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Iatrogenic Ocular Surface Diseases Occurring during and/or after Different Treatments for Ocular Tumours. Cancers (Basel) 2021; 13:cancers13081933. [PMID: 33923737 PMCID: PMC8073875 DOI: 10.3390/cancers13081933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The ocular surface represents a finely regulated system that allows the protection of the eye. It can be affected by therapies used for the treatment of various intraocular tumours, particularly conjunctival cancers and uveal melanoma. In these conditions, treatments are chosen according to the characteristics of the lesion, and include a combination of selective surgery, anticancer eye drops, and/or radiotherapy delivered through different mechanisms. Possible side effects affecting the ocular surface range from transient dry eye or keratitis up to more severe complications such as corneal melting and perforation. These complications deserve careful evaluation for the risk of permanent sight-threatening sequelae. Physicians involved in the management of patients affected by ocular tumours should be aware of this risk in order to reach an early diagnosis and promptly set up an adequate treatment. The present review summarizes acute and chronic complications affecting the ocular surface following different therapies for the treatment of conjunctival cancers and uveal melanoma, and also reports clinical cases of representative patients who experienced these complications. Abstract The ocular surface represents a finely regulated system that allows the protection of the eye. It is particularly susceptible to different treatments for intraocular tumours, such as uveal melanoma and conjunctival cancers. Traditionally, the management of ocular tumours depends on the characteristics of the lesion, and is based on a combination of selective surgery, topical chemotherapy, and/or radiotherapy delivered through different mechanisms (e.g., charged-particle radiotherapy or brachytherapy). Possible complications involving the ocular surface range from transient dry eye disease or keratitis up to corneal melting and perforation, which in any case deserve careful evaluation for the risk of permanent sigh-threatening complications. Clinicians involved in the management of these patients must be aware of this risk, in order to reach an early diagnosis and promptly set up an adequate treatment. The present review of the literature will summarize acute and chronic complications affecting the ocular surface following different therapies for the treatment of ocular tumours.
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Elhamaky TR, Elbarky AM. AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C. Clin Ophthalmol 2019; 13:2269-2278. [PMID: 31819351 PMCID: PMC6877399 DOI: 10.2147/opth.s229399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT). Subjects and methods A prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results. Results The study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm2) was significantly lower than in no MMC group (92.4±17.3 mm2). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Conclusion The treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.
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Affiliation(s)
- Tarek Roshdy Elhamaky
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Retrospective Comparative Study of Topical Interferon α2b Versus Mitomycin C for Primary Ocular Surface Squamous Neoplasia. Cornea 2017; 36:327-331. [PMID: 28079688 DOI: 10.1097/ico.0000000000001116] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the efficacy and safety of topical interferon alpha 2b (IFNα2b) and mitomycin C (MMC) for ocular surface squamous neoplasia. METHODS In this retrospective study, medical records of 51 eyes of 50 patients with a diagnosis of primary ocular surface squamous neoplasia were included. All cases were treated with either topical IFNα2b (1 million IU/mL) or MMC (0.4 mg/mL) 4 times a day. The primary outcome measure was frequency of clinical resolution of tumors along with failure and recurrence rates after treatment. Other outcome measures included the duration of treatment and adverse effects associated with both topical therapies. RESULTS Twenty-six eyes were treated with topical IFNα2b and 25 eyes were treated with topical MMC. A complete response was achieved in 23 (89%) and 23 (92%) eyes with topical IFNα2b and MMC, respectively (P = 0.67). The median time to lesion resolution was significantly different between the groups (median 3.5 months in the IFNα2b group and 1.5 months in the MMC group) with an average difference of 1.7 months (P < 0.005). Five (10%) of 51 patients showed no or partial response to topical therapy. Subsequently, they underwent surgical excision. Adverse effects occurred in 3 (12%) patients using IFNα2b and 22 (88%) patients using MMC (P < 0.005). CONCLUSIONS Both IFNα2b and MMC seemed to be equally effective topical monotherapies. Despite a prolonged time to lesion resolution, IFNα2b-treated eyes had better safety and tolerance in comparison with MMC-treated eyes.
