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Correction of literature review with tittle
Comparison of Surgical excision and Mitomycin C
of Ocular Surface Squamous Neoplasia cases :
1. Page 7 (line 1) : Tweleve studies published between 2000 and
2008.
Should be : Seven studies published between 2002 and 2008.
2. Page 7 (table III.1 ):
Shoud be :
4 Starges A,et all,
2007
III/Retrospe
ctive
SE + AMG
+ Interferon
29 12
months
4 Starges A,et all,
2007
III/Retrospe
ctive
SE + AMG
+
Interferon
29 2 months
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3. Page 7 (line 9) : Mean of follow up time were 2 months 50
months.
Should be : Mean of follow up time were 3 months 50 months
4. Page 9 (line 3) : tire current rateme
Should be : of recurrence rate.
5. Page 13 (line 5-7) :Based on journals in this literary review, thefollow-up time in OSSN treatment reported in all studies ranged
from 2 months until 50 months. The minimal follow-up time on
both procedures was 2 months (Shields CL, et all)
Should be : Based on journals in this literary review, the follow-
up time in OSSN treatment reported in all studies ranged from 3months until 50 months. The minimal follow-up time on both
procedures was 3 months (Rahimi F, et /ll)
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COMPARISON
OF SURGERY AND MITOMYCIN C TREATMENT
OF OCULAR SURFACE SQUAMOUS NEOPLASIA CASES
LITERATURE REVIEW
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CHAPTER IINTRODUCTION
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BACKGROUND
Ocular surface squamous neoplasia
(OSSN)
slowly progressing cancerous lesion
of the ocular surface caused by
a neoplastic proliferation of dysplasticsquamous epithelium
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OSSNmost common
conjunctiva malignancyin the United States
the third most commonocular tumor after
melanoma andlymphoma in the older
population
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Differentialdiagnosis
pannus, actinic disease, pinguecula, pterygium,benign intraepithelial dyskeratosis,
keratinization of the corneal epithelium,anterior basement membrane dystrophy,
malignant melanoma, conjunctival papillomata, nevi,and pseudoepitheliomatous hyperplasia.
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Treatment of choice : Surgical excision (SE) +
cryotherapy.
Reported recurrence rates after surgical treatment
are significant
Various topical agents advocate :
Mitomycin C (Mit C), 5-fluorouracil, and interferonalfa-2b
>> Mit C
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PROBLEM
Tabin et al : RR 11.5 years after primary treatment.
Frucht-Pery and Rozenman : RR by Mit C : 35%.
Hirst, L.W. : RR after SE: >50%.
(?) efficacy and safety the treatment of OSSN
SEMit C
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PURPOSE
To compare the efficacy and safety resultof SE and Mit C treatment
in OSSN
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CHAPTER IIMATERIAL AND METHODS
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Internet browsing Highwire & PUBMED (2002 2008)
Keywords : OSSN, SE & Mit C.
The inclusion criteria :
Minimum follow-up six weeks
OSSN treatment with SE + AMG and Mit C.
I/ : typically elevated lesion, involve the limbus,
gelatinous, papilliform or leukoplakic, with tufts of
blood vessels
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Efficacy : primary & secondary outcomemeasure
The primary outcome : complete clinical resolution
slit-lamp biomicroscopy
The secondary outcome : recurrance rate pathologyreports
Safety : complication during the study.
Most study : follicular conjunctivitis, corneal ephitelial
and eyelid skin erythema
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OCULAR SURFACE SQUAMOUSOCULAR SURFACE SQUAMOUS
NEOPLASIANEOPLASIA
OSSN : simple dysplasia carcinoma in situ invasive
squamous cell carcinoma involving conjunctiva & cornea
Histopathologically : features of overgrowth of conjunctival
epithelium with neovascularization, disruption of the basement
membrane and inflammatory cell infiltrates
Pizzarello , et al have described the macroscopic appearanceas being either gelatinous, velvety or papilliform or leukoplakic
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Retrobulbar anesthesia lesions wereremoved by superficial keratectomy (3-4mm tumor-free margin at the corneal andconjunctival side)
The corneal epithelium 2 mm anterior tothe tumor is treated with absolute alcohol
The AMG was sutured to the adjacentconjunctiva and episcleral tissue usinginterrupted 10-0 nylon sutures with thebasement membrane side facing up
SURGICAL
EXCISION
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Is an antibiotic isolated fromStreptomyces caespitosis
inhibits the synthesis of RNA,DNA, and protein
damages cells by cross linkingDNA and has significant anti-tumor activity
MYTOMCIN CMYTOMCIN C
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Mitomycin C 0.04% prepared by :Mitomycin powder content of a 2-mg +5 ml artificial tears
Put into sterile eye drop bottles shakenfor several times apply four times a day(seven days) followed by more sevendays put in refrigerator.
Close the eye (5) after using the drop close the punctum by finger pressure (1).
