINICAL PRESENTATION AND TREATMENT OUTCOME OF OCULAR SURFACE SQUAMOUS NEOPLASIA

Purpose: The aim of the study is to analyze demographic, clinical profile and treatment outcome of ocular surface squamous neoplasia (OSSN). Methods: It was a retrospective study and analysis of 36 eyes (36 cases) diagnosed with OSSN, treated at teritiary eye care center over 3 years. Results: The median age of the treated patients was 53 years, patients with outdoor activity were 77.7% (28/36), while human immunodeficiency virus infection (2/36) with predisposing conditions had a younger median age of (32 years). Carcinoma insitu was found in half of the patients n=18 (50%) and treatment advised was wide local excision (4 mm margin clearance) with cryotherapy followed by topical treatment with mitomycin-c 0.04% . Overall, complete regression was achieved in all cases during a mean follow-up of 16.8 ± 3.65 months. No recurrence was seen. Conclusion: Although OSSN is associated with old age, earlier onset of OSSN is seen in patients with systemic predisposing conditions. Males and females are equally prone to OSSN. Most of the patients with OSSN belong to 41-60 years age group. In HIV positive patients, OSSN appeared at an early age and was more aggressive in nature. Nasal quadrant was most commonly involved and the tumor epicenter was limbus. Most common symptom was mass or growth followed by redness and diminution of vision. Sunlight exposure is a major risk factor. Carcinoma insitu was most common histopathological diagnosis followed by Dysplasia and Squamous cell carcinoma. Surgical excision and cryotherapy followed by topical Mitomycin-C weekly on and off for 3-4cycles is associated with best control of primary OSSN with no tumor recurrence.

Mitomycin-C as adjunctive treatment of Ocular Surface Squamous Neoplasia

The aim of this study is to report the efficacy of topical Mitomycin-C (MMC) as adjunctive treatment following primary excision of ocular surface squamous neoplasia (OSSN).After detailed evaluation, 25 eyes in 25 patients with localized primary OSSN were selected in a prospective, interventional study and subjected to primary excision followed by the application of topical 0.04% MMC as an adjunct and thereafter followed up over a 24 month period for signs of any tumor recurrence. The 25 patients selected with primary OSSN had a mean age of 64(SD 13) with a range of 47-87 years. They underwent surgical excision followed by 3 cycles of freshly prepared 0.04% MMC with 2 weeks on and 2 weeks off for 12weeks.All patients were followed up thereafter at 1 week, 2 weeks, monthly for 6 months and every 3 months for the next 24 months. No tumor recurrence was observed in any of the cases.Topical MMC has a definite role in preventing tumor recurrence when used as adjunctive treatment following primary surgical excision of OSSN.

Complications of esophageal strictures dilatation in children. A tertiary-center experience.

Objectives:To report the results of endoscopic dilatation of esophageal strictures in children, its complications, and their management. The outcomes of esophageal dilatation differ according to the underlying etiology.Methods:The study included 46 patients who underwent esophageal dilatation between 2014-2019. All patients underwent a contrast study of the esophagus before endoscopic dilation to determine the location, number, and length of the narrowing. In addition, the type of dilators (balloon versus semi-rigid dilators), the number of dilatation sessions, the interval between them, and the duration of follow-up were also documented. The median age was 2.47 years, and 26 patients were females. Dysphagia was the main presenting symptom, and the leading cause of stricture was esophageal atresia.Results:The main treatment modality was endoscopic balloon dilatation (n=29, 63%). The esophageal diameter was significantly increased after dilation (9 [7-11] versus 12 [10-12.8]) mm; p<0.001). Topical mitomycin-C was used as adjuvant therapy in 3 patients (6.5%). Esophageal perforation was reported in 2 cases (4.3%). Patients needed a median of 3 dilatation sessions, 25-75th percentiles: 1-5, and the median duration between the first and last dilatation was 2.18 years 25-75th percentiles: 0.5-4.21.Conclusion:Esophageal dilatation is effective for the management of children with esophageal stricture; however, repeated dilatation is frequent, especially in patients with corrosive strictures. Complications are not common, and open surgery is not frequently required.

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 Melt with Perforation Following Topical Mitomycin-C Application in Pterygium Excision

Corneal Melt with Perforation Following Topical Mitomycin-C Application in Pterygium Excision