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Abstract
Cryosurgery, a method of treating disease by the production of freezing temperatures in the tissue, is a useful technique for the treatment of tumors. When the modern era of cryosurgery began in the mid 1960's, the technique was used only for tumors easily accessible by direct observation or via endoscopy, such as those of the skin, oral cavity, and prostate gland. In general, the technique had limited usefulness in the next two decades. However, with the advent of intraoperative ultrasound as a method of monitoring the process of freezing and with the development of more effective cryosurgical apparatus, the cryosurgical treatment of tumors of the viscera and other deep tissues became practical in the 1990's. This review assesses the present day status of cryosurgery in the management of diverse tumors.
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Affiliation(s)
- Andrew A Gage
- School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 14214, USA.
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Moon CS, Nanji AA, Galor A, McCollister KE, Karp CL. Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia: A Cost Comparison. Ophthalmology 2015; 123:497-504. [PMID: 26686965 DOI: 10.1016/j.ophtha.2015.10.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of this study was to compare the cost associated with surgical versus interferon-alpha 2b (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN). DESIGN A matched, case-control study. PARTICIPANTS A total of 98 patients with OSSN, 49 of whom were treated surgically and 49 of whom were treated medically. METHODS Patients with OSSN treated with IFNα2b were matched to patients treated with surgery on the basis of age and date of treatment initiation. Financial cost to the patient was calculated using 2 different methods (hospital billing and Medicare allowable charges) and compared between the 2 groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the 2 groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis. MAIN OUTCOME MEASURES Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges. RESULTS When considering cost in terms of time, the medical group had an average of 2 more visits over 1 year compared with the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean, $17 598; standard deviation [SD], $7624) when compared with the IFNα2b group (mean, $4986; SD, $2040). However, cost between the 2 groups was comparable when calculated on the basis of Medicare allowable charges (surgical group: mean, $3528; SD, $1610; medical group: mean, $2831; SD, $1082; P = 1.00). The highest cost in the surgical group was the excisional biopsy (hospital billing $17 598; Medicare allowable $3528), and the highest cost in the medical group was interferon ($1172 for drops, average 8.0 bottles; $370 for injections, average 5.4 injections). CONCLUSIONS Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. In this article, we consider costs of therapy and found that medical treatment involved two more office visits, whereas surgical treatment could be more or equally costly depending on insurance coverage.
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Affiliation(s)
- Christina S Moon
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Afshan A Nanji
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Miami Veterans Affairs Medical Center, Miami, Florida
| | | | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
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Sarici AM, Arvas S, Pazarli H. Combined excision, cryotherapy, and intraoperative mitomycin C (EXCRIM) for localized intraepithelial and squamous cell carcinoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol 2013; 251:2201-4. [PMID: 23949688 DOI: 10.1007/s00417-013-2437-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To report the results of patients undergoing combined excision, cryotherapy, and intraoperative mitomycin-C (EXCRIM) for primary ocular surface squamous neoplasia (OSSN) METHODS: A retrospective review of a non-comparative interventional case series. Histopathologically confirmed primary localized (less than four clock hours) OSSN treated with EXCRIM using adjuvant 0.02 % mitomycin-C (MMC) were included in the study. The main outcome measures were recurrence and complications related to MMC. RESULTS The study enrolled 28 eyes of 28 patients with OSSN with a median age of 64.5 (range 43 to 84) years. The mean tumor size was 6.9 × 4.35 mm. There was corneal involvement in 23 of 28 (82 %). Seven patients (21 %) had delayed epithelial healing. Two of eight patients (25 %) with squamous cell carcinoma (SCC) had positive lateral margins. There were no recurrences over a mean follow-up of 49 months (range 24 to 96). CONCLUSION The excision of OSSN combined with cryotherapy and intraoperative MMC is effective with a low recurrence rate. Long-term follow-up yielded favorable results.
