Vol. 110, No.5 Correspondence 581

by M. E. Migliori and A. M. Putterman (Am. J.Ophthalmol. 110:17, July 1990), the authorsfailed to cite an important reference. Lass andassociates) and Nagashafar and associates!have shown by Southern blot hybridizationthat human papillomavirus DNA can be foundin most conjunctival papillomas. Furthermore,latent viral infection may persist in clinicallynormal epithelium even after complete exci­sion of the papilloma." It is unclear whetheradjuvant cryotherapy would be sufficient toeradicate this latent infection." Although spe­cific antiviral therapy is not yet available, Lassand associates) concluded that systemic inter­feron therapy can be tumor-suppressive. Adju­vant interferon may have been helpful in thetreatment of these patients, particularly thepatient who ultimately required exenterationsof the lacrimal sac and canaliculi.

SIMEON A. LAUER, M.D.Bronx, New York

References

1. Lass, ]. H., Foster, C. 5., Grove, A. 5., Ruben­feld, M., Lusk, R. P., Jenson, A. B., and Lancaster,W. D.: Interferon-alpha therapy of recurrent con­junctival papillomas. Am. J. Ophthalmo!. 103:294,1987.

2. Nagashafar, Z., McDonnell, P. J., McDonnell,J. M., Green, W. R., and Shah, K. V.: Genital tractpapillomavirus type 6 in recurrent conjunctival pap­illoma. Arch. Ophthalmo!. 104:1814, 1986.

3. Ferenczy, A., Mitao, M., Silverstein, S. ]., andCrurn, C. P.: Latent papillomavirus and recurringgenital warts. N. Eng!.]. Med. 313:784, 1985.

_______ Reply _

EDITOR:We agree with Dr. Lauer that cryotherapy

does not always prevent recurrence, as both ofour patients had recurrences after cryotherapy.

We do believe, however, that the rate of recur­rence of conjunctival papillomas is lower whencryotherapy is applied at the time of surgerythan when the lesions are simply excised.

Alpha-interferon has been shown to sup­press the growth of human papillomavirus inconjunctival.t laryngeal,' and cervical papillo­mas." Dosage and duration of therapy are vari­ables that have to be defined, but preliminaryreports are encouraging. Intralesional therapywas used with some success, according to onereport." It is not known if the latent virus canbe eliminated, or how long therapy can orshould be continued. The recurrence rate afterdiscontinuation of therapy also remains to bedetermined. Alpha-interferon therapy mayprove to be useful in recurrent cases of con­junctival papillomas when the tumors involvelarge areas and removal of the entire lesionwould require a major operative procedure.

MICHAEL E. MIGLIORI, M.D.Providence, Rhode Island

ALLEN M. PUTTERMAN, M.D.Chicago, Illinois

References

1. Lass, ]. H., Foster, C. 5., Grove, A. 5., Ruben­feld, M., Lusk, R. P., Jenson, A. B., and Lancaster,W. D.: Interferon-alpha therapy of recurrent con­junctival papillomas. Am. ]. Ophthalmo!. 103:294,1987.

2. Kashima, H., Leventhal, B., Clark, K., Cohen,S.,Dedo, H., Donovan, D., Fearon, B., Gardiner, L.,Goepfert, H., and Lusk, R.: Interferon alpha-n l(Wellferon) in juvenile onset recurrent respiratorypapillomatosis. Results of a randomized study intwelve collaborative institutions. Laryngoscope98:334, 1988.

3. Germano, A., Stellato, G., Lombardo, G., deSimone, A., and Semenza, G.: Intralesional therapyusing recombinant interferon alpha 2B in lesions ofthe uterine cervix caused by human papillomavirus.Minerva Gineco!. 41:277,1989.