Mitomycin C Application Research Articles

Safety and Efficacy of Mitomycin C: Augmented Trabeculectomy: Subtenon's Injection versus Sponge Application.

The objective of the study was to study the safety and efficacy of subtenon injection of mitomycin C (MMC) versus sponge application of MMC during trabeculectomy. Thirty-seven patients having primary glaucoma warranting trabeculectomy were enrolled in the study and their forty eyes were alternately allocated into either of the two groups: subtenon injection (ST) of 0.1 mL of 0.01% of MMC or sponge application (SP) of 0.02% of MMC and were operated by a single surgeon and followed for 3 months. The outcome was analyzed primarily based on reduction in intraocular pressure (IOP) and bleb morphology. Similar outcome in terms of complete success (ST - 90% and SP - 85%), qualified success (ST - 5% and SP - 5%), and failure rate (ST - 5% and SP - 10%) was seen at the end of 3 months. The absolute reduction in IOP from the baseline was -10.00 ± 3.67 mmHg (-41.2% ± 12.30) in ST versus -8.90 ± 5.56 mmHg (-35.9% ± 16.1) in the SP group at the end of 3 months. At the end of 3 months, blebs in the ST group had low-to-medium height and in the SP group had low height. Blebs in both the groups were diffuse with mild vascularity. Antiglaucoma medications required postoperatively were 0.20 ± 0.62 versus 0.40 ± 1.10 in the ST and SP group, respectively. The duration of surgery was 19.85 ± 0.75 min in the ST group versus 22.50 ± 0.51 min in the SP group. Subtenon injection of MMC is as efficacious and safe as the conventional sponge application technique.

Early topical mitomycin-C prevents stricture formation in children with caustic ingestion.

Stricture formation is the most common remote complication of caustic ingestion. The aim of this study was evaluation of the efficacy of early topical endoscopic application of mitomycin C (MMC) in prevention of stricture formation after corrosive ingestion in children. We enrolled 78 children with a history of caustic ingestion within 48 h in a prospective, randomised-controlled study. Only 61 children completed the study and were classified into two groups: group A and B. After initial stabilisation, patients in group A (n = 30) received topical application of MMC within the initial 48 h while patients in group B (n = 31) only received conventional management. Follow-up endoscopic dilatation was done every 2 weeks to patients in either group until no need for further dilatation. The barium study, which was done on the third week, revealed that all the patients (100%) on conservative management (group B) had strictures while only nine patients (30%) in group A had strictures (P < 0.001). The median number of dilatations required for patients in group B was 26 (min. = 23 and max. = 32) while in group A, it was 0 (min. = 0 and max. = 7) (P < 0.001). The success of early MMC application was complete response in 26 patients (86.7%), partial response in 3 patients (10%) and no response in 1 patient (3.3%). On the other side, conventional therapy with endoscopic dilatation achieved complete response in 11 patients (35.5%). Early topical MMC application proved its efficacy and safety in prevention of scar and stricture formation in children following caustic ingestion.

A Modified Approach for Preventing Anterior Glottic Web Formation Using Mitomycin C in Bilateral Vocal Fold Lesions.

Objectives: Laryngeal keel insertion, mucosal suture, application of mitomycin-C (MMC), and staged operations are approaches to prevent the anterior glottic web, but there are limitations. Our study suggests a modified approach to prevent the formation of an anterior glottic web. Methods: This retrospective single-institution tertiary center study (N = 23) involved the simultaneous removal of bilateral vocal fold lesions with topical MMC application. If exudate was identified after 4 to 6 weeks, second laryngomicroscopic surgery (LMS) was performed to remove it with topical MMC application. Extent of anterior glottic web was measured as a percentage of the total length of the membranous vocal fold. Results: After the initial surgery, 18 patients recovered without anterior web or fibrin exudate. Thick exudate was observed in 5 patients. After the second LMS, all patients showed improvement and did not develop anterior web. Conclusion: This modified method has been developed to prevent the anterior glottic web without complications.

The effect of adjuvant Mitomycin C during vitrectomy on functional and anatomical outcomes in patients with severe diabetic tractional retinal detachment.

