Management Of Conjunctival Intraepithelial Neoplasia With Cyclosporine A And Mitomycin C Combination: A Case Series

We present the clinical features and treatment results of four cases of conjunctival intraepithelial neoplasia surgically and medically treated at our clinic.

We conducted the study at the Mugla Sitki Kocman University Hospital, Türkiye. 

This was a prospective case series of four patients histologically diagnosed with conjunctival intraepithelial neoplasia. We collected data regarding the size and characteristics of the tumor, clinical and histological diagnoses, and prognosis.

We diagnosed four cases of conjunctival intraepithelial neoplasia during the study period. The median age of the patients was 77 years (range: 58-84 years). All four of them were male. The widest diameter of the tumors ranged from 2.5 mm to 10 mm (mean = 4.9 mm). The mean tumor thickness was 3,75 mm (range = 2-7 mm). All four patients in this series received the same surgical and medical treatment. We preferred the "no-touch technique" for surgical excision. Amniotic membrane transplantation was used to stabilize the excised area with the fibrin glue (Tisseel). Postoperatively, patients were treated with topical Cyclosporine A (CsA) and topical Mitomycin C (MMC). There were no recurrences after 18 months of follow-up.

The combination of topical CsA (0.05%) and topical MMC (0.01%) prevented tumor recurrence and resulted in excellent healing of the ocular surface as an additional treatment after surgical resection. The "no touch technique" prevented the seeding of tumor cells. Amniotic membrane transplantation should be preferred for patients with large scarring, symblepharon, or the possibility of future glaucoma surgery. It has been shown that applying adjuvant treatment in combination with total surgical excision and wide-area cryotherapy results in a lower recurrence rate in diffuse tumors with corneal involvement.