Journal List > J Korean Ophthalmol Soc > v.57(2) > 1010440

Ahn, Kim, Choung, Hyon, and Khwarg: Clinical Features and Surgical Treatment Outcomes of Conjunctival Squamous Papilloma

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.

REFERENCES

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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).
jkos-57-167f1.tif
Table 1.
Anatomic distribution of conjunctival squamous papilloma
Tumor location No. of cases*
Bulbar conjunctiva 4
Tarsal conjunctiva 9
Forniceal conjunctiva 6
Eyelid margin 6
Punctum or peripunctum 6
Caruncle 8
Medial canthal angle 3

* Permission for counting of repetition.

Table 2.
Quadrantic distribution of conjunctival squamous papilloma
Tumor location No. of cases*
Superior temporal 1
Superior nasal 7
Inferior temporal 11
Inferior nasal 25

* Permission for counting of repetition.

Table 3.
Comparison of clinical features of conjunctival squamous papilloma based on primary and recurred tumor at initial examination
Case Sex Age (years) Laterality No. of papilloma* Quadrantic distribution No. of quadrant which papilloma in* Papilloma features Size of papilloma (mm)§
Male Female Right Left n = 1 n = 2 n ≥ 3 Superotemporal Superonasal Inferotemporal Inferonasal 1 2 3 4 Sessile Pedunclated ≤5 5< and ≤10 10<
Recurred cases (N =9 patients 9 eyes) 5 4 38.44 + 14.10 3 6 3 i 5 1 4 3 5 7 1 0 1 3 6 3 4 2
Primary cases (N = 22 patients 23 eyes) 12 11 40.82 + 19.61 13 10 22 1 0 0 3 8 20 15 8 0 0 6 13 17 2 0

Values are presented as mean ± SD unless otherwise indicated.

* p = 0.001, Fisher's exact test;

Permission for counting of repetition;

Excluded 4 eyes which have no medical records about papilloma features;

§ Excluded 4 eyes which have no medical records about size of papilloma.

Table 4.
Surgical treatment and result of conjunctival squamous papilloma
Surgery and adjuvant therapy No. of cases Total period of F/U (months) No. of recurred cases during F/U period after treatment (n, %)
Excision only 13 3.6 ± 5.8 3 (23.07)
Excision and cryotherapy 15 18.5 ± 36.5 1 (6.67)
Excision, cryotherapy, and IFN-α 3 10 ± 7.9 1 (33.33)
Excision and amniotic membrane transplantation 1 0.5 0
Total 32 11.1 ± 25.9 5

Values are presented as mean ± SD unless otherwise indicated. IFN-α = interferon alfa-2b; F/U = follow up.

Table 5.
Recurred cases after surgical resection with or without adjuvant therapy: further treatments and results
Recurred cases
1 2 3 4 5
Sex/age F/39 M/39 M/44 M/71 M/27
Laterality of eye Left Left Left Right Left
Primary or recurred case on initial visit Recurred case Recurred case Primary case Primary case Secondly recurred case
Main location of tumor Medial canthal angle Inferior fornix, punctum Caruncle Nasal bulbar conjunctiva Upper and lower tarsal conjunctiva, caruncle
Initial treatment Excision only Excision only Excision only Excision and cryotherapy Excision and cryotherapy + IFN-α
First recurrence time after treatment (months) 2 0.1 (3 days) 6 4 9
Treatment after first recurrence Excision only Excision + IFN-α Excision + IFN-α Excision and cryotherapy Excision and cryotherapy + IFN-α
Second recurrence time after second treatment (months) 36 3 - - -
Treatment after second recurrence Excision and cryotherapy + IFN-α Excision + IFN-α - - -
Total period of F/U (months) 180 8 15 128 16
Result on last F/U No recurrence No recurrence No recurrence No recurrence No recurrence

IFN-α = interferon alfa-2b; F/U = follow up.

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