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Topical interferon alpha-2B topic as the first therapeutic option in a clinical case of conjunctival intraepithelial neoplasia
Interferón alfa-2B tópico como primera opción terapéutica en un caso clínico de neoplasia intraepitelial córneo-conjuntival
S. Pagán Carrasco
, D. Arranz Maestro
Corresponding author
Servicio Extremeño de Salud, Unidad de Córnea y Superficie Anterior, Hospital Nuestra Señora de la Montaña, Cáceres, Spain
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Pagán Carrasco, D. Arranz Maestro" "autores" => array:2 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Pagán Carrasco" "email" => array:1 [ 0 => "silviapagan90@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Arranz Maestro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Extremeño de Salud, Unidad de Córnea y Superficie Anterior, Hospital Nuestra Señora de la Montaña, Cáceres, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Interferón alfa-2B tópico como primera opción terapéutica en un caso clínico de neoplasia intraepitelial córneo-conjuntival" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 742 "Ancho" => 990 "Tamanyo" => 82350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy one-week after treatment, showing discrete corneal opacification reduction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Corneal-conjunctival intraepithelial neoplasia (CIN) is one of the most frequent ocular surface tumors, with an incidence of approximately 2 cases per 100,000 inhabitants per year. Clinically, it appears in fair-skin patients between 60 and 70 years of age. It can also appear in immunosuppressed young people and it could be bilateral. CIN is a gelatinous sessile or papillomatous lesion exhibiting a tendency toward diffuse superficial extension, generally in the interpalpebral fissure, that affects the limbus with poorly defined edges and usually extends over the corneal epithelium. The development of CIN has involved the human papilloma virus (even more so in patients with bilateral disease or immunosuppression), the acquired immunodeficiency virus, exposure to sun and environmental factors such as petroleum derivates, industrial oils, tobacco smoking, etc.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The term CIN (<span class="elsevierStyleItalic">conjunctival intraepithelial neoplasia</span>) includes the various degrees of dysplasia (slight, moderate and severe) and in situ carcinoma, which implies that these entities are different levels of development of intraepithelial neoplasia regarded as a pre-cancerous lesion because if the atypical cells break the basal membrane and invade the subconjunctival tissue, the result is invasive conjunctival squamous carcinoma. The risk of developing squamous carcinoma is low, but probably higher than the risk of developing actinic keratosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Due to the lack of precision of its borders and its tendency to diffuse growth, incomplete resection is more likely to occur than in actinic keratosis, giving rise to frequent relapses. Compared to similar lesions in other locations, the course of CIN is relatively benign as it usually remains confined to the epithelium and rarely becomes invasive. The majority of these lesions do not follow the course of a typical malign, invasive and metastatic tumor. The degree of surface extension and recurrences are bigger problems than the potential of systemic extension of this type of tumor. Early diagnostic is important because excisional biopsy with resection margin, with or without adjuvant treatment, is generally a definitive treatment. However, advanced lesions could extend throughout the cornea and large parts of the conjunctiva, making complete extirpation difficult and thus endangering the visual function and requiring complex surgical operations and adjuvant treatments such as topical chemotherapy (mitomycin C, 5-fluorouracil [5-FU], interferon alpha-2b [INFα-2b]).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Interferons are a family of glycoproteins with antitumoral and antiviral properties. INF α-2b has been successfully applied in the treatment of CIN.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">An extended CIN clinic case report is presented below. It was successfully treated with topical INF α-2b to avoid surgical interventions or the use of other chemotherapy agents with the potential sequels this would involve.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinic case report</span><p id="par0030" class="elsevierStylePara elsevierViewall">Male, 71, referred to the Ocular Surface Unit due to the appearance of an elevated neoformation in the left eye (LE) with several months evolution. Relevant personal history includes agricultural work. On the other hand, ophthalmological antecedents include being phakic in both eyes and exhibiting a visual acuity of 1 in the right eye and 0.9 in the LE.</p><p id="par0035" class="elsevierStylePara elsevierViewall">LE biomicroscopic examination revealed a gelatinous lesion with diffuse growth at the superior limbus comprising nearly 270° (from 9 to 5 o’clock), with visual axis involvement in addition to abundant superficial vascular dilatations throughout the entire lesion (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Clinic diagnostic was compatible with extense CIN in LE. It was decided to treat with topical INF α-2b (as compassionate medication) at a dose of one million international units (UI)/milliliter (ml), 4 times a day, in order to diminish lesion size in addition to the use of artificial tears (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">One week later, the first checkup showed corrected visual acuity in LE of 0.7 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 5</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">One month after beginning treatment a second checkup evidenced difficult 1.2 visual acuity in LE as well as significant improvement in biomicroscopy (CIN in regression) (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 6</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Two months after beginning treatment, macroscopically the lesion had disappeared, evidencing only very discreet dotted epithelium defect and tenuous central vascularization. Visual acuity in LE was 1. Accordingly, it was decided to continue with said treatment.