To evaluate the effect of adjuvant Mitomycin C (MMC) use on the anatomical and functional success of vitreoretinal surgery (VRS) in severe diabetic tractional retinal detachment (dTRD) patients. A retrospective analysis of consecutive patients undergoing VRS due to severe dTRD was conducted. Patients were categorized into those who received 20µg/0.1mL MMC via MMC sandwich method (Group 1) and those who did not (Group 2). Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analyzed. A total of 25 eyes were included, 13 in Group 1 and 12 in Group 2. No statistical difference was observed in baseline characteristics between the groups. The mean best-corrected visual acuity was 1.90 ± 0.43 logMAR and 1.93 ± 0.41 logMAR preoperatively and 1.60 ± 0.78 logMAR and 1.56 ± 0.78 logMAR postoperatively in Groups 1 and 2, respectively (p = 0.154). The postoperative mean intraocular pressure was 16.23 ± 2.55mmHg and 13.08 ± 4.94mmHg in Groups 1 and 2, respectively (p = 0.225). The rate of re-surgery was significantly lower in Group 1 (0% vs. 41.7% in Group 2, p = 0.015). Retina was attached in all patients at the last visit. No MMC-related complication was recorded. Intraoperative adjuvant MMC application for severe dTRD significantly reduces re-surgery rates with good anatomical and functional outcomes safely.

Conjunctival Autograft with Mitomycin C (MMC) in Primary Pterygium Excision

Purpose: To evaluate role of conjunctival Autograft (CAG) with Mitomycin C (MMC) in primary pterygium excision. Place and Duration of Study: Mughal eye hospital Lahore from 2020 to 2022. Methods: Patients with primary pterygium were operated. Pterygium excision was followed by Mitomycin C (MMC) 0.02% application for 2 minutes under the conjunctiva at base of the pterygium and this was followed by CAG. Patients were followed up at 1 week, 1 month and 2 months to see recurrence and any side effects of MMC. Google sheets were used for recording data of pterygia. Results: A total of 385 eyes of 316 patients with primary pterygium were included in the study. There were 209 males and 107 females. Mean age was 35 years (range 26 to 58 years). Follow up ranged from one month to 2 months. Four eyes (1%) had recurrence. It was noted that blood vessels of recurrent pterygium grew above or below the conjunctival graft on the side which was short. No complication of MMC was observed. There were 2 cases of graft dehiscence due to early breakdown of sutures. Conclusion: Recurrence after pterygium excision can be reduced to minimum by application of MMC with CAG and it is a safe procedure. Recurrence mostly encroaches on the cornea from above or below the conjunctival graft. A large conjunctival graft is thus necessary to cover the pterygium area and prevent recurrence. MMC is safe. Suturing the conjunctival graft provides minimum chances of graft loss.

Use of Mitomycin-C in Laryngotracheal Stenosis: A Focused Clinical Review.

Therapeutic options for managing laryngotracheal stenosis (LTS) are limited. Endoscopy is a minimally invasive approach to treating LTS, but carries a high risk of stenosis recurrence. Mitomycin C (MMC) is often used as an adjunct therapy to delay the time to symptomatic recurrence of LTS. This review synthesizes the current literature on the topic of MMC as an adjunct treatment strategy for LTS. A focused literature search was carried out from PubMed on June 12, 2022 using the terms "mitomycin c AND stenosis" in all fields with no date limitations. Evidence-based recommendations relevant to the clinical application of MMC as an adjunct therapy for LTS were formulated. Three questions were addressed: 1) efficacy of MMC, 2) single versus multiple application(s) of MMC, and 3) safety of MMC. The evidence rating and recommendation strength were guided by the GRADE system. Twenty-nine studies were reviewed. The efficacy of MMC as an adjunct therapy for LTS varied across studies. Randomized controlled trials have not shown an outcome difference with MMC use, although methodologic flaws including underpowering were noted. A meta-analysis of observational studies with a comparator arm found the unadjusted probability of remaining symptom-free for >1 year is greater with versus without MMC application (73% vs. 35%). Single versus multiple application(s) of MMC resulted in similar restenosis rates at long-term follow-up. Complications related to MMC use are rarely reported using conventional doses (0.4mg/mL). Overall, the quality of evidence was low and the recommendation for intervention was weak. The role for MMC as an adjunct therapy in LTS is uncertain. While safe in its application, the efficacy of MMC in reducing stenosis recurrence remains a matter of debate. Large, prospective studies are needed to inform future recommendations.

