Long-Term Outcomes after Cryotherapy for Conjunctival Mucosa-Associated Lymphoid Tissue Lymphomas

Si Eun Lee; Keun Hae Kim

doi:10.3341/jkos.2015.56.11.1653

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Lee and Kim: Long-Term Outcomes after Cryotherapy for Conjunctival Mucosa-Associated Lymphoid Tissue Lymphomas

Original Article

J Korean Ophthalmol Soc 2015;56(11):1653-1660.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1653

Long-Term Outcomes after Cryotherapy for Conjunctival Mucosa-Associated Lymphoid Tissue Lymphomas

Si Eun Lee, M.D, Keun Hae Kim, M.D, PhD

Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea

Address reprint requests to Keun Hae Kim, MD, PhD Department of Ophthalmology, Daegu Catholic University Hospital, #33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: 82-53-650-4148, Fax: 82-53-623-7507 E-mail: kimkh@cu.ac.kr

Received 22 May 201515 June 2015 Accepted 4 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate long-term outcomes after cryotherapy for conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas.

Methods

We retrospectively analyzed 11 eyes of 8 patients who underwent cryotherapy with a confirmed histopathological di-agnosis of conjunctival MALT lymphoma between January 2006 and December 2010 and were followed up for at least a year.

Results

The mean patient age was 36.8 years and the average follow-up was 4.1 years. Complete remission was achieved in 3 patients (4 eyes) and recurrence occurred in 5 patients (7 eyes) after the first cryotherapy. After the third cryotherapy, complete remission was achieved in 2 patients (2 eyes) and recurrence occurred in 3 patients (5 eyes). Therefore, 3 patients (5 eyes) un-derwent radiotherapy and finally achieved complete remission. After cryotherapy, significant complications were not observed except mild symblepharon in 4 patients (6 eyes).

Conclusions

Cryotherapy, although having a higher recurrence rate than radiotherapy, is a simple treatment modality with fewer complications for patients. In the conjunctival MALT lymphoma patients who cannot undergo radiotherapy, cryotherapy should be considered as an alternative treatment modality.

Keywords: Conjunctiva, Cryotherapy, Mucosa-associated lymphoid tissue (MALT) lymphoma

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Figure 1.

Carbon dioxide cryotherapy with cryoprobe. Treating the conjunctiva until the ice ball becomes 1.5 times the diame-ter of the cryoprobe.

Figure 2.

Case 2. (A, B) The left eye shows salmon-patched lesion at the lower forniceal and upper bulbar conjunctiva. (C, D) The left eye shows the regression of conjunctival MALT lymphoma and mild symblepharon 13 months after third cryotherapy. MALT = mucosa-associated lymphoid tissue.

Figure 3.

Case 3. (A) The left eye shows pinkish bulging mass at the lower fornix. (B) Photograph a week after mass excision. (C) The left eye shows the regression of conjunctival MALT lymphoma 12 months after cryotherapy. MALT = mucosa-associated lym-phoid tissue.

Figure 4.

Case 6. (A, B) The left eye shows salmon patch appearance at the lower forniceal and upper bulbar conjunctiva and caruncle. (C, D) The left eye shows the regression of conjunctival MALT lymphoma 15 months after cryotherapy. MALT = muco-sa-associated lymphoid tissue.

Figure 5.

Case 8. (A) The left eye shows salmon-patched lesion at the lower forniceal conjunctiva and caruncle. (B) The left eye shows recurred lesion 7 months after cryotherapy.

Table 1.

Demographics and clinical characteristics of patients

Case	Sex/age	Laterality	Sx/duration (months)	Sites	Frequency of cryotherapy	Follow-up (years)	Final response	Cx	Radiation
1	F/28	OU	Conjunctival swelling/3	Both inferior fornix and left superior fornix	3	4.2	NR	Mild symblepharon	+
2	F/23	OS	Foreign body sensation/1	Inferior fornix, caruncle, superior bulbar conjunctiva	3	3	CR	Mild symblepharon	-
3	M/54	OS	Lower lid swelling/36	Inferior fornix	1	1	CR	-	-
4	F/23	OU	Discharge and foreign body sense/1	Both inferior fornix and right superior fornix	1	8	CR	-	-
5	F/41	OU	Ocular discomfort/2	Both inferior and superior fornix, both caruncles	3	7	NR	Mild symblepharon	+
6	F/37	OS	Epiphora/3	Inferior fornix and superior bulbar conjunctiva, caruncle	3	5	CR	-	-
7	F/62	OS	Foreign body sensation/2	Inferior fornix and caruncle	1	1.1	CR	-	-
8	F/26	OS	Conjunctival mass/24	Inferior fornix and superior bulbar conjunctiva, caruncle	3	3.5	NR	Mild symblepharon	+

Sx = symptoms; Cx = complications; F = female; M = male; OU = oculus uterque; OS = oculus sinister; NR = no remissio complete remission.

on; CR =

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