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Three months after beginning treatment, it can be said that complete remission has been achieved. It was decided to extend treatment one additional month with the initial pathology.</p><p id="par0065" class="elsevierStylePara elsevierViewall">At present, several months after completing treatment, no signs of relapse have been observed and visual acuity in LE remains at one.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Firstly, it must be mentioned that even though the proposed clinic case report did not carry out anatomopathological studies of the lesion, it is recommendable to carry out these studies for this type of lesion for an adequate differential diagnostic with other tumor lesions. At least it is essential to take an OCT imaging test to verify that the lesion does not invade subconjunctival tissue below and that therefore it is not an invasive conjunctival squamous carcinoma.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> In the present case, invasive conjunctival squamous carcinoma was discarded by means of OCT.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Typical treatment for CIN is surgical extirpation with safety margins. However, this treatment is not always effective as the margins are frequently infiltrated, producing recurrence rates between 8 and 51%.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In an attempt to reduce the number of recurrences, adjuvant topical treatments are utilized such as mitomycin C (MMC) and 5-FU.</p><p id="par0085" class="elsevierStylePara elsevierViewall">However, side effects derived from MMC treatment frequently require termination due to conjunctival hyperemia, epithelium keratopathy, secondary glaucoma, corneal edema, scleromalacia, scleral necrosis or cataracts. Similarly, a range of side effects associated to the administration of 5-FU has been described including conjunctival inflammation, cutaneous erythema and stenosis of the inferior lacrimal tip.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Occasionally, both chemotherapy agents could give rise to severe limbic insufficiency.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> For this reason, therapeutic alternatives are being considered such as the use of topical INF α-2b,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> that achieves a clinic resolution of 100% of lesions in the various series of patients with primary or relapsed CIN within approximately 6 months.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Even in cases of non-invasive squamous cell carcinoma with 360° limbar involvement, the use of topical INF α-2b at a dose of 3 million UI/ml (instead of one million UI/ml) has demonstrated to be safe and effective as it diminishes the risk of limbar insufficiency caused by other therapies.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Interferons are proteins produced by immune cells that confer unspecific resistance against viral infections, cell proliferation and also intervene in the immune system regulation.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The most frequently side effects of systemic treatment with INF α-2b include pseudo-fever, headaches and fatigue, among others. However, these symptoms rarely arise after topical administration (not even after subconjunctival administration).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In some applications, slight side effects have been observed such as conjunctival hyperemia and follicular conjunctivitis, which revert with termination of the treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition to the treatment mentioned above, there are other less relevant topical treatments such as the use of transretinoic acid. Some published studies reported that said medicament promotes the reversion of conjunctival keratinization and the restoration of normal conjunctival goblet cells. However, transretinoic acid is poorly tolerated due to its side effects at the local level, in addition to taking some time to produce effects.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The main disadvantage of topical treatment with INF α-2b is that it requires authorization to be used as compassionate medicament for topical or subconjunctival treatment for CIN.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In the present clinic case report, CIN was diagnosed clinically due to the nearly pathognomic findings it presented, reserving histological confirmation for atypical cases. In addition, on the basis of the excellent results reported with a single topical administration of INF α-2b,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> it was decided to initiate the same treatment, obtaining remission of the lesion at treatment month 3.</p><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand, due to the slow progression of relapsing lesions and their malignization potential, it is necessary to establish a long-term checkup regime because relapses have been reported up to 10 years after surgical extirpation, ranging between 5 and 33% when there is no involvement of the surgical piece and post-surgery adjuvant treatments is associated.