1/38. Combined intraepithelial squamous neoplasia and atypical fibroxanthoma of the cornea and limbus.PURPOSE: To investigate a case of an unusual neoplasm of the cornea and limbus. methods: A 59-year-old man presented with a highly vascularized, nodular mass involving the left cornea and limbus. An excisional biopsy and, subsequently, a superficial lamellar keratectomy and multiple conjunctival biopsies were performed. At the 6-month follow-up examination, repeat conjunctival biopsies were performed. RESULTS: Histopathologic examination of the corneal specimen showed a high-grade intraepithelial squamous neoplasia (in situ carcinoma) overlying an atypical fibroxanthoma. CONCLUSION: We report the clinical and histologic appearance of a corneal/limbal neoplasm consisting of an intraepithelial squamous neoplasia and an atypical fibroxanthoma.- - - - - - - - - - ranking = 1keywords = intraepithelial, neoplasia (Clic here for more details about this article) |
2/38. 5-fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea.OBJECTIVE: To evaluate the efficacy of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of conjunctival and corneal intraepithelial neoplasia. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Seven patients with histologic evidence of intraepithelial neoplasia were identified by conjunctival biopsy or tumor excision. methods: Seven patients with a minimum of 7 months of follow-up were treated with pulsed dosing of 1% 5-FU. Topical 1% 5-FU was administered four times daily for 2 to 4 days for each cycle. The number of initial treatment cycles was two to six, with the time between cycles being 30 to 45 days. MAIN OUTCOME MEASURES: The presence or absence of clinically evident intraepithelial neoplasia was evaluated after each treatment interval. patients were also monitored for adverse reactions to the use of topical 5-FU. RESULTS: Four patients remain disease free with a mean follow-up of 18.5 months (range, 7-36 months) with no additional treatment after the initial treatment cycles (mean, 3.75 cycles; range, 2-5 cycles). Three patients had recurrence of disease after the initial treatment cycles. Two patients were treated with additional cycles for recurrent disease (six cycles in one patient and five cycles in the other patient) and are free of disease at 20 and 21 months after treatment, respectively. One patient had persistent disease despite treatment with topical 5-FU and was treated with topical mitomycin C with resolution of the disease without recurrence for 16.5 months. No adverse reactions to pulse dose treatment with topical 5-FU were noted. CONCLUSIONS: Pulsed dosing with 1% topical 5-FU for the treatment of conjunctival and corneal intraepithelial neoplasia, alone or as an adjunct to excision of bulky disease, is a well-tolerated and effective method of treatment.- - - - - - - - - - ranking = 3.0517770427656keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
3/38. Treatment of conjunctival and corneal intraepithelial neoplasia with topical interferon alpha-2b.OBJECTIVE: To evaluate the role of topical interferon alfa-2b (IFNalpha2b) in the treatment of conjunctival and corneal intraepithelial neoplasia (CIN). DESIGN: Noncomparative case series. PARTICIPANTS: Five patients with histologically proven CIN or recurrences of proven CIN were studied prospectively. INTERVENTION: After histologic confirmation, patients were given topical recombinant IFNalpha2b (INTRON A, Schering Plough, Kenilworth, NJ) 1 million IU/ml four times a day. patients were continued on interferon until complete resolution of the tumor had occurred. MAIN OUTCOME MEASURES: patients were followed clinically and photographically for evidence of tumor resolution. RESULTS: All patients had complete resolution of the CIN lesion on IFNalpha2b. The mean time to clinical resolution was 11.6 weeks (range, 4-22 weeks). The mean follow-up was 17.6 months (range, 7-28 months). One patient had a clinical recurrence of his corneal CIN 1 year after tumor resolution. This patient was retreated, resulting in clinical resolution within 6 weeks, and has been tumor free for 8 months of follow-up.- - - - - - - - - - ranking = 1.9073606517285keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
4/38. Typical ocular findings in a patient with multiple endocrine neoplasia type 2b syndrome.BACKGROUND: Multiple endocrine neoplasia (MEN) type 2b syndrome is accompanied by typical ocular findings; however, the disease is often only diagnosed at an advanced stage by symptoms of C-cell carcinoma or pheochromocytoma and is then fatal in most cases. Therefore, the importance of ophthalmic assessment in making the diagnosis has to be stressed. methods: The history and ocular findings of a patient with MEN 2b syndrome are described, and a brief overview of the syndrome is given. RESULTS: Slit-lamp examination showed extremely thickened corneal nerves as well as multiple small plexiform and nodular subconjunctival tumors. Both eyes also displayed thickened upper and lower eyelids. A molecular genetic study of the RET proto-oncogene showed a heterozygous ATG to ACG mutation in codon 918 of exon 16. CONCLUSION: Greatly thickened corneal nerves and subconjunctival tumors may be the first hint of MEN 2b. Whenever greatly thickened corneal nerves are detected, MEN 2b must be ruled out.- - - - - - - - - - ranking = 0.025309840985399keywords = neoplasia (Clic here for more details about this article) |