Comparison of the outcome of 0.02% mitomycine C versus limbal conjunctival autograft after primary pterygium excision.

Objective: is to compare the outcomes of mitomycin 0.02% intra-operatively and limbal conjunctival autograft after excision of primary pterygium. Methodology: Randomized controlled trial (RCT) was conducted at Opthalmology department Shalamar medical and Dental College, Lahore from October 2021 to September 2022 in duration of 1 year. A total of 62 patients enrolled in study. Patients were divided into two groups MMC and LCAG. Main variables of study were laterality of pterygium, size of pterygium cross limbus, preoperative and post operative BCVA and proportion of pterygium recurrence in both groups. SPSS version 24 was used for data analysis. Results: Laterality were right for 48.4% patients in Group MMC and 58.1% for Group LCAG, (p=0.445). The average Size of pterygium cross limbus, Preoperative and postoperative BCVA of both the groups were almost equal, (p&gt;0.050). The recurrences at 3, 6 &amp; 9 months and after 1 year in Group MMC was 12.9%, 6.5%, 16.1%, 9.7%, 45.2% which is greater than Group LCAG 9.7%, 9.7%, 3.2%, 6.5%, 29% respectively, but the difference was statistically insignificant, (p=0.526). Conclusion: Limbal conjunctival autograft is more successful in prevention of recurrence after excision of primary pterygium as compare intraoperative application of mitomycin-c. But simple excision and LCAG or MMC both are acceptable in terms of minor difference in recurrence rate, surgeon’s skill and preferences of local practice are main risk factors.

Augmented trabeculectomy - The surgical journey and road trip forward.

Augmented trabeculectomy - The surgical journey and road trip forward.

A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer.

Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

Two routes of administration of mitomycin C in a trabeculectomy.

The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates. https://youtu.be/RLEbK4IeRtU.

Visual outcomes and recurrence rate of macular corneal dystrophy following phototherapeutic keratectomy in Saudi Arabia.

The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK). This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery. This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK. PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD.

Cauterized conjunctival autograft with and without mitomycin C in primary pterygium surgery

Aim To compare between the outcomes of cauterized conjunctival autograft (CA) with and without mitomycin C (MMC) in primary pterygium surgery. Patients and methods This prospective interventional comparative study included 50 eyes in 50 patients with primary pterygium. Patients were randomly assigned into two equal groups: group 1 underwent pterygium excision with cauterized CA fixation, and group 2 underwent pterygium excision with cauterized CA fixation and intraoperative application of 0.02% MMC for 3 min. All patients underwent a preoperative, first day, first week, first month, third month, and sixth month postoperative ophthalmic examination. Any intraoperative or postoperative complications were recorded. Primary outcomes were reported as incidence of recurrence and any major (sight threatening) complications. Secondary outcomes were reported as any minor complications. Results A total of 50 patients (28 males and 22 females, with male to female ratio 1 : 1.3) were included in this study. Complications encountered in our study included recurrence of pterygium, which occurred in one (4%) eye in group 1 and 0 eyes in group 2. Two (8%) eyes in group 1 versus one (4%) eye in group 2 showed subconjunctival hemorrhage, one (4%) eye in group 2 showed focal scleral thinning, and one (4%) eye in group 2 showed a corneal epithelial defect. There was no statistically significant difference between the two groups regarding the incidence of any complication (P&gt;0.05). Conclusion Cauterized CA without MMC is a safe and effective procedure for the surgical treatment of primary pterygium. There was no added benefit to intraoperative MMC application.

