Topical mitomycin C chemotherapy in the management of ocular surface neoplasia: a 10-year review of treatment outcomes and complications

Abstract

IntroductionThe use of topical mitomycin C (MMC) has gained popularity in the management of ocular surface neoplasia. The aim of this study is to determine outcomes and complications following such treatment. Methods This study is a retrospective review of patients treated with topical MMC for ocular surface neoplasia, including primary acquired melanosis (PAM), melanoma, cornealeconjunctival intraepithelial neoplasia (CCIN), squamous cell carcinoma (SCC) and sebaceous gland carcinoma (SGC). Data regarding diagnosis, short-and long-term outcomes, and short-and long-term complications, were recorded. Results 58 patients were identified, with a mean age of 63 years and mean follow-up of 36 months. 21 received MMC as primary therapy and 37 as surgical adjuvant. The regimen was 0.04% MMC four times a day for 3 weeks on, 3 weeks off, 3 weeks on, with topical steroid and lubricants throughout. Initial clinical response was either partial or complete in 93%. Overall, 26% developed recurrent disease at a mean of 13 months post treatment. Recurrence rates by pathology were 20% PAM, 25% melanoma, 0% CCIN, 67% SCC and 57% SGC. Short-term complications occurred in 52%, but only 7% required treatment cessation. Long-term complications such as persisting keratoconjunctivitis, epiphora and corneal problems, occurred in 31%. Conclusion The results confirm the effectiveness of topical MMC chemotherapy in the management of ocular surface neoplasia. Self-limiting short-term complications were common; however, limbal stem cell deficiency appears to be a significant long-term complication of treatment, occurring in 12%.

Meibomian gland loss due to trabeculectomy

“…In addition, in our study, doctors used MMC for the trabeculectomy. MMC is an antimetabolite commonly used to treat cancers, including eyelid sebaceous carcinoma originating from the meibomian glands, and it has a very strong efficacy in suppressing cell cleavage [31][32][33]. It is possible that a portion of the MMC applied during the surgery may have adversely affected the meibomian glands.…”

Local and Regional Spread of Primary Conjunctival Squamous Cell Carcinoma

“…16 Adjunctive treatments, cryotherapy and chemotherapeutics, including mitomycin C, 5-fluorouracil and recombinant interferon a2b, are also often employed especially with larger, more aggressive neoplasms. [17][18][19][20][21][22][23][24][25][26] In addition, radiotherapy has been described for recalcitrant SCC of the conjunctiva and cornea. 27 Limited data exist to compare therapeutic modalities and their combinations because studies are often retrospective in nature with limited follow-up and inadequate sample sizes.…”

Modern management of ocular surface squamous neoplasia

“…Conjunctival hyperemia, allergic conjunctivitis [41], ectropion [42], uveitis [42], photophobia, blepharospasm [32], superficial punctate epithelial erosions with stinging sensation (Figure 4), punctal stenosis [43] and limbal stem cell deficiency may occur, especially with higher doses/increased cycles of treatment. Stopping topical MMC or applying it in alternate weeks with the use of a topical steroid during the off-period is preferred due to increased patient comfort and compliance [38].…”

“…This leads to an increase in the duration of exposure of the affected tissue to MMC and a reduction of MMC absorption by the nasal mucosa. Russell et al, however, argue that exposure of the lacrimal system to MMC is important in reducing the likelihood of tumor recurrence at this site [42].…”