Effective Management Of Recurrent Conjunctival Intraepithelial Neoplasia Using Topical Mitomycin C 0.02%

To evaluate the effectiveness and safety of topical Mitomycin C (MMC) 0.02% as a non-surgical treatment for recurrent conjunctival intraepithelial neoplasia (CIN) and assess its role in tumor regression.

This study aims to contribute to the growing evidence supporting MMC 0.02% as a viable alternative to surgical excision.

This study was conducted at Prince Mohammed Bin Abdulaziz Hospital, Second Health Cluster, Riyadh, Saudi Arabia

A 63-year-old Egyptian male was referred for a comprehensive eye exam due to a recurrent mass causing irritation in his right eye. His vision remained stable, with uncorrected visual acuity of 20/20 in both eyes. Examination revealed a 6x7 mm raised, vascularized, irregular gelatinous mass on the nasal conjunctiva of the right eye, extending from the caruncle to the limbus and approximately 2 mm onto the cornea. The posterior segment was unremarkable. The mass had gradually increased over the past five years.

The patient had undergone a similar mass excision at the same site 10 years earlier in Egypt, which was histopathologically diagnosed as Conjunctival Intraepithelial Neoplasia (CIN).

Due to the recurrence and clinical presentation, treatment with topical Mitomycin C (MMC) 0.02% was initiated using a regimen of one drop four times daily for one week on, one week off, one week on, and one week off. Lubricating eye drops were prescribed throughout. Weekly clinical assessments showed mild transient side effects, including conjunctival injection and tearing. After four weeks, significant clinical regression was noted.

A second course of MMC 0.02% was prescribed for two weeks (one drop four times daily for four days on, three days off, four days on, and three days off). By the one-week follow-up, the mass had almost fully resolved, and upon completion of treatment, it had fully regressed. Two weeks after treatment cessation, only scarring remained in the previously affected area.

This case highlights the efficacy of topical MMC 0.02% in treating recurrent CIN. The patient achieved complete lesion regression with no significant side effects, demonstrating MMC 0.02% as a valuable treatment option for managing recurrent ocular surface neoplasia.