Intraoperative Application Of Mitomycin C Research Articles

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.

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>0.050). The recurrences at 3, 6 & 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.

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>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.

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.

Efficacy of mitomycin C 0.02% for prevention of haze after transepithelial photorefractive keratectomy for mild and moderate myopia

Objective: To investigate the efficacy of mitomycin C (MMC) 0.02% for prevention of haze after transepithelial photorefractive keratectomy (Trans-PRK) for mild and moderate myopia. Methods: Retrospective cohort study. We reviewed medical records of 295 patients (588 eyes) who underwent Trans-PRK with or without use of MMC. There were 45 patients (90 eyes) in the mild myopia group (aged between 18 and 41 years; 37 males and 8 females; myopia diopter <3.00 D) and 250 patients (498 eyes) in the moderate myopia group (aged between 18 and 46 years; 168 males and 82 females; myopia diopter: 3.00 to 6.00 D). The two groups were divided into subgroups with MMC 0.02% and without MMC, respectively. The time of intraoperative application of MMC, if there was, was 15 s and 30 s in the mild myopia group and the moderate myopia group, respectively. The mean follow-up time was 6 months. Postoperative best corrected visual acuity (BCVA), spherical equivalent (SE) and haze were analyzed and compared using an independent Student t-test or Mann-Whitney U test between subgroups. Haze variables were compared using chi-square statistics. Results: Haze was quantified with Fantes from grade 0.5 to 4. In the mild myopia group, all haze grades were 0.5 within 3 months. The incidence of haze was 6.25% (2/32) in eyes treated with MMC and 8.62% (5/58) in eyes treated without MMC; there was no statistical significance (χ²=0.00, P>0.999). In the moderate myopia group, the incidence of haze was 9.19% (24/261) in eyes treated with MMC within 3 months; the grade was 0.5 in 91.67% (22/24) of eyes with haze and 1 in 8.33% (2/24). The incidence of haze was 29.53% (70/237) in eyes treated without MMC; the grade was 0.5 in 60.00% (42/70) of eyes with haze, 1 in 18.57% (13/70), and 2 in 5.71% (4/70) within 3 months, and 0.5 in 15.71% (11/70) after 3 months (χ²=12.36, P=0.002). In the mild myopia group, BCVA was 5.0(5.0, 5.1) versus 5.0(5.0, 5.1) in the subgroups with MMC and without MMC (Z=-0.34, P=0.733). In the moderate myopia group, BCVA was 5.0(5.0, 5.1) versus 5.0(5.0, 5.1) in the subgroups with and without MMC (Z=-2.05, P=0.040). In the mild myopia group, SE was (0.33±1.07) D versus (0.32±0.57) D in the subgroups with and without MMC (t=0.25, P=0.805). In the moderate myopia group, SE was (0.66±0.85) D versus (0.53±0.67) D in the subgroups with and without MMC (t=2.97, P=0.003). Conclusions: MMC 0.02% was effective in preventing haze after Trans-PRK in the treatment of moderate myopia. However, it was not effective in mild myopia.

Comparative Analysis of Tear Film Parameters in Patients Undergoing Pterygium Excision by Conjunctival Autograft or Bare Sclera Technique Augmented by Intraoperative Mitomycin C Application

Introduction: Excision of the pterygium has been shown to enhance tear film stability. The study was designed to assess the effects of pterygium removal utilising two different surgical procedures on tear film parameters: bare sclera with Mitomycin C (MMC) and conjunctival autograft. The bare sclera with MMC application and conjunctival autograft techniques are the two most common treatments for pterygium. Conjunctival autograft is a procedure in which the superior conjunctiva of the patient's eye is removed in one piece and the excised tissue is used to cover the area where the pterygium was removed.The bare sclera with MMC application procedure involves removing the pterygium and intraoperatively applying 0.02% MMC to the scleral bed, leaving it to re-epithelialise. Aim: Comparative analysis of improvement in tear film parameters of patients undergoing pterygium excision by conjunctival autograft or bare sclera technique augmented by intraoperative MMC application. Materials and Methods: The prospective interventional study was conducted in Department of Ophthalmology, SGT University affiliated hospital, Gurugram, Haryana, India, from January 2019 to January 2020. A total of 54 Patients were divided into two groups. Group 1 has 26 patients undergoing pterygium excision with bare sclera technique (with MMC 0.02%), and Group 2 has 28 patients undergoing pterygium excision with conjunctival autograft technique (with MMC). Tear Break-up Time (TBUT) and Schirmer's I were measured in 54 eyes with pterygium before and after surgery. Data analysis was done using Two tail (inequality) test on Statistical Package for the Social Sciences (SPSS) software version 28.0. Patients were randomly divided into two groups by using RAND between software. Results: The mean preoperative Schirmer's I was 9.333 mm which improved to 12.203 mm after pterygium excision, which was a statistically significant change irrespective of the technique used. The mean preoperative Tear Break-up Time (TBUT) was 7.212 seconds which improved to 13.059 seconds after pterygium excision, which was a statistically significant change irrespective of the technique used. In the autograft group, TBUT improved from preoperative mean value of 7.253 seconds to 14.0 seconds and Schirmer's I mean values improved from 9.178mm to 12.678 mm, respectively.In the bare sclera group TBUT improved from preoperative mean value of 7.169 second to 12.046 second and Schirmer's I mean values improved from 9.500 mm to 11.692 mm, respectively. The mean postoperative Schirmer’s1 in autograft technique was 12.678 mm and postoperative Schirmer’s1 in bare sclera technique was 11.692 mm.The postoperative improvement in both groups was statistically similar. The mean postoperative TBUT in autograft technique was 14 seconds and postoperative TBUT in bare sclera technique was 12.046 seconds. Postoperative results in the autograft group were statistically better than the bare sclera group. Conclusion: The tear film stability parameters in pterygium patients improved after surgery in both the groups. Statistical analysis of postoperative Schirmer's I data was similar in both the techniques. Although postoperative TBUT values were statistically better in the autograft group, the mean value in both the techniques were more than ten seconds. The analysis of data indicates that bare sclera technique with MMC can be used as an alternative surgical procedure in patients with scarred conjunctiva or in situations where superior conjunctiva has to be preserved for future use.

