Assessment of corneal endothelial cell changes caused by mitomycin-C application during pterygium surgery

Abstract

Background Topical Mitomycin-C (MMC) can have a deleterious effect onto corneal endothelium in some ophthalmic surgeries. Aim To evaluate safety of intraoperative topical MMC in pterygium surgeries onto corneal endothelium. Design Prospective comparative cohort study. Subjects and methods Forty-six patients were included in this study. Twenty-three patients underwent pterygium surgery with intraoperative MMC application (trial group) and equal number of patients underwent pterygium excision without MMC (control group) at the Suez Canal University Hospital. Corneal endothelial images were acquired with a specular microscope before surgery and at one week, one month, and three months following surgery. Results Mean preoperative endothelial cell counts were 2364±220 cells/mm2 in the pterygium excision without MMC group and 2411±227 cells/mm2 in the pterygium excision with MMC group (P=0.7). One week, one month and three months after surgery, the pterygium with MMC group showed a statistically insignificant endothelial cell loss (P=0.06) whereas the other group didn’t encounter any decrease in ECD (P=0.349), similar insignificant changes were found between the different measurements in the follow-up periods as compared to the preoperative measurements of central corneal thickness (CCT), cellular hexagonality, coefficient of variation and standard deviation of cell area as well as between patients of both groups. Conclusions A single intraoperative 0.02% MMC topical application using MMC solution-moistened cellulose sponges, onto the scleral bed under the conjunctiva with care not to touch the cornea has not resulted in a statistically-significant deleterious effect onto corneal endothelium.