Treatment of ocular surface squamous neoplasia with Mitomycin C

AIM To report the outcome of treatment of non-invasive ocular surface squamous neoplasia (or conjunctival-corneal intra-epithelial neoplasia (CCIN)) where topical mitomycin C (MMC) has been used in the treatment regimen. DESIGN Prospective, non-comparative interventional case series. PARTICIPANTS 91 primary or recurrent CCIN lesions from 90 patients treated in a single ocular oncology centre over a 10.5-year period. INTERVENTION 73 cases of localised, non-invasive CCIN and eight cases of recurrent CCIN received a treatment regimen of surgical excision+/-cryotherapy, followed by two to three 1-week cycles of adjuvant topical MMC (0.04% four times a day). 10 cases of diffuse CCIN received two to three 1-week cycles of topical MMC (0.04% four times a day) as sole primary treatment. Main outcome measure Successful treatment was defined as no clinical recurrence of CCIN. RESULTS Mean follow-up of 56.8 months (range 5.8 to 119.8) and median 57.3 months, revealed no recurrences (0%) in the localised primary group, and one persistent case and two recurrences (30%) in the diffuse primary group. There was one recurrence (12.5%) in the recurrent group, but this was in the only eye with a diffuse type of recurrence. CONCLUSIONS MMC treatment following surgical excision appears to decrease the recurrence rate of localised CCIN and should be considered as adjuvant therapy in primary treatment. MMC should also be considered as adjuvant therapy in the treatment of localised recurrent disease. MMC may be used as sole therapy in more diffuse disease, but close ongoing follow-up is recommended in view of the significant risk of persistent or recurrent disease.