MYTOMCIN CMYTOMCIN C
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CAPTER IIIRESULT
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No Author RatingLevel/design Procedure Number of
eyes
Follow-up
(/mean/average/
range)
1 Hirst L. W., 2007 I/Prospective Mit-C 26 6-12 months
2 Rahimi F, et all,2008
III/Retrospective Mit-C 17 3 months
3 Masoomeh E,et
all, 2008
III/Retrospective Mit-C 17 4-36 months
4 Starges A,et all,
2007
III/Retrospective SE + AMG +
Interferon
29 12 months
5 Chen C,et all,
2004
III/Retrospective Mit C 27 27 months
6 Yeh LK et all,
2003
III/Retrospective SE + AMG + Cryo 5 27 months
7 Shields CL, et
all, 2002
III/Retrospective Mit-C 10 6-50 months
Table III.1 Characteristics of Journal articles
collected
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Table III.2 Complete resolution ofOSSN(Primary Outcome)
No Author, year Procedure No of eyes Resolutions
(mean/average)1 Hirst L. W., 2007 Mit C 26 2 months
2 Rahimi F, et all,2008
Mit C 17 2.5-41 months
3 Masoomeh E,et all,
2008
Mit C 17 2-16 months
4 Starges A,et all,
2007
SE + AMG +
Interferon
14 2 months
5 Chen C,et all, 2004 Mit C 27 NA6 Yeh LK et all, 2003 SE + AMG + Cryo 5 NA
7 Shields CL, et all,
2002
Mit C 10 NA
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Tabel III.3Recurrence rate of Mit C and SE.
(Secondary Outcome)
No Author, year Procedure Noumber
of eyes
Recurrence
rate
1 Hirst L. W., 2007 Mit C 26 NA
2 Rahimi F, et all,
2008
Mit C 17 5%
3 Masoomeh E,et all,
2008
Mit C 17 NA
4. Starges A,et all,
2007
SE + AMG +
interferon
14 0%
5 Chen C,et all, 2004 Mit C 27 0%
6 Yeh LK et all, 2003 SE + AMG + Cryo 5 0%
7 Shields CL, et all,
2002
Mit C 10 0%
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Table III.4 Complication of Mit C and SE
No Author, year Procedure Number of
eyes
Granuloma Red eye Chemosis
1 Hirst L. W., 2007 Mit C 26 NA 100% NA
2 Rahimi F, et all,
2008
Mit C 17 NA NA NA
3 Masoomeh E,et
all, 2008
Mit C 17 NA 24% 24%
4 Starges A,et all,
2007SE + AMG
+ Interferon
14 NA NA NA
5 Chen C,et all,
2004
Mit C 27 19% NA NA
6 Yeh LK et all,
2003
SE + AMG
+ Cryo
5 NA 40% NA
7 Shields CL, et all,
2002
Mit C 10 NA NA NA
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CHAPTER IVDISCUSSION
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Mit C has been used over many years in studies of
small numbers of patients with OSSN.
It also has been used in conjunction with surgery and
interferon and by direct application.
Mit C eye drop 0.04% has shown good clinical
results and no serious side effects when used as
alternate seven-day courses.
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Standard treatment for OSSN traditionally : surgical
excision + cryotherapy recurrence rates are high
(5% - 56%) depending on surgical approach, status
of surgical margins, and length of follow-up
Positive margins in pathology specimens indicative
of incomplete excision the most important predictor
of recurrence
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Promotes epithelialization and restores ocular surface
integrity without inflammation or scarring.
Contains protease inhibitors reduce inflammation-
associated proteolytic activity after application. Prevent subsequent conjunctival ingrowth and corneal
vascularization.
Excellent cosmetic outcome and a normal conjunctival
epithelial phenotype as demonstrated by impressioncytology
AMG
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Mit C Recurrence rate :
Frucht-Pery and Rozenman : no recurrence
Shield et al : no recurrence
Mit C related side effects :
conjunctival erythema,
chemosis
punctate epithelial keratopathy.
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Systemic side effects of Mit C : bone marrow suppression
profound leucopenia, thrombocytopenia
gastrointestinal toxicity
dermatitis
alopecia
fever, malaise, and
cardiotoxicity
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In these study
successfully controlled the tumors only 5%recurrence
related side effects : red eye, granuloma,
chemosis
long-term side effects : not defined
Summary : Mit C to be effective treatment forextensive and recurrent OSSN with minimal
ocular toxicity
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SE Recurrence Rate : 5% to 56% depending on surgical approach.
Akpek E.K. et al : 50%.
Chen C, et al : no recurrences.
Lynn B. McMahan (1994): 33% - 56%
Hirst, L.W. (2007) : 50%.
Tabin et al : 11.5 years after primary treatment
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SE related side effects :
Secondary tissue granulation
Pseudopterygium
Symblepharon Diplopia from tissue foreshortening
Blepharoptosis
SE sistemic side efects : -
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In these study
All cases had good results with no specialcomplications
Limited short-term complications :
redness and chemosis
Complete epithelialization occurred within2 months
(mean following-up period of 27 months)
No recurrence was note
The cosmetic outcome was good
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CHAPTER V
CONCLUSION & SUGGESTION
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CONCLUSION
Mitomycin C drop as safe and effective assurgical excision combined with AMG and cryoor interferon alfa 2b seems for OSSNtreatment
SUGGESTION
Larger population + longer follow-up periods to further assessing the risk of recurrence andother possible side effects.
Combining surgical excision and Mit C :alternative method
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