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,8,9</span></a> Relapses after topical interferon treatment range in the area of 0–29% after 28 months follow-up according to some series such as those published by Karp.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion, treatment with topical INF α-2b can by itself eradicate neoplasia and avoid surgery as well as the use of other chemotherapy agents.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Even though this article is based on the experience of a single clinic case report and therefore does not enable significant conclusions, other studies published on the same topic with high numbers of study cases, such as those by Schecheter and Karp, found complete resolution after interferon treatment of up to 96.4%.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Accordingly, on the basis of other more relevant studies and with the added absence of severe systemic effect after topical instillation of INF α-2b, it can be inferred that said medicament is among the first options for treatment of CIN, including extended cases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">The present study has no commercial interest and has not received any financial support.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres888083" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec874026" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888082" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec874027" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:2 [ "identificador" => "xack297019" "titulo" => "Acknowledgments" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-13" "fechaAceptado" => "2017-01-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec874026" "palabras" => array:3 [ 0 => "Conjunctival intraepithelial neoplasia" 1 => "Topical interferon α-2b" 2 => "Other topical adjuvant treatments" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec874027" "palabras" => array:3 [ 0 => "Neoplasia intraepitelial córneo-conjuntival" 1 => "Interferón α-2b tópico" 2 => "Otros tratamientos tópicos coadyuvantes" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conjunctival intraepithelial neoplasia is a pre-malignant lesion of the ocular surface. It can be treated with topical interferon alpha-2b (INF α-2b) as first choice.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical case</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 71-year-old man referred for corneal-conjunctival, gelatinous lesion in the left eye (LE) with an area of almost 270°. The clinical diagnosis was compatible with a corneal-conjunctival intraepithelial neoplasia. Topical treatment was started with INF α-2b at a dose of one million international units (IU)/ml, 4 times/day for 4 months, with remission being achieved.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The isolated use of topical INF α-2b is an effective treatment as a first option in the case of corneal-conjunctival intraepithelial neoplasia, positioning itself as a form of effective and safe treatment compared to other therapeutic options. Surgical excision and use of other chemotherapy agents could lead to severe limbic deficits and other side effects.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La neoplasia intraepitelial córneo-conjuntival es una lesión premaligna de la superficie ocular. Puede ser tratada con interferón alfa-2b (INF α-2b) tópico como tratamiento de primera elección.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Varón de 71 años de edad remitido por lesión córneo-conjuntival en ojo izquierdo (OI) de aspecto gelatinoso con una extensión de casi 270° (de las <span class="elsevierStyleSmallCaps">IX</span> a las <span class="elsevierStyleSmallCaps">V</span> h), cuyo diagnóstico clínico era compatible con una neoplasia intraepitelial córneo-conjuntival. Se inició tratamiento tópico con INF α-2b, en dosis de un millón de unidades internacionales (UI)/mililitro (ml), con una posología de 4 veces/día durante 4 meses, con lo que se consiguió su remisión.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusión</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El uso aislado de INF α-2b tópico es un tratamiento efectivo como primera opción en el caso de neoplasia intraepitelial córneo-conjuntival, que se sitúa como una forma de tratamiento eficaz y segura frente a otras opciones terapéuticas como la escisión quirúrgica y frente al empleo de otros agentes quimioterápicos que pueden condicionar insuficiencias límbicas severas, entre otros efectos secundarios.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pagán Carrasco S, Arranz Maestro D. Interferón alfa-2B tópico como primera opción terapéutica en un caso clínico de neoplasia intraepitelial córneo-conjuntival. Arch Soc Esp Oftalmol. 2017;92:442–446.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Partially presented as an ocular surface panel at the 92nd Congress of the Ophthalmology Society of Spain, Spain.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 740 "Ancho" => 990 "Tamanyo" => 104912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy of clinic case report at diagnostic: corneal-conjunctival gelatinous lesion between 11 and 5 o’clock.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 742 "Ancho" => 990 "Tamanyo" => 77909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The same case of <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> with greater magnification.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figs. 3 and 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:2 [ 0 => array:1 [ "imagen" => "gr3.jpeg" ] 1 => array:1 [ "imagen" => "gr4.jpeg" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy at treatment baseline, showing 360° superficial corneal neovascularization and epithelial defect secondary to limbar insufficiency.