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Affiliation(s)
- Ahmet M Sarici
- Ophthalmology Department, Istanbul University Cerrahpasa Medical School, Abacımahmut Sokak No:7-9 Daire:6, 34093, Istanbul, Aksaray, Turkey,
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Kashkouli MB, Heirati A, Pakdel F, Kiavash V, Naseripour M, Aghamohammadi F. Long-term follow-up of invasive ocular surface squamous cell carcinoma treated with excision, cryotherapy, and topical mitomycin C. Graefes Arch Clin Exp Ophthalmol 2012; 250:1527-1532. [PMID: 22297537 DOI: 10.1007/s00417-012-1931-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/19/2011] [Accepted: 01/10/2012] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND: To evaluate the efficacy of surgical excision, cryotherapy and topical Mitomycin C (MMC) for ocular surface squamous cell carcinoma (SCC) with at least 24 months follow-up. METHODS: Seventeen patients with primary and recurrent invasive SCC of ocular surface underwent surgical excision and map biopsy of the margins, and double freeze-thaw cryotherapy of the bed and margins. Topical MMC (0.04%, 4 times daily) was commenced 7-10 days after operation. It was delivered in cycles that consisted of medication 4 times daily for 7 consecutive days followed by 7 consecutive days of no medication. Patients with primary SCC received two cycles (protocol 1) and those with recurrent SCC received three cycles (protocol 2). Patients with intra-ocular and or orbital extension or those with less than 24 months of follow-up were excluded. The frequency of tumor recurrence and complications associated with treatment were measured. RESULTS: Mean age was 70.7 years (SD = 10, range: 48-80). Mean follow-up time was 48 months (SD = 21, range: 24-89). There were 12 patients with primary SCC and five with recurrent SCC. Mean largest diameter was 9.7 mm (3-20). Surgical margins were free in 12 cases. One patient with recurrent SCC who received protocol 2 treatment developed recurrence 9 months after excision, and remained free of recurrence 24 months after second treatment. Complications comprised transient mild punctate corneal epithelial erosion (eight), irritation and conjunctival hyperemia (11), corneal scar (six), and scleral thinning (three). All except one responded well to conservative management. One scleral thinning required scleral patch graft 1 year after treatment. CONCLUSION: The combination of surgical excision, cryotherapy, and post-operative topical mitomycin-C was effective treatment for ocular surface invasive SCC in long-term follow-up.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14455-364, Iran,
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Clode AB, Miller C, McMullen RJ, Gilger BC. A retrospective comparison of surgical removal and subsequent CO2 laser ablation versus topical administration of mitomycin C as therapy for equine corneolimbal squamous cell carcinoma. Vet Ophthalmol 2011; 15:254-62. [PMID: 22151345 DOI: 10.1111/j.1463-5224.2011.00982.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the complications and nonrecurrence rate following topical mitomycin C (MMC) therapy vs. CO(2) laser ablation for treating equine corneolimbal squamous cell carcinoma (SCC). STUDY DESIGN Retrospective study. SAMPLE POPULATION Twenty-five horses with corneolimbal SCC. PROCEDURES Medical records of horses undergoing surgical tumor resection followed by either topical MMC therapy (0.04%) or CO(2) laser ablation between the years of 2004 and 2010 were reviewed. Recurrence and complications were compared between groups and within MMC subgroups defined by the time at which treatment was initiated relative to surgery. RESULTS Therapy with topical MMC resulted in a nonrecurrence rate comparable to that achieved with CO(2) laser ablation (82.4% vs. 85.7%, respectively). Initiation of MMC following epithelialization of the surgical site a mean of 15 days postoperatively did not result in increased recurrence rates relative to treatment in the immediate postoperative period. Vision- or globe-threatening complications tended to occur with greater frequency in horses receiving topical MMC in the immediate postoperative period (5 of 6 major complications) relative to following epithelialization of the surgical site (1 of 6 major complications). CONCLUSIONS Horses receiving adjunctive topical MMC therapy were no more likely to experience tumor recurrence than were horses undergoing CO(2) laser ablation in the horses in this study. Initiation of two to three rounds of MMC following epithelialization of the surgical site results in fewer major complications and achieves comparable disease resolution relative to treatment in the immediate postoperative period.