5/38. Regression of presumed primary conjunctival and corneal intraepithelial neoplasia with topical interferon alpha-2b.PURPOSE: To evaluate topical interferon alpha-2b (IFNalpha2b) as a lone therapy in the treatment of primary conjunctival and corneal intraepithelial neoplasia (CIN). methods: Noncomparative, prospective, interventional case series. Seven patients from three institutions, treated between February and October 1999, with presumed primary CIN lesions (clinically diagnosed by corneal specialists) were given topical IFNalpha2b drops (1 million units/mL) four to six times daily. Follow-up was performed biweekly until there was complete clinical resolution of the presumed CIN lesions. patients were to continue topical IFNalpha2b drops for 1 month after clinical resolution. Patient charts and clinical photographs were reviewed, and data were analyzed. RESULTS: All seven eyes had complete resolution of the presumed CIN lesions after an average of 77.0 /- 59.2 days (range, 28-188 days). Average posttreatment follow up was 12.4 /- 2.5 months (range, 9-16 months). No patients were lost to follow-up. No recurrences have yet been seen. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in four (57.1%) eyes. In all cases, there was total resolution of conjunctival hyperemia and follicular changes within 1 month after cessation of the medication, without additional treatment. CONCLUSIONS: Topical IFNalpha2b alone may be an effective treatment of primary CIN. It appears to be a safe alternative to radiation, intralesional IFNalpha2b injection, and surgical excision with cryotherapy. Larger population studies with longer follow-up are recommended to better assess the risk of recurrence and other possible adverse effects.- - - - - - - - - - ranking = 1.9073606517285keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
6/38. mitomycin C therapy for conjunctival-corneal intraepithelial neoplasia.PURPOSE: To evaluate the efficacy and safety of topical mitomycin C (MMC) for conjunctival-corneal intraepithelial neoplasia (CCIN). methods: One patient with primary CCIN received seven applications for 3 minutes of mitomycin C 0.02%, for 2 weeks, on alternative days. The size of the CCIN before and after the treatment and ophthalmic mitomycin C related complications were evaluated. RESULTS: The lesion started to regress during the second month after the last application of mitomycin C, and by the third month it disappeared completely. The patient remains disease free after 36 months follow up. The complications of mitomycin C included a mild tearing and a slight conjunctival hyperemia that resolved 7 days after the end of the therapy. CONCLUSION: Multiple applications of mitomycin C could be an effective treatment for selected cases of CCIN.- - - - - - - - - - ranking = 1.9073606517285keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
7/38. Amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem cell deficiency.PURPOSE: To evaluate the outcomes of corneal surface reconstruction with conjunctival limbal autograft when combined with amniotic membrane transplantation on both the donor and recipient eyes. DESIGN: Retrospective, noncomparative, interventional small case series. PARTICIPANTS: Five eyes of five patients with total limbal stem cell deficiency (LSCD) resulting from pseudopemphigoid (n = 1), chemical burns (n = 3), and extensive removal of conjunctival intraepithelial neoplasia (n = 1) were operated on by one surgeon (SCGT). INTERVENTION: After the removal of fibrovascular pannus from the corneal surface, two conjunctival limbal free grafts were harvested from the fellow eyes in all five patients with unilateral LSCD. Amniotic membrane, with the basement membrane side up, was grafted onto the defect created at the donor site and onto the recipient corneal and limbal sclera before placement of conjunctival limbal grafts. MAIN OUTCOME MEASURES: Symptomatic relief, improvement in visual acuity, fornix deepening, and rapid healing and restoration of normal cornea and limbus in the recipient and donor eyes were assessed. RESULTS: During the mean follow-up of 22 months (range, 11-48 months), all eyes experienced symptomatic relief. All recipient eyes had a mean improvement in visual acuity of nine lines (range, 7-12). The three eyes with stromal vascularization showed regression, and all recipient eyes had marked improvement in corneal clarity. Three eyes receiving simultaneous symblepharon lysis and fornix reconstruction successfully regained deep, stable fornices. The donor eyes showed rapid healing and restoration of the normal limbal landmark, even in one eye where nearly the entire limbus was removed. CONCLUSIONS: Limbal conjunctival transplantation is an effective procedure for restoring the corneal surface integrity in eyes with total LSCD. The additional use of amniotic membrane may contribute to a higher rate of success in the recipient eye and a lower rate of complications in the donor eye, as well as allow the simultaneous correction of concomitant cicatricial abnormalities.- - - - - - - - - - ranking = 0.38147213034569keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
