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AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C

PURPOSE: To evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT). SUBJECTS AND METHODS: A p...

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Autores principales: Elhamaky, Tarek Roshdy, Elbarky, Ahmed Mohammed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877399/
https://www.ncbi.nlm.nih.gov/pubmed/31819351
http://dx.doi.org/10.2147/OPTH.S229399
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author Elhamaky, Tarek Roshdy
Elbarky, Ahmed Mohammed
author_facet Elhamaky, Tarek Roshdy
Elbarky, Ahmed Mohammed
author_sort Elhamaky, Tarek Roshdy
collection PubMed
description PURPOSE: To evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT). SUBJECTS AND METHODS: A prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results. RESULTS: The study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm(2)) was significantly lower than in no MMC group (92.4±17.3 mm(2)). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. CONCLUSION: The treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.
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spelling pubmed-68773992019-12-09 AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C Elhamaky, Tarek Roshdy Elbarky, Ahmed Mohammed Clin Ophthalmol Original Research PURPOSE: To evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT). SUBJECTS AND METHODS: A prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results. RESULTS: The study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm(2)) was significantly lower than in no MMC group (92.4±17.3 mm(2)). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. CONCLUSION: The treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort. Dove 2019-11-20 /pmc/articles/PMC6877399/ /pubmed/31819351 http://dx.doi.org/10.2147/OPTH.S229399 Text en © 2019 Elhamaky and Elbarky. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Elhamaky, Tarek Roshdy
Elbarky, Ahmed Mohammed
AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title_full AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title_fullStr AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title_full_unstemmed AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title_short AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C
title_sort as-oct guided treatment of diffuse conjunctival squamous cell carcinoma with resection, amniotic membrane graft and topical mitomycin c
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877399/
https://www.ncbi.nlm.nih.gov/pubmed/31819351
http://dx.doi.org/10.2147/OPTH.S229399
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