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Affiliation(s)
- Alison B Clode
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC 27607, USA.
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Squamous Neoplasms of the Conjunctiva. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Ocular surface squamous neoplasia (OSSN) in sub-Saharan countries is an aggressive tumor that affects younger patients and appears to be increasing in incidence. There are data to suggest the association of this disease with solar radiation exposure, HIV, and human papilloma virus (HPV). This trend possibly reflects the association of the high incidence of HIV, concomitant high incidence of exposure to HPV, and the solar radiation exposure that people in this region of the world receive. We undertook a PubMed search with the terms 'ocular surface squamous neoplasia', 'conjunctival carcinoma', 'HIV' and 'HPV', and 'sub-Saharan/Africa' to ascertain the scope of the problem and to review the available data, with an emphasis on publications of 2009 and the first quarter of 2010. RECENT FINDINGS There is increasing evidence of a significant association between HIV seropositivity and OSSN. The role of HPV as contributing to the cause of OSSN is being investigated. SUMMARY Patients with conjunctival cancer in sub-Saharan Africa are typically younger and more than 50% have underlying HIV infection. Initial presentation can be asymptomatic; however, many of these patients have advanced disease before they seek medical help and OSSN appears to have a more aggressive clinical course in sub-Saharan Africa. Treatment in Africa is primarily surgical. Chemotherapy and antiviral agents have been used. A diagnosis of OSSN in younger patients in sub-Saharan Africa should prompt HIV serotesting.
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Management of intraepithelial and invasive neoplasia of the cornea and conjunctiva: a long-term follow up. Cornea 2009; 28:986-8. [PMID: 19724215 DOI: 10.1097/ico.0b013e3181a0a23d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this work is to report the long-term results of using immunotherapy for the management of cornea and conjunctiva intraepithelial neoplasia and squamous cell carcinoma after surgical excision of the neoplasm. METHODS Ten eyes of 10 patients with cornea and conjunctiva intraepithelial neoplasia or squamous cell carcinoma had wide surgical excisions of the neoplasm after evaluation of the level of corneal involvement using ultrasound biomicroscopy. All eyes received topical cyclosporine A (0.05%) and topical mitomycin C (0.01%) 4 times daily for 12 weeks after surgery. All eyes were followed up every month for 6 months and then every 6 months for another 18 months. RESULTS All eyes showed total cure with no recurrence during the 2-year follow-up period. Epithelial toxicity (punctate keratopathy) occurred in 3 eyes, ocular irritation and mild conjunctival hyperemia in 5 eyes, and lid toxicity in 2 cases during the treatment with mitomycin C. There were no serious complications that necessitated stopping the treatment. CONCLUSION During a 2-year follow-up period, the use of topical cyclosporine A (0.05%) combined with mitomycin C (0.01%) as an adjunctive treatment after surgical excision in cornea and conjunctiva intraepithelial neoplasia and squamous cell carcinoma was found to prevent tumor recurrence, especially in extensive lesions, when surgical excision cannot ensure a tumor-free margin.
