Limbal stem cell deficiency following topical mitomycin C treatment of conjunctival-corneal intraepithelial neoplasia

PURPOSE: 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. DESIGN: Interventional case report. METHODS: 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. RESULTS: The CCIN regressed completely following mitomycin C therapy. Three months later, the patient developed recurrent nonhealing epithelial defects in the right cornea. CONCLUSIONS: 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.     

Mitomycin C therapy for corneal intraepithelial neoplasia masquerading as limbal stem cell deficiency with recurrent epithelial defect

Diagnosis of corneal intraepithelial neoplasia was missed in a patient who presented with recurrent large epithelial defects with pannus. The patient was eventually diagnosed and successfully treated with topical mitomycin C. Mitomycin C may be preferable to surgery in lesions with extensive corneal involvement. Impression cytology should be used for early diagnosis in suspicious lesions.     

Use of mitomycin C for corneal-conjunctival intraepithelial neoplasia: management options--case reports

Three cases of corneal-conjunctival intraepithelial neoplasia treated differently with mitomycin C based on clinical presentation are reported. The selected patients were followed at the Department of Ophthalmology of the Casa de Saúde Santo Inácio. According to the clinical appearance of the lesions, 0.04% mitomycin C was employed in three different ways: 1) postoperative chemoablation; 2) preoperative chemoreduction; and 3) isolated chemoablation. Regression of the neoplastic lesion was observed in all cases with no recurrence detected during a follow-up time ranging from 18 to 29 months. Conjunctival hyperemia was the single side effect. The use of mitomycin C seems to be efficient and safe for the treatment of corneal-conjunctival intraepithelial neoplasia under several approaches.     

Keratinizing corneal intraepithelial neoplasia

Corneal intraepithelial neoplasia (CIN) is the term applied by some authors to the spectrum of disease ranging from mild dysplasia to carcinoma in situ. Such lesions usually are associated with dysplastic or neoplastic processes at the limbus or adjacent conjunctiva; isolated corneal dysplasia is rare. Clinically, CIN appears as a geographic, gray, translucent thickening of the epithelium with fimbriated or scalloped borders and lesions often contain scattered white dots. We report a case of intraepithelial neoplasia limited to the cornea that had the unusual clinical appearance of a white plaque, which prompted the misdiagnosis of a calcific scar. Histopathologic examination of the debrided tissue revealed intraepithelial neoplasia and marked hyperkeratosis as the cause of the opacification.     

Treatment of conjunctival intraepithelial neoplasia with topical drops of mitomycin C

PURPOSE: To evaluate the efficacy and risks of complications of topical mitomycin C (MMC) for small-size conjunctival intraepithelial neoplasia (CIN). METHODS: Eight patients with clinically diagnosed CIN <8 mm were included in the study. Patients received topical drops of MMC, 0.02-0.04%, 4 times daily for 14 days. Retreatment was done when lesions were not eliminated or recurred after the first treatment. RESULTS: Three patients remained disease free after one course of MMC application. Retreatment was done in four patients because of lesions that decreased in size but were not eliminated, and for regrowth in one case. After retreatment, the lesions were eradicated in four patients, whereas in one patient, the treatment failed, and the lesion was surgically excised. The complications of MMC use included mild conjunctival hyperemia in two patients and mild allergy in one patient, which resolved after discontinuation of the treatment. CONCLUSION: Application of topical MMC is an effective treatment for most but not all cases of small-size CIN.     

Topical treatment with mitomycin C in considerably raised conjunctival intraepithelial neoplasia

CASE REPORT: We present a case of recurrent conjunctival intraepithelial neoplasia, treated previously on two occasions with excisional biopsy. Although the lesion was considerably raised, topical treatment with mitomycin-C 0.04% was applied, achieving the complete regression of the tumor. DISCUSSION: Topical mitomycin-C acts at the ocular surface. However, successive treatment cycles can achieve complete regression, even in considerably thick tumors.     