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 742 "Ancho" => 990 "Tamanyo" => 82350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy one-week after treatment, showing discrete corneal opacification reduction.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 742 "Ancho" => 990 "Tamanyo" => 75602 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Lesion after one month of treatment with INF alfa-2b, showing CIN in regression, disappearance of corneal epithelial growth, persistent temporal conjunctival lesion and superior and temporal tenuous perilimbic vascularization. Complete resolution will become macroscopically apparent as from the second month.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumores de la conjuntiva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Saornil" 1 => "E. Becerra" 2 => "M.C. Méndez" 3 => "G. Blanco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2009" "volumen" => "84" "paginaInicial" => "7" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19173134" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferón alfa-2b tópico como primera opción en las neoplasias intraepiteliales corneoconjuntivales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Pérez de Arcelus" 1 => "M. Aranguren" 2 => "J. Andonegui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "2012" "volumen" => "35" "paginaInicial" => "137" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22552136" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Número 12" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferón tópico como tratamiento único en un caso de neoplasia córneo. Conjuntival severa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Díaz" 1 => "J.M. del Castillo" 2 => "T. Díaz" 3 => "Y. Poza" 4 => "A. Arteaga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2005" "volumen" => "8" "paginaInicial" => "0" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Topical interferón alpha-2b for treatment of noninvasive ocular surface squamous neoplasia with 360° limbar involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Zarei-Ghanavati" 1 => "R. Alizadeh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2008-322X.150811" "Revista" => array:6 [ "tituloSerie" => "J Ophthalmic Vis Res" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "423" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25709765" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Empleo de interferón alfa-2b para el tratamiento de carcinomas conjuntivales intraepiteliales en casos de recurrencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Toledano" 1 => "S. García" 2 => "D. Día" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2003" "volumen" => "78" "paginaInicial" => "265" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12789630" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of conjunctival and corneal intraepithelial neoplasia using ultra high-resolution optical coherence tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Shousha" 1 => "C.L. Karp" 2 => "V.L. Perez" 3 => "R. Hoffmann" 4 => "R. Ventura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2011.01.005" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2011" "volumen" => "118" "paginaInicial" => "1531" "paginaFinal" => "1537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21507486" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Vetrugno" 1 => "A. Maino" 2 => "G. Cardia" 3 => "G.M. Quaranta" 4 => "L. Cardia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2001" "volumen" => "85" "paginaInicial" => "537" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11316710" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late recurrences and the necessity for long-term follow-up in corneal and conjunctival intraepithelial neoplasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Tabin" 1 => "S. Levin" 2 => "G. Snibson" 3 => "M. Laughnan" 4 => "H. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "1997" "volumen" => "104" "paginaInicial" => "485" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9082277" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subconjunctival/perilesional recombinant interferon alpha2b for ocular surface squamous neoplasia: a 10-year review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.L. Karp" 1 => "A. Galor" 2 => "S. Chhabra" 3 => "S.D. Barnes" 4 => "E.C. Alfonso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2010.03.052" "Revista" => array:5 [ "tituloSerie" => "Ophthalmology" "fecha" => "2010" "volumen" => "117" "paginaInicial" => "2241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20619462" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term follow-up of conjunctival and corneal intraepithelial neoplasia treated with topical interferon alfa-2b" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Schechter" 1 => "F. Koreishi" 2 => "L. Karp" 3 => "W. Feuer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2007.10.039" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2008" "volumen" => "115" "paginaInicial" => "1291" "paginaFinal" => "1296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18187195" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack297019" "titulo" => "Acknowledgments" "texto" => "<p id="par0140" class="elsevierStylePara elsevierViewall">The authors wish to acknowledge all the members of the Ophthalmology Dept. of the Nuestra Señora de la Montaña hospital of Cáceres, Spain.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300798/v2_201708291316/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000009/v2_201708291316/S2173579417300798/v2_201708291316/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300798?idApp=UINPBA00004N" ]
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