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Acis D, Donnio A, Ayéboua L, Richer R, Guyomarch J, Warter A, Merle H. Carcinome épidermoïde conjonctival. À propos de quatre cas aux Antilles. J Fr Ophtalmol 2008; 31:533.e1-5. [DOI: 10.1016/s0181-5512(08)72472-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Karasawa K, Matsuda H, Tanaka A. Superficial keratectomy and topical mitomycin C as therapy for a corneal squamous cell carcinoma in a dog. J Small Anim Pract 2007; 49:208-10. [PMID: 17725585 DOI: 10.1111/j.1748-5827.2007.00402.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 10-year-old female West Highland white terrier was presented with refractory hyperplastic keratitis of the left cornea of one month's duration. At this time, a vascularised and rough lesion 5 mm in diameter was observed on the left cornea. No other abnormality was recognised on the affected eye. The corneal neoplasm was surgically removed and histologically diagnosed as a squamous cell carcinoma. For two months after the surgery, 0.04 percent mitomycin C (MMC) eye drops were applied as adjuvant chemotherapy. Primary corneal squamous cell carcinoma with no history of keratoconjunctivitis sicca is rare in dogs. In the present report, surgical removal of the neoplasm was combined with the topical administration of the anticancer drug mitomycin C and a good prognosis was obtained. The result indicates that the combination treatment used in this case may be an appropriate therapeutic choice for corneal squamous cell carcinoma in dogs.
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Affiliation(s)
- K Karasawa
- Laboratory of Veterinary Molecular Pathology and Therapeutics, Division of Animal Life Science, Graduate School, Institute of Symbiotic Science and Technology, Tokyo University of Agriculture and Technology, Fuchu, Tokyo 183-8509, Japan
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Gage AA, Baust JG. Cryosurgery for tumors. J Am Coll Surg 2007; 205:342-56. [PMID: 17660083 DOI: 10.1016/j.jamcollsurg.2007.03.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew A Gage
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY, USA
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Ozcan AA, Sizmaz S, Yagmur M. Topical mitomycin C for the treatment of conjunctival tumor. Ophthalmologica 2006; 221:14-7. [PMID: 17183195 DOI: 10.1159/000096516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 04/21/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate the efficacy of topical mitomycin C (MMC) for the treatment of conjunctival tumor in a prospective design. METHODS Nine patients (nine eyes) with conjunctival tumor were studied. The patients received topical MMC 0.04% four times daily by one to six courses. Each course consisted of medication for consecutive 7 days followed by 1 week without medication. Follow-up was conducted on patients for control of disease, and side effects. RESULTS In 7 patients, the tumor completely disappeared during the mean follow-up period of 24.57 +/- 5.94 months (range 18-35 months) with no recurrence. In 1 patient, there was no regression of the tumor, and in 1 patient cessation of the treatment was needed because of an adverse effect of the drug. CONCLUSION Topical MMC is effective for the treatment of conjunctival tumor. Longer follow-up and large series are needed to assess the duration of tumor control.
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Affiliation(s)
- Altan Atakan Ozcan
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey.
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Rayner SG, Van Zyl N. The use of mitomycin C as an adjunctive treatment for equine ocular squamous cell carcinoma. Aust Vet J 2006; 84:43-6. [PMID: 16498834 DOI: 10.1111/j.1751-0813.2006.tb13124.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effectiveness of topical mitomycin C application as an alternative adjunctive therapy to CO2 laser ablation in the treatment of equine ocular squamous cell carcinoma. DESIGN A retrospective clinical study of eight client owned horses in which 10 affected eyes were treated for ocular squamous cell carcinoma over a 17 month period. (March 2003 to August 2004). PROCEDURE Each horse was given a general anaesthetic to allow CO2 laser ablation of the lesion(s). Mitomycin C at a concentration of 0.4 mg/mL was then applied intraoperatively to the affected areas for 1 or 5 minutes. Postoperatively a triple antibiotic eye ointment was applied to the eye twice daily and each horse was treated with systemic non-steroidal anti-inflammatory drugs for 7 days. RESULTS Recurrence following treatment was noted in three eyes. Two of these were retreated and no further signs developed. The remaining eye was enucleated at the request of the owner. Overall 90% of treated eyes appeared free of tumour a minimum of 11 months post treatment. CONCLUSION In this case series mitomycin C appeared to offer a valid alternative to other adjunctive therapies currently employed in the treatment of equine ocular squamous cell carcinoma.
