Brownstein S, Jakobiec F A, Wilkinson R D, Lombardo J, Jackson W B
Arch Ophthalmol. 1981 Jul;99(7):1224-31. doi: 10.1001/archopht.1981.03930020098009.
Two patients with progressive, diffuse precancerous melanosis (intraepithelial atypical melanocytic hyperplasia or melanocytic dysplasia) of the conjunctiva were treated with cryotherapy. In one patient, the contiguous cutaneous portions of both eyelids were involved and received the same therapy; the extensive disease of the patient was managed by two cryotherapy sessions during a period of 21/2 months. The melanocytic process in both patients showed a good response to this therapy, which resulted in a slough of the superficial conjunctiva with reepithelialization from adjacent areas. Neither patients has shown recurrent disease in more than seven months of follow-up, although one patient had incomplete regression of the melanocytic condition in the perilimbal region, which was subsequently treated by an excisional biopsy. Serious complications occurred in one patient who had corneal and lenticular opacities; this patient had severe extensive disease for which exenteration was considered the only feasible alternative therapy to control the melanocytic proliferation disorder adequately. Less severe complications also developed, including trichiasis, ptosis, transient hypotony, and macular edema. In this article, we discuss the clinical and histologic features of acquired pigmentations of the conjunctiva, the criteria for their management, and the approaches to minimize the complications that we have encountered with cryotherapy.
两名患有进行性、弥漫性结膜癌前黑素沉着症（上皮内非典型黑素细胞增生或黑素细胞发育异常）的患者接受了冷冻治疗。其中一名患者双侧眼睑的相邻皮肤部分也受到累及，并接受了相同的治疗；该患者的广泛性疾病在2个半月的时间里通过两次冷冻治疗得以控制。两名患者的黑素细胞病变对此治疗均显示出良好反应，表现为浅表结膜脱落，邻近区域重新上皮化。在超过七个月的随访中，两名患者均未出现疾病复发，尽管其中一名患者角膜缘区域的黑素细胞病变未完全消退，随后接受了切除活检。一名患者出现了角膜和晶状体混浊等严重并发症；该患者病情严重且广泛，眼球摘除术被认为是充分控制黑素细胞增殖性疾病的唯一可行替代疗法。还出现了不太严重的并发症，包括倒睫、上睑下垂、短暂性低眼压和黄斑水肿。在本文中，我们讨论了结膜后天性色素沉着的临床和组织学特征、治疗标准以及将冷冻治疗中遇到的并发症降至最低的方法。
