J Korean Ophthalmol Soc.  2016 Feb;57(2):167-173. 10.3341/jkos.2016.57.2.167.

Clinical Features and Surgical Treatment Outcomes of Conjunctival Squamous Papilloma

• Ahn CJ
• Kim NJ
• Choung HK
• Hyon JY
• Khwarg SI

• KMID: 2213654
• DOI: http://doi.org/10.3341/jkos.2016.57.2.167

Abstract

PURPOSE
To investigate the clinical features, surgical treatments, and their outcomes in conjunctival squamous papilloma.
METHODS
A retrospective chart review was conducted on 31 patients with 32 eyes that were treated for conjunctival papilloma from October 2000 to February 2015 in Seoul National University Hospital and Seoul National University Bundang Hospital.
RESULTS
Among the 31 patients, 9 patients had papilloma which recurred after previous surgical excision at another hospital. Twenty-five eyes had one papilloma lesion, 2 eyes had 2 lesions, and 5 eyes had more than 3 lesions. The most affected location of papilloma was the tarsal conjunctiva. The recurrent group displayed a tendency to have multiple lesions. Surgical excision without any adjuvant therapy was performed in 13 eyes; surgical excision and cryotherapy in 15 eyes; surgical excision, cryotherapy, and topical interferon alfa-2b in 3 eyes; and surgical excision and amniotic membrane transplantation in 1 eye. The mean postoperative follow up period was 11.1 months. There were 5 cases of recurrence and the mean time of recurrence after surgical excision was 4.22 months (range, 3 days to 9 months). Among 5 cases of recurrence, 3 cases were after surgical excision only, 1 case was after surgical excision and cryotherapy, and 1 case was after surgical excision, cryotherapy, and topical interferon alfa-2b. These 5 recurred cases were retreated with surgical excision and cryotherapy, surgical excision and topical interferon alfa-2b, or surgical excision, cryotherapy, and topical interferon alfa-2b.
CONCLUSIONS
Conjunctival squamous papilloma is likely to recur even though the tumor is completely removed. Therefore, long-term postoperative follow up may be necessary for recurrence.

Keyword

Conjunctival papilloma; Conjunctival squamous papilloma; Cryotherapy; Interferon alfa-2b; Surgical excision

MeSH Terms

Amnion
Conjunctiva
Cryotherapy
Follow-Up Studies
Humans
Interferons
Papilloma*
Recurrence
Retrospective Studies
Seoul
Interferons

Figure

• 

  Figure 1. Conjunctival squamous papilloma before and after treatment. 27-year-old man (recurred case 5 on Table 5) visited our clinic because of 2 times' recurrence of conjunctival squamous papilloma after surgical excision over 2 years. (A) Multiple confluent papilloma are observed in the caruncle, inferior fornix, inferior bulbar and tarsal conjunctiva of left lower lid on the first examination. (B) The photography taken at 2 month after surgery. Conjunctival squamous papilloma resolved completely after treatment with excision and cryotherapy and interferon alfa-2b for 2 months. (C, D) The photography taken at 9 months after surgery. There was recurrence of conjunctival squamous papilloma at medial tarsal conjunctiva of left upper lid (arrow in C), and lateral tarsal conjunctiva of left lower lid (arrow in D).

Reference

1). Yuen HK, Yeung EF, Chan NR, et al. The use of postoperative topical mitomycin C in the treatment of recurrent conjunctival papilloma. Cornea. 2002; 21:838–9.

2). Harkey ME, Metz HS. Cryotherapy of conjunctival papillomata. Am J Ophthalmol. 1968; 66:872–4.

3). Schachat A, Iliff WJ, Kashima HK. Carbon dioxide laser therapy of recurrent squamous papilloma of the conjunctiva. Ophthalmic Surg. 1982; 13:916–8.

4). Bosniak SL, Novick NL, Sachs ME. Treatment of recurrent squamous papillomata of the conjunctiva by carbon dioxide laser vaporization. Ophthalmology. 1986; 93:1078–82.

5). Petrelli R, Cotlier E, Robins S, Stoessel K. Dinitrochlorobenzene immunotherapy of recurrent squamous papilloma of the conjunctiva. Ophthalmology. 1981; 88:1221–5.

6). Hawkins AS, Yu J, Hamming NA, Rubenstein JB. Treatment of recurrent conjunctival papillomatosis with mitomycin C. Am J Ophthalmol. 1999; 128:638–40.

7). Hwang JH, Shin KH, Lee SK, et al. Treatment of recurrent conjunctival papilloma with topical mitomycin C. J Korean Ophthalmol Soc. 2012; 53:1889–92.

8). Kim JY, Kim YD. The effect of topical interferon alpha-2b in the treatment of conjunctival squamous papilloma. J Korean Ophthalmol Soc. 2006; 47:1729–34.

9). Kaliki S, Arepalli S, Shields CL, et al. Conjunctival papilloma: features and outcomes based on age at initial examination. JAMA Ophthalmol. 2013; 131:585–93.

10). Morgenstern KE, Givan J, Wiley LA. Long-term administration of topical interferon alfa-2beta in the treatment of conjunctival squamous papilloma. Arch Ophthalmol. 2003; 121:1052–3.

11). Schechter BA, Rand WJ, Velazquez GE, et al. Treatment of conjunctival papilloma with topical interferon Alfa-2b. Am J Ophthalmol. 2002; 134:268–70.

12). de Keizer RJ, de Wolff-Rouendaal D. Topical alpha-interferon in recurrent conjunctival papilloma. Acta Ophthalmol Scand. 2003; 81:193–6.

13). Sjö N, Heegaard S, Prause JU. Conjunctival papilloma. A histopathologically based retrospective study. Acta Ophthalmol Scand. 2000; 78:663–6.