Case #15: Topical Interferon for Squamous Conjunctival Neoplasia

By Paul T. Finger, MD

History

There was keratinization of the overlying corneal epithelium
There was keratinization of the overlying corneal epithelium, corneal neovascularization, and punctate keratopathy (arrow).

A 71-year-old white female presented with a growth which appeared on her left eye 3 months prior to examination. Slit lamp examination revealed a gray, gelatinous, slightly elevated neovascular mass measuring 2.4 x 3.6 mm at the limbus centered in the 8 o’clock meridian.

An exfoliative biopsy was performed and a plug was placed in the lower punctum. Histopathology confirmed the diagnosis of CIN (corneal and conjunctival intraepithelial neoplasia).

The known risks and potential benefits of topical Interferon Alfa-2b (IFNa2b) and traditional forms of treatment (including but not limited to surgical excision and cryotherapy) were extensively discussed. After informed consent was obtained, treatment was given with topical IFNa2b (Schering Plough, Kenilworth, NJ).

Case #15 Three Month Follow-up Photograph
Three Month Follow-up Photograph – Dose Given = 1 million units/cc, 1 drop, four times daily. She was followed biweekly and by the 3-month follow-up, the lesion had completely resolved. At 15 months of follow-up, there has been no recurrence.

Treatment of CIN has traditionally involved wide excision of the tumor with application of cryotherapy, topical Mitomycin-C, or radiation.

At The New York Eye Cancer Center, currently almost all patients with squamous conjunctival neoplasia can be treated without surgery, using topical chemotherapy eye drops. Depending on the type of chemotherapy eye drops, there may be local side effects (conjunctival hyperemia, follicular conjunctivitis) which generally resolve within 1 month of therapy.

This patient has done well, with no apparent side effects. It is my impression that topical interferon should the primary treatment for most cases of ocular surface squamous carcinoma and moderate to severe dysplasia.

Impression:

Topical Interferon Chemotherapy for Squamous Conjunctival Intraepithelial Neoplasia

References

  1. Schechter BA, Schrier A, Nagler RS, Smith EF, Velazquez GE. Regression of Primary Conjunctival and Corneal Intraepithelial Neoplasia with Topical Interferon Alfa-2b. Cornea 2002; 21(1):6-11.
  2. Wilson MW, Czechonska G, Finger PT, Rausen A, Hooper ME, Haik BG. Chemotherapy for eye cancer. Survey of Ophthalmology 45(5):416-444, 2001.

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