The Efficacy and Safety of Topical Mitomycin C for Conjunctival-Corneal Intraepithelial Neoplasia

M. Iqbal Sofyan, Nila F. Moeloek, Rossalyn Sandra Andrisa, Neni Anggraeni

Department of Ophthalmology, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta 2010

Background: One of treatments for conjunctival-corneal intraepithelial neoplasia (CCIN) is topical mitomycin C (MMC). Despite potential adverse effect of mitomycin C as topical drugs, the positive results of treatment were seen in many patients.

Objectives: To evaluate the efficacy and safety topical MMC for CCIN.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library), and MEDLINE (January 1950 to February 2010).

Study eligibility criteria and participants: We included all randomized controlled trials and nonrandomized studies studying the administration of topical MMC for CCIN patients. Patients of any age with CCIN (mild, moderate, severe dysplasia and carcinoma-in-situ) were considered.
Data collection and analysis: One review author (MIS) assessed trial quality and extracted the data, then the second review author (NFM) checked the results.

Results: Twenty-six studies (198 subjects received topical MMC) are included. In one randomized controlled trial 24/26 (92%) subjects had complete resolution in MMC group, whereas in placebo group complete resolution was 0%. The similar results of efficacy showed by analyzing nonrandomized studies which reported 158/172 (91.8%) subjects had complete resolution, 5/172 (2.9%) had incomplete resolution, 7/172 (4.1%) had recurrence, and 2/172 (1.2%) failed. As high as 52% of subjects received topical MMC for CCIN had some degree of adverse events.

Authors' conclusion: Topical MMC seems has high efficacy for primary and recurrent conjunctival CCIN. However, we found high proportion of subjects' experienced adverse events, and most of them were considered as mild, tolerable, and reversible adverse events.