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Affiliation(s)
- S G Rayner
- Oakey Veterinary Hospital, PO Box 2, Oakey, Queensland 4401
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Prabhasawat P, Tarinvorakup P, Tesavibul N, Uiprasertkul M, Kosrirukvongs P, Booranapong W, Srivannaboon S. Topical 0.002% Mitomycin C for the Treatment of Conjunctival-Corneal Intraepithelial Neoplasia and Squamous Cell Carcinoma. Cornea 2005; 24:443-8. [PMID: 15829803 DOI: 10.1097/01.ico.0000148314.86557.6a] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To demonstrate the efficacy of topical 0.002% mitomycin C (MMC) as an adjunctive and alternative treatment in primary and recurrent conjunctival-corneal intraepithelial neoplasia (CCIN) and squamous cell carcinoma (SCC). METHODS The medical records of 7 patients with histopathologically confirmed CCIN and conjunctival SCC were retrospectively reviewed. All cases were treated with topical 0.002% MMC 4 times daily. The tumor size pre- and post-treatment, clinical response, and ocular complications were evaluated. RESULTS The mean age of the patients was 56 +/- 13.4 years. The most common presenting symptom was foreign body sensation (57.1%) with a mean duration of 2.3 +/- 3.8 months. Six patients had pathologically proven CCIN (85.7%) and 1 had SCC (14.3%). Before MMC treatment, 6 eyes (85.7%) had recurrences after surgical excision. The tumor-free period ranged from 2 to 19 months. Two patients had multiple recurrences. MMC 0.002% 4 times daily was applied for a period of 5.4 +/- 4.4 weeks (range, 2-14). All had complete tumor regression as observed clinically and confirmed by impression cytology. Side effects of MMC therapy included ocular irritation, mild conjunctival hyperemia, and punctate keratopathy. There were no serious complications detected. The mean follow-up time was 30.7 +/- 15 months (range, 2-52) with no evidence of clinical recurrence in any case. CONCLUSIONS Topical 0.002% MMC showed a favorable outcome as an adjunctive and alternative treatment of CCIN and SCC with regression of primary and recurrent tumors.
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Affiliation(s)
- Pinnita Prabhasawat
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Abstract
PURPOSE To determine the current standard of care in the treatment of ocular surface squamous neoplasia (OSSN) with particular regard to topical chemotherapeutic agents including mitomycin C, 5-fluorouracil, and interferon-alpha2b. METHODS A mail survey of the 325 physician members of the Ocular Microbiology and Immunology Group. RESULTS The survey response rate was 38%, and the average number or cases of OSSN managed by respondents was 6.5 per year. A majority (54%) believed sufficient evidence existed to justify the use of mitomycin C in the treatment of OSSN, and fewer felt the published literature justified the use of 5-fluorouracil or interferon (11% and 21%, respectively). About one-half of responding physicians always perform a biopsy before institution of topical therapy. The reported use of topical chemotherapy as an adjunct to surgical excision increased with the size of the lesion; 45% of the respondents utilize topical therapy along with surgery for lesions greater than 8 mm in diameter. CONCLUSION The standard of care for the treatment of ocular surface squamous neoplasia appears to have shifted from surgery toward the use of topical chemotherapeutic agents as adjuncts to surgery or even as sole therapy, despite a paucity of long-term studies in the published literature. Longer-term observational studies and prospective masked and controlled studies are indicated to determine the optimal treatment(s) for squamous neoplasia of the ocular surface.
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Affiliation(s)
- Donald U Stone
- Department of Ophthalmology, Molecular Pathogenesis of Eye Infection Research Center, Dean A. McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Chen C, Louis D, Dodd T, Muecke J. Mitomycin C as an adjunct in the treatment of localised ocular surface squamous neoplasia. Br J Ophthalmol 2004; 88:17-8. [PMID: 14693762 PMCID: PMC1771954 DOI: 10.1136/bjo.88.1.17] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- C Chen
- Ophthalmic Oncology Unit, Department of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
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Comment on Intraoperative Use of Mitomycin C in Excision of Ocular Surface Neoplasia With or Without Limbal Autograft Transplantation. Cornea 2002. [DOI: 10.1097/00003226-200211000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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