Topical mitomycin chemotherapy for malignant conjunctival and corneal neoplasia

Over the past 14 years, topical mitomycin chemotherapy (TMC) has come to be commonly and widely used for the treatment of malignant conjunctival and corneal neoplasia. Reported methods of clinical application have varied by drug concentration (for example, 0.02% and 0.04%) as well as the number and spacing of weekly cycles. Despite these differences, no patient has been reported to lose an eye or experience a catastrophic side effect. In fact, all reported side effects are preferable to what would be expected with alternative treatments (extensive local surgery ith global cryotherapy, external beam irradiation, or orbital exenteration surgery). Though there is no substitute for invention with subsequent evolution of clinical practice patterns, advances in new treatments (for example, TMC) could also be facilitated by the widespread adoption of standardised methods of tumour grad-ing and treatment. Such "staging systems" would allow multiple centres to compare and pool their results for multivariate analysis. Particularly necessary in the study of rare diseases, multicentre international cooperation would facilitate evaluations of both treatment efficacy and side effects. Khong and Muecke should be complimented for reporting the first large scale survey of ocular complications related to TMC in treatment of malignant conjunctival neoplasia. This study is clearly the largest retrospective, single centre evaluation of ocular complications related to TMC for malignant conjunctival neoplasia. They found allergic reaction and punctal stenosis to be the significant side effects. However, only two cases had persistent epiphora attributed to more distal obstruction of the nasolacrimal apparatus. The lack of clinically evident limbal stem cell deficiency, corneal or scleromalacia, uveitis, cataract, or glaucoma clearly supports the continued use and investigation of topical mitomycin chemotherapy for malignant conjunctival neoplasia.