Long-term Results of Ahmed Valve Implantation With Mitomycin-C in Pediatric Glaucoma.

Mitomycin was used with Ahmed valve implantation in 81 eyes of 63 children. After 5 years, probability of intraocular pressure (IOP) control without glaucoma medication was 35±6%; 57% achieved IOP control with topical medications after 10 years. The purpose of this study was to determine the long-term outcomes of Ahmed glaucoma valve (AGV) implantation with intraoperative application of mitomycin-C (MMC) for the treatment of childhood glaucoma. Retrospective review of children undergoing AGV implantation with subtenon application of MMC between 2000 and 2019. We defined surgical success as a final IOP of 5 to 21 mm Hg with no glaucoma medication, no subsequent glaucoma surgery, and no severe complication. Qualified success was defined if the above criteria were met with topical antiglaucoma medication. Eighty-one eyes of 63 patients were included. The probability of complete success was 72±5% (63% to 83%) at 1 year, 58±6% (48% to 70%) at 2 years, and 35±6% (25% to 48%) at 5 years. The probability of qualified success was 92±3% (87% to 98%) at 1 year, 79±5% (70% to 89%) at 5 years, 57±7% (44% to 73%) at 10 years, and 39±9% (24% to 62%) at 14 years. The IOP was reduced by an average of 10.7±9 mm Hg from preoperative visit to the last follow-up, and the number of medications decreased from 3.0±1.4 to 1.5±1.4 after implantation. A significant proportion of patients achieved long-term IOP control without glaucoma medication. The majority achieved IOP control with additional topical antiglaucoma medications. When compared with existing AGV implantation in childhood literature, the use of MMC appears to lengthen the drop-free (complete success) duration, as well as the long-term IOP control with topical medications.

History, presence, and future of mitomycin C in glaucoma filtration surgery.

Mitomycin C (MMC) is an alkylating agent with extraordinary ability to crosslink DNA, preventing DNA synthesis. By this virtue, MMC is an important antitumor drug. In addition, MMC has become the gold standard medication for glaucoma filtration surgery (GFS). This eye surgery creates a passage for drainage of aqueous humor (AqH) out of the eye into the sub-Tenon's space with the aim of lowering the intraocular pressure. A major cause of failure of this operation is fibrosis and scarring in the sub-Tenon's space, which will restrict AqH outflow. Intraoperative application of MMC during GFS has increased GFS success rate, presumably mainly by reducing fibrosis after GFS. However, still 10% of glaucoma surgeries fail within the first year. In this review, we evaluate risks and benefits of MMC as an adjuvant for GFS. In addition, we discuss possible improvements of its use by adjusting dose and method of administration. One way of improving GFS outcome is to prolong MMC delivery by using a drug delivery system.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments.

To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.

Pterygium excision with modified bare sclera technique combined with mitomycin C.

Numerous surgical methods, with varying rates of recurrence, have been applied for the treatment of pterygium. Adjuvant mitomycin C (MMC) application has shown promising results in the prevention of recurrence. Here we propose and describe modified bare sclera technique combined with the intraoperative application of MMC for pterygium excision. Retrospective study. Primary pterygium patients who underwent pterygium excision via the bare sclera combined with 0.04% MMC technique from January 2014 to December 2016 were reviewed. In all patients, the subconjunctival pterygium strand was exposed and then sufficiently excised in combination with the safe use of MMC; i.e., the prevention of MMC dilution and diffusion to surrounding tissue. Surgical complications, recurrence rates, and recurrence onset were recorded. This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). The mean postoperative follow-up period was 26.4 ± 14.5months (range: 12-60months). MMC was applied for 1-3min. The mean complete epithelialization was 12.6 ± 7.6days and no surgical complications were observed. In 1 patient with double-head primary pterygium, recurrence occurred at 15-months postoperative. The modified bare sclera technique combined with MMC application was found to be safe, effective, and presents good cosmetic appearance for the treatment of primary pterygium when safety points are strictly applied.