Mitomycin C as adjunct therapy in correcting punctal stenosis

PURPOSE: To assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure. METHODS: The charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation. RESULTS: In group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed. CONCLUSIONS: Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.     

Short-term mitomycin C followed by long-term interferon alpha2beta for conjunctiva-cornea intraepithelial neoplasia

PURPOSE: To report a case of extensive conjunctiva-cornea intraepithelial neoplasia (CIN) treated topically with mitomycin C (MMC) and interferon (INF)-alpha2beta without surgical resection. METHODS: Case report. RESULTS:: An 82-year-old woman showed an extensive gelatinous red mass in the bulbar conjunctiva with invasion into the caruncle, inferior fornix, and tarsal conjunctiva and extending for 270 degrees of the corneal surface. A diagnosis of CIN was made by surgical biopsy. Surgical excision with safety margins carried the risk of limbal stem cell depletion. A conservative treatment strategy was used with 2 cycles of topical MMC (0.02%), followed by INF-alpha2beta eye drops at a dose of 1 million IU/mL, 4 times a day until tumor disappearance. Total resolution was noted after 75 days of treatment with INF, with no clinical evidence of limbal stem cell deficiency. After 1 year of monitoring, no signs of CIN recurrences were observed. CONCLUSION: MMC (0.02%), followed by INF-alpha2beta (1 million IU/mL) 4 times a day, is an effective treatment against highly extensive CIN, in cases where surgical resection with safety margins is unfeasible.     

Mitomycin C and 5-fluorouracil antimetabolite therapy for pediatric glaucoma filtration surgery

PURPOSE: To evaluate the efficacy and safety of augmented trabeculectomy with 5-fluorouracil (5-FU) and mitomycin C (MMC) compared to 5-FU only for the treatment of pediatric glaucoma. PATIENTS AND METHODS: In a prospective randomized clinical trial, 8 children (12 eyes) with pediatric glaucoma, either congenital or secondary to: lens aspiration, Sturge-Weber syndrome, or steroids underwent augmented trabeculectomy. Six patients (8 eyes) underwent augmented trabeculectomy with 5-FU plus MMC and 2 patients (4 eyes) underwent augmented trabeculectomy with 5-FU only. MAIN OUTCOME MEASURES: Between-group comparison of postoperative parameters: change in intraocular pressure (IOP), dependence on antiglaucoma medication, number of 5-FU injections, cup-disc ratio, corneal diameter, drug-induced complications. RESULTS: In the 5-FU/MMC group, 7/8 eyes showed good control of postoperative IOP (9-16 mm Hg), which was independent of antiglaucoma therapy; only 2 injections of 5-FU were needed. By contrast, in the 5-FU group, no control of the postoperative IOP (21-23 mm Hg) was achieved in 4/4 eyes, and these patients remained dependent on antiglaucoma medication; up to 6 injections of 5-FU were used. There was no deterioration in the cup-disc ratio or the corneal diameter in either group. Results were maintained on follow-up (23-27 months). No significant drug-induced complications were noted. CONCLUSION: Augmented trabeculectomy with adjunctive 5-FU/MMC may be an option for the control of pediatric glaucoma in patients with a poor surgical prognosis.     

Mitomycin C as an adjunct in the treatment of localised ocular surface squamous neoplasia

AIM: To report the outcome of topical mitomycin C (MMC) used as adjunctive treatment following primary excision of ocular surface squamous neoplasia (OSSN). METHOD: Prospective, non-comparative interventional case series of 27 primary OSSN lesions from 26 patients treated in a single ocular oncology centre over a 4 year period. RESULT: 27 cases of OSSN received a treatment regimen of surgical excision, followed by topical MMC. Mean follow up of 27 (SD 12) months (range 12-50, median 25 months) revealed zero recurrences. CONCLUSION: MMC treatment following surgical excision decreases the recurrence rate of primary ocular surface neoplasia and should be considered as adjunctive therapy in primary treatment.