Simultaneous bilateral choanal and nasopharyngeal stenosis in an adult patient: case report and treatment approach

&lt;p class="abstract"&gt;Choanal and nasopharyngeal stenosis in adults are extremely rare. They usually are detected and treated in pediatric age as they typically result from congenital malformations. In adulthood, they mostly result from acquired causes such as iatrogenic trauma after surgeries, infectious or autoimmune diseases, or radiotherapy. However, sometimes it is not possible to determine the exact etiology. Treatment is challenging, with restenosis being the most feared and frequent complication. With this case report, we aimed to highlight the diagnostic and treatment approaches for choanal and nasopharyngeal stenoses in adults. We present a 61-year-old patient with persistent bilateral nasal obstruction and discharge, snoring, and recurrent frontal headaches for years which turned out to be a bilateral choanal and nasopharyngeal stenosis. Previously, the patient had been diagnosed with chronic rhinosinusitis without any other relevant medical history. Additionally, no previous surgical procedures or radiation therapy were found to be associated with the etiology. The patient was treated with surgery. A combined modality of trans-nasal endoscopic excision of choanal and nasopharynx fibrous tissue using cold cutting instruments and posterior septectomy followed by the topical application of Mitomycin-C, without stenting, was an effective option.&lt;/p&gt;

Risk Factors Involved in Recurrence of Pterygium Excision after Surgical Excision

Aim: To determine the effect of the type and size of growth, sex and patients age, and the application of mitomycin-C intraoperatively and its application duration effect on pterygium recurrence afterwards excision. Study Design: A retrospective and descriptive case series. Place and Duration: In Alshifa Trust Eye Hospital, Rawalpindi and the department of Ophthalmology CMH, Lahore for the duration from November 2022 to April 2022. Methods: Data files from 80 patients (80 eyes) who underwent bare sclera technique surgery with MMC at 0.2 mg / ml (0.02%) and application time ranging from 1 to 5 mints. The study included 60 males and 20 females with 46.4 years of mean age (16 to 60 years). Cases were classified according to sex, age, pterygium type and size and MMC application time. The main outcome measures were to compare the eye affected by the pterygium for any type of recurrence after at least 1-year of follow-up. Results: In our case series, the rate of pterygium recurrence was 10% in the mean follow-up of 1 year. The influencing factors like younger age at admission (&lt;50 years), secondary pterygium (p = 0.330) was suggestively related with pterygium recurrence. There was a clear tendency of less rate of recurrence with smaller pterygium size, with MMC administration times greater than 3 minutes. However, it was not possible to obtain statistical significance due to the smaller sample size. Conclusions: This study results propose that younger age &lt; 50-years, a history of multiple recurrences, increased size and a duration of MMC administration &lt; 3 mints are risk factors for postoperative recurrence of pterygium

The "Three Cherries Technique" for glaucoma drainage devices

Small sponges are used to apply antimetabolites in order to reduce the risk of fibrosis in filtering glaucoma surgery. Due to the posterior location of the filtering bleb in glaucoma drainage implants, there is arisk that the sponges can dislocate in this area and cannot be retrieved after the exposure time has elapsed. We use the "three cherries technique" to minimize the risk. The term "three cherries technique" was coined by us and has not been used before in the literature. The three sponges that are used for mitomycinC application are each connected by single button sutures with a7.0 vicryl thread. At the end of the application time, the sponges can be quickly removed by pulling the thread.

Esophageal Dilation in Children: A State of the Art Review.

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.

Endobronchial tuberculosis in children: Defining the role of interventional bronchoscopy.

Endobronchial tuberculosis (EBTB) can lead to bronchopulmonary complications when diagnosis is delayed. Bronchoscopic treatment in children can be challenging due to small airway size. We report our experience treating children with EBTB. Retrospective study (2014-2020) of patients diagnosed with EBTB. Flexible bronchoscopy (FB) was performed in patients with previous diagnosis of pulmonary tuberculosis (PTB), after respiratory/radiological worsening was observed in spite of medical treatment. Treatment consisted in oral corticotherapy in all patients, and interventional bronchoscopy in selected cases. Our aim is to describe the endoscopic findings, interventional bronchoscopy alternatives, and outcome. Of 45 patients with PTB, 13 (28.9%, 7M/6F) were diagnosed with EBTB, with a mean age of 3.9 years (0.4-12.8). Four bronchoscopic patterns were observed. Endobronchial granuloma (N:9; 69.2%): Excision with rigid bronchoscopy was achieved in five (1-5 procedures per patient), while corticotherapy alone was preferred in the remaining four due to small size/distal location of the granuloma. Caseum obstruction (2; 15.4%): dense mucous molds were removed with flexible/rigid bronchoscopy (6 and 8 procedures, respectively). Bronchial stenosis (1; 7.7%): two balloon dilatations with mitomycin-C application were performed. Extrinsic compression (1; 7.7%): oral corticotherapy alone was initiated. One patient developed bronchoscopy-related complications (pneumothorax requiring thoracic tube 48 h). With a medium follow-up of 4.6 years (1.8-7.6), three patients developed bronchiectasis while the remaining 10 improved clinically and radiologically. Bronchoscopic findings in EBTB include granuloma, stenosis, caseum obstruction and external compression. In selected cases, interventional bronchoscopy can minimize long-term bronchopulmonary complications.

