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Mitomycin C treatment for conjunctival-corneal intraepithelial neoplasia: a multicenter experience
J Frucht-Pery1, J Sugar, J Baum
1Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
Objective:
The purpose of the study is to evaluate the efficacy and risks of topical mitomycin C (MMC) for conjunctival-corneal intraepithelial neoplasia (CCIN).
Design:
The study design was a clinical case series of CCIN.
Participants:
Seventeen patients, 16 with biopsy-confirmed CCIN and 1 with invasive squamous cell carcinoma (SCC), were included in the study.
Intervention:
Patients received topical drops of MMC 0.02% to 0.04% four times daily from 7 to 28 days. Retreatment was done in cases of lesion recurrence.
Main Outcome Measures:
The size of the CCIN before and after the treatment and ocular complications post-MMC application were evaluated.
Results:
Ten patients remained disease-free after one course of MMC application. In one case, residual CCIN remained very small without regrowth. In the one patient with invasive SCC and in five patients with CCIN, regrowth occurred within 6 months of the first treatment. After retreatment, invasive SCC and CCIN in an additional two patients were eradicated. In two cases, although the size of the lesions decreased after two and three applications of MMC, regrowth occurred, and the CCIN returned to its original size. In the final case, limited recurrence has occurred and no retreatment has been done. The complications of MMC use included mild-to-moderate conjunctival hyperemia and mild allergy, which resolved after discontinuation of the treatment. Severe pain manifested when treatment was longer than 14 days.
Conclusions:
Application of topical MMC is an efficient treatment for most but not all cases of CCIN.
Insights
Topical mitomycin C (MMC) effectively treats most conjunctival-corneal intraepithelial neoplasia (CCIN), though some cases require retreatment due to recurrence. Mild side effects were observed, with severe pain noted in longer treatments.
Area of Science:
- Ophthalmology
- Oncology
Background:
- Conjunctival-corneal intraepithelial neoplasia (CCIN) is a precancerous ocular surface lesion.
- Topical chemotherapy is a potential treatment modality for CCIN.
Observation:
- A clinical case series evaluated 17 patients with CCIN or invasive squamous cell carcinoma (SCC).
- Patients received topical mitomycin C (MMC) 0.02%-0.04% for 7-28 days, with retreatment for recurrences.
Findings:
- Ten patients achieved disease-free status after one MMC course.
- Recurrence occurred in six patients (five CCIN, one SCC) within six months.
- Retreatment eradicated CCIN/SCC in two additional patients.
- Mild conjunctival hyperemia and allergy were common; severe pain occurred with treatment >14 days.
Implications:
- Topical MMC is an effective treatment for the majority of CCIN cases.
- Treatment duration and retreatment strategies may influence outcomes.
- Monitoring for recurrence and managing side effects are crucial for successful MMC therapy.