8/38. A case of conjunctiva-cornea intraepithelial neoplasia successfully treated with topical mitomycin C and interferon alfa-2b in cycles.PURPOSE: To report a case of conjunctiva-cornea intraepithelial neoplasia (CCIN) treated with topical mitomycin C (MMC) and interferon alfa-2b in cycles. methods: A 52-year-old woman referred for limbal stem cell deficiency and epithelial defect was found instead to have CCIN. The diagnosis was confirmed by impression cytology and treated in cycles with topical 0.02% MMC for 14 days in the first cycle, 12 days in the second cycle, and 3 days in the third cycle followed by topical interferon alfa-2b 1 x 106 U/mL for 11 days. RESULT: Topical MMC for 2.5 cycles resulted in 95% reduction of CCIN and improvement of 2 lines of vision. Because of intolerance to MMC, she was switched to topical interferon alfa-2b for 11 days, resulting in total resolution of CCIN, which lasted for at least 10 months. CONCLUSIONS: After differentiation from a persistent corneal epithelial defect and limbal stem cell deficiency by dye staining and impression cytology, the patient in this case of CCIN was successfully treated with topical MMC and interferon alfa-2b in cycles.- - - - - - - - - - ranking = 1.9073606517285keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
9/38. Limbal stem cell deficiency following topical mitomycin C treatment of conjunctival-corneal intraepithelial neoplasia.PURPOSE: To report a case of conjunctival-corneal intraepithelial neoplasia (CCIN) in an elderly African American patient treated with topical mitomycin C and the subsequent complication of limbal stem cell deficiency. DESIGN: Interventional case report. methods: A 92-year-old African American woman was diagnosed with CCIN in the right eye. Following incisional biopsy, the patient received five 1-week courses of 0.04% mitomycin C and was followed over a period of 10 months. RESULTS: The CCIN regressed completely following mitomycin C therapy. Three months later, the patient developed recurrent nonhealing epithelial defects in the right cornea. CONCLUSIONS: Conjunctival-corneal intraepithelial neoplasia may occur in the African American population. Although MMC is effective in eradicating CCIN, a limbal stem cell deficiency may complicate the treatment.- - - - - - - - - - ranking = 2.2888327820742keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
10/38. Treatment of recurrent corneal and conjunctival intraepithelial neoplasia with topical interferon alfa 2b.OBJECTIVE: To evaluate topical interferon alfa 2b (IFNalpha2b) as a single therapeutic agent in the treatment of presumed recurrent corneal and conjunctival intraepithelial neoplasia. DESIGN: Noncomparative, retrospective case series. PARTICIPANTS: Seven consecutive patients with recurrent corneal and conjunctival intraepithelial neoplasia diagnosed at the University of minnesota from July 2000 to November 2003 were studied retrospectively. All patients had a history of histologically proven primary corneal and conjunctival intraepithelial neoplasia and were treated by surgery, cryotherapy, radiation, and/or topical mitomycin C before recurrence. INTERVENTION: patients with a clinical diagnosis of recurrent corneal and conjunctival intraepithelial neoplasia were treated with recombinant topical IFNalpha2b drops (1 million IU/ml) 4 times daily until lesion resolution was noted. MAIN OUTCOME MEASURES: A review of medical records was performed to assess the duration of and response to treatment with topical IFNalpha2b, defined by clinical resolution of corneal and conjunctival intraepithelial neoplasia. RESULTS: The average age of the 7 patients at the initiation of topical IFNalpha2b treatment for presumed recurrent corneal and conjunctival intraepithelial neoplasia was 68.7 years (range, 54-88). Six of 7 patients had successful treatment of recurrent corneal and conjunctival intraepithelial neoplasia lesions with topical IFNalpha2b treatment. The average length of IFNalpha2b treatment to resolution of recurrent corneal and conjunctival intraepithelial neoplasia was 14.5 weeks (range, 5-24). After treatment with topical IFNalpha2b for recurrent corneal and conjunctival intraepithelial neoplasia, 2 patients had another recurrence of corneal and conjunctival intraepithelial neoplasia, noted at 1 year and 2 months, respectively. The average post-treatment follow-up was 11.7 months (range, 8-17) after the resolution of recurrent corneal and conjunctival intraepithelial neoplasia. No side effects of treatment were noted in any patient. CONCLUSIONS: Topical IFNalpha2b as a single therapeutic agent is an effective treatment of presumed recurrent corneal and conjunctival intraepithelial neoplasia. It offers the benefits of topical therapy and avoids the risks of surgical or other interventions-specifically, ocular surface toxicity, cicatricial conjunctival changes, and limbal stem cell deficiency. Larger controlled studies with longer follow-up periods are recommended to confirm the long-term efficacy and safety of this topical treatment.- - - - - - - - - - ranking = 6.1035540855311keywords = intraepithelial neoplasia, intraepithelial, neoplasia (Clic here for more details about this article) |
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