Elsevier

Ophthalmology

Volume 109, Issue 2, February 2002, Pages 249-252
Ophthalmology

Successful treatment with 5-fluorouracil of conjunctival intraepithelial neoplasia refractive to mitomycin-C1 Historical image

https://doi.org/10.1016/S0161-6420(01)00926-5Get rights and content

Abstract

Purpose

To describe the histopathological findings and successful treatment with 5-fluorouracil (5-FU) of a conjunctival intraepithelial neoplasia with limbal stem cell deficiency that was refractive to topical mitomycin-C (MMC).

Design

Interventional case report.

Intervention

A 64-year-old male patient presented with a diffuse conjunctival intraepithelial neoplasia (CIN) that was excised with concurrent keratoepithelioplasty. Because of a recurrence and the presence of limbal stem cell deficiency, he was placed on topical MMC. Despite two courses of MMC, the tumor size did not decrease, and topical 5-FU was started 1 year after MMC therapy began. Limbal autograft transplantation was performed thereafter.

Main outcome measures

The clinical and histopathologic findings including impression cytology and biomicroscopic observations.

Results

After 5-FU treatment, the patient was free of the tumor clinically and cytologically, and the corneal surface had cleared. No recurrence was observed during the 30 months after the 5-FU therapy. Serious complications have not been observed.

Conclusions

Topical 5-FU may be a therapeutic option for the treatment of patients with MMC-resistant CINs. The success of 5-FU is believed to be the result of a difference in the mechanism of cytotoxicity of MMC and 5-FU or the additive effects of the two agents.

Section snippets

Case report

A 64-year-old-male patient presented with discomfort in his left eye of several years duration. The visual acuity was 20/30 and intraocular pressure was normal in this eye. Slit-lamp examination showed a slightly elevated, gelatinous lesion involving 210° of the limbus in the left eye (Fig 1). A superficial keratopathy was also noted. Impression cytology showed dysplastic epithelial cells and limbal stem cell deficiency. Multiple map biopsies revealed that the tumor had extended to the

Discussion

The primary treatment for CIN is surgical excision because histopathologic documentation of the diagnosis should be made.1, 3 When the tumor is diffuse, as in our patient, the recurrence rate is high.3 Even with negative findings at the excision borders, recurrence may occur.2, 3, 15 When the tumor is large, reconstruction is necessary. Lesions involving more than 50% of the corneal limbus tend to have poor prognosis after excision because of conjunctivalization.1, 16 In our case, limbal

Acknowledgements

The authors thank Professor Yozo Miyake, Department of Ophthalmology, Nagoya University School of Medicine, Japan, for invaluable suggestions during the preparation of the article.

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    The authors have no financial interests in the products or devices mentioned in this article.

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