Posters

Treatment of extensive conjunctival intraepithelial neoplasia in patient with mitomycin intolerance

Poster Details

First Author: B.Garcia Valcarcel SPAIN

Co Author(s):    R. Vera Echevarria   L. Marinas Garcia   A. Baeza Autillo   M. Balado Vazquez           

Abstract Details

Purpose:

Emphasize the value of adjuvant therapies in the treatment of extensive or recurrent conjuntival intraepithelial neoplasia (CIN)

Setting:

Cornea and ocular surface section. Gregorio Marañon University Hospital. Madrid, Spain

Methods:

Patient 58 years old presents red eye and discomfort in his right eye. The best corrected visual acuity (BCVA) was 20/40 and 20/25 in right and left eye respectively, 0.9 OI Slit lamp examination of the right eye shows papilomatous conjunctival lesion affecting cornea 2 mm from 9 to 7 hours. Biopsy and pathology study is performed and resulting in CIN (moderate dysplasia). Given the extent of the injury and so extensive involvement of limbo it is established adjuvant treatment with interferon alpha 2b (1 million IU / ml) 1 drop every 6 hours.

Results:

In subsequent revisions is not observed response to treatment, so it is changed by mitomycin C 0.02% drops. Six week later complete regression is achieved but the patient shows drug intolerance so the treatment is stopped. Two months later a recurrence of the lesion is observed so it is established topical alpha 2 beta interferon treatment . After two months is observed growth of the lesion. It gets subconjunctival injection of interferon, followed by topical interferon, with no response. Finally Surgical resection is performed. Eight months later no signs of recurrence of the lesion was observed.

Conclusions:

The treatment of choice in CIN is resection with safety margins. This is sometimes not possible, especially in large tumors or corneal involvement. The use of different adjuvant therapies reduces the risk of recurrence and avoid multiple surgeries. Topical MMC at 0.02% often show efficacy but the side effects of this treatment are sometimes cause for discontinuation due to intolerance . The α- IFN 2b topical or subconjunctival can be a good alternative for the treatment of recurrent CIN in selected cases, such as resistance or intolerance to MMC, or in cases where it has a significant risk (epithelial defects).

Financial Disclosure:

NONE