Posters

Interferon alfa-2b treatment in a conjunctival intraepithelial neoplasia affecting long limbal extension: a case report

Poster Details

First Author: D.Aragón Roca SPAIN

Co Author(s):    S. Martín   C. García-Arumí   S. Banderas   V. Lázaro           

Abstract Details

Purpose:

To describe the case of a patient with conjunctival intraepithelial neoplasia (CIN) in which treatment with topical interferon alpha 2b was preferred over surgical excision with cryotherapy because of the long limbal extension of the lesion (six clock-hours) and therefore the risk of inducing limbal stem cell deficiency, in addition to the significant recurrence rates after surgical excision. Nevertheless, the main disadvantage of topical treatments versus surgical excision is that they don’t enable histopathologic evidence for the diagnosis.

Setting:

Cornea and Ocular Surface Unit. Hospital Vall d’Hebron. Barcelona. Spain.

Methods:

We present the case of a 91-year-old woman who presented at the ophthalmology emergency department reporting symptoms of redness, mild burning and foreign body sensation for the prior week. She had no previous record of ocular history. Anterior segment evaluation of the left eye found mild diffuse bulbar conjunctival injection and an elevated, gelatinous lesion affecting the limbus from clock-hours nine to three and extending itself to superior bulbar conjunctiva. The patient was referred to a cornea specialist of our unit and the lesion was re-evaluated. Based on the clinical appearance, the lesion was diagnosed as suspicious for CIN.

Results:

Treatment with interferon was started with a standard dose of 1 million IU/mL one drop 4 times/ day, with very good tolerability and remission was achieved in five months. However, after five months without topical treatment, there was a recurrence as a papilliform lesion. Consequently, treatment was re-started and dosage was gradually reduced according to clinical improvement, leading to a second recurrence as a gelatinous lesion nine months later. Eventually, we maintained the interferon 4 times/day dosage during five months and then we added topic 5-fluorouracil 1% drops 4 times/day, therefore achieving clinical resolution after one month of combined treatment.

Conclusions:

CIN is the most common tumour of the ocular surface and is a precursor to invasive squamous cell carcinoma. CIN is an epithelial neoplasia that usually begins near the limbus and spreads to the cornea. The diagnosis is based on histopathologic evidence. Traditional management is surgical excision with cryotherapy but topical interferon alpha 2b and chemotherapeutic agents mitomycin C and 5-fluorouracil are effective primary treatment alternatives. Furthermore, they can also be used with the adjunction of surgical resection (before, intraoperatively or after the procedure). Moreover, they allow the treatment of the entire ocular surface, having topical interferon minimal side effects.

Financial Disclosure:

None