Effect of Prophylactic Mitomycin C on Corneal Endothelium Following Transepithelial Photorefractive Keratectomy in Myopic Patients.

PurposeThis study investigated the effect of prophylactic mitomycin C (MMC) on corneal endothelium to inhibit corneal haze formation post transepithelial photorefractive keratectomy (T-PRK).MethodsA total of 120 eyes of 60 patients with low, moderate, and high myopia were subjected to T-PRK with intraoperative application of MMC (0.02%) for 30–50s. Patients’ files were categorized into three groups according to ablation depths (if ≥100 µm) during T-PRK as follows: (1) Group A – low myopia without MMC, (2) Group B – low myopia with MMC, and (3) Group C – moderate/high myopia with MMC. Preoperative/surgical parameters and refractive outcomes were documented. Cell density (CD), number of cells (NUM), coefficient of variation, central corneal thickness (CCT), hexagonality (HEX/6A), average cell area (AVG), and its standard deviation (SD) were evaluated using specular microscopy preoperatively and postoperatively.ResultsOverall, 119 out of 120 eyes showed significant prevention of corneal haze. Groups A and C showed no significant changes in endothelial CD and NUM. Group B showed a non-significant reduction in CD. However, all three groups showed significant variations in HEX/6A, CCT, AVG, and SD.ConclusionThe MMC application did not significantly affect corneal endothelial density or number and can be used safely and effectively to prevent corneal haze following T-PRK in myopia.

Bronchoscopic Management of Benign Bronchial Stenosis by Electrocautery and Balloon Dilatation

Benign bronchial stenosis is managed by surgical or bronchoscopic methods. Although surgical approach is definitive, it is technically demanding and is costlier than bronchoscopic treatment. Here, we report the case of a 27-year-old female patient with symptomatic benign bronchial stenosis of the left main bronchus. The stenosis was dilated successfully through a fibreoptic bronchoscope by electrocautery followed by balloon bronchoplasty and application of mitomycin-C. On follow up, there was no evidence of re-stenosis.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

The aim of this study is to determine adhesion formation rate and antrostomy closure rate after the use of Mitomycin-C in patients underwent FESS. This is a prospective case control study conducted at ENT Department Lyari General Hospital, Karachi, Pakistan. Fifty one patients included with diagnosis of bilateral chronic rhinosinusitis or allergic fungal sinusitis and were the surgical candidate, underwent bilateral Functional Endoscopic Sinus Surgery (FESS). The patients were evaluated using Lund-Mackay staging system prior to surgery. At the completion of surgery Mitomycin-c (MMC) was applied in one nasal cavity the other nasal cavity served as a control. Among fifty one patients both nostrils were used hence we have 51 cases and 51 controls. The patients were followed for a minimum period of three months after surgery. Subjective improvement of symptoms were recorded as well as rigid nasoendoscpic examination was also performed regularly. The adhesion formation rate in MMC applied nasal cavities was 11.7% as compared to 64.7% of controls. The middle meatal antrostomy closure rate was 41% and 5% in controls and MMC applied group respectively. Hence mitomycin-c application has shown benefit in reducing post FESS ostial stenosis and adhesion formation between middle turbinate and lateral nasal wall. Application of Mitomycin-C has impact on reducing post FESS adhesion formation and middle meatal antrostomy closure.