Oral Cimetidine Adjuvant Therapy for Recalcitrant, Diffuse Conjunctival Papillomatosis

Far Eastern Memorial Hospital, T’ai-pei, Taipei, Taiwan
Cornea (Impact Factor: 2.04). 08/2006; 25(6):687-90. DOI: 10.1097/01.ico.0000214221.05991.ed
Source: PubMed


To describe a case of recurrent, advanced conjunctival papillomatosis, treated by oral cimetidine (CIM) combined with secondary surgical intervention and an application of intraoperative mitomycin C.
Case report and literature review.
A 9-year-old boy suffered from recurrent, progressive, diffuse multifocal conjunctival papillomatosis over the left upper and lower palpebral and the fornical conjunctiva. He underwent 3 separate surgeries; however, they did not prevent tumor recurrence. The recurrent lesions were more severe and extensive than before the surgeries. To avoid postoperative symblepharon, ankyloblepharon, dry eye, and possible corneal neovascularization after extensive lesion excision, oral CIM at a dosage of 200 mg 4 times daily was administered for 4 months before surgery. A debulking excision of the residual tumor with an intraoperative application of mitomycin C was performed as a secondary therapy after the main mass decreased in size. Postoperative oral CIM was continued for 6 months. The papillomatosis cleared without recurrence or symblepharon, ankyloblepharon, conjunctival scarring, or corneal neovascularization after 4 years of follow-up examinations.
Oral CIM can be used as an initial, nonsurgical strategy for treating cases of massive, recalcitrant conjunctival papillomatosis. If there is tumor shrinkage, surgical debulking with applications of mitomycin C may be sufficient to eliminate any residual tumor tissue without inducing conjunctival scarring or corneal neovascularization.

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    ABSTRACT: Purpose: To report a case of papilloma from the lacrimal canaliculus treated by excision and instillation of mitomycin. Case: A 49-year-old female presented with a tumor in the inner canthus of her left eye since one month before. She had no discharge or ocular pain. Findings: A tumor was present in the inner canthus of the left eye. It simulated a cauliflower and measured 5 mm × 3 mm × 4 mm. The lower punc-tum was dilated. A tumor mass was expressed by applying pressure. Resected tumor was diagnosed with squamous papilloma. The tumor recurred 10 days later and was resected followed by instillation of 0.02% mitomycin. It recurred 2 months later and was resected followed by 0.04% mitomycin. The patient is doing well for 2 years until present. Conclusion: Instillation of mitomycin was apparently effective in preventing recurrence after resection of papilloma of the canaliculus.
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