Role of mitomycin-C in endoscopic dacryocystorhinostomy with lacrimal sac stenting

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; This study critically evaluates the effectiveness of mitomycin-C in conventional endoscopic dacryocystorhinostomy (ENDODCR) that minimizes the reclosure of a neo-ostium by retaining an enlarged marsupialized lacrimal sac.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The combined retrospective and prospective study included 24 patients in the study group, who underwent endoscopic dacryocystorhinostomy in the Department of Otorhinolaryngology and Ophthalmology in a period of 1.5 years (June 2006 to January 2008). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; An 83.33% primary success rate was observed, without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in 20.83% cases. Overall, the success rate of group I was 91.67% as compared to 75% in group II.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intra operative mitomycin-C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.&lt;/p&gt;

Effect of intraoperative mitomycin-C application on epithelial regeneration after transepithelial photorefractive keratectomy

To investigate the effect of mitomycin-C (MMC) intraoperative application on postoperative corneal epithelial remodeling, haze incidence, and refractive correction in transepithelial photorefractive keratectomy (transPRK). Eye Hospital of Wenzhou Medical University, Wenzhou, China. Prospective randomized controlled study. Eyes that completed all follow-ups were included. Epithelial thickness (ET) map measurement was conducted preoperatively and at 1 week, and at 1 month, 3 months, and 6 months postoperatively, generating ET in central, paracentral, and midperipheral zones. The difference between postoperative and preoperative ET (ΔET) was computed for each zone. During follow-up, haze incidence and visual acuity were assessed and compared between groups. A total of 100 eyes completed all follow-up, including 40 eyes treated with MMC in MMC group and 60 eyes in control group without MMC treatment. For ΔET, between-group difference was found in midperipheral (P = .011) zone at 1 week postoperatively and in central (P = .036) and paracentral zones (P = .039) at 1 month postoperatively. Haze incidence was lower in MMC group at 1 week and 1 month postoperatively (P = .035 and .018, respectively). Safety index (postoperative uncorrected distance visual acuity/preoperative corrected distance visual acuity [CDVA]) and efficacy index (postoperative CDVA/preoperative CDVA) were higher in MMC group (P = .012 and P = .036, respectively) at 1 month postoperatively. No difference was found after 3 months postoperatively. With a temporary impact on corneal epithelial regeneration and refractive correction, intraoperative MMC application in transPRK decreased the haze incidence but had no effect on epithelial remodeling.

A challenging case of refractory childhood glaucoma associated with bilateral congenital ectropion uveae

Congenital ectropion uveae (CEU) is a rare disorder, resulting from the proliferation of iris pigment epithelium on the anterior surface of the iris. We report the case of a 3-year-old boy, who was recently diagnosed with glaucoma, on treatment with two topical antiglaucoma medications and referred to us for further evaluation and management. His visual acuity, at presentation, was 6/7.5 (Cardiff) in both his eyes. Slit-lamp examination of both his eyes revealed the presence of ectropion uveae, with intraocular pressure (IOP) of 32 mm Hg. Gonioscopy in both eyes showed anterior insertion of iris. On Fundoscopy, both eyes showed glaucomatous disc changes. He had no systemic associations. Owing to inadequate IOP control, despite optimal medical therapy, he underwent trabeculectomy with intra-operative application of Mitomycin-C. However, the IOP reduction post-trabeculectomy was inadequate, and he subsequently required a bleb needling, which also failed. Hence, he underwent Ahmed glaucoma valve implantation in his right eye, with a favorable final outcome. IOP in the right eye was brought under control following multiple surgical interventions and additional medical treatment. CEU in children can be associated with refractory childhood glaucoma. It is important to evaluate for glaucoma in CEU cases to prevent blindness, especially in young patients and improve their overall prognosis.

Conjunctival Autograft Combined With Either Preoperative Mitomycin C Injection or Intraoperative Local Mitomycin C Over the Medial Rectus Muscle Tendon in Primary Pterygium Surgery.

To evaluate and compare the recurrence rate and complications of conjunctival autograft (CAG) combined with preoperative mitomycin C (MMC) injection versus CAG with intraoperative local MMC over the medial rectus muscle tendon in primary pterygium. Randomized prospective study. This study included 108 eyes of 108 patients with primary fleshy or growing pterygium. All patients were from rural areas and less than 50 years old. Fifty-three patients were treated with injection of 0.1 mL of 0.15 mg/mL MMC into the body of pterygium followed 1 day later by pterygium excision and CAG (group I), and 55 patients were treated with pterygium excision and local application of 0.2 mg/mL MMC for 2 min over the medial rectus tendon followed by CAG (group II). The minimum follow-up period was 18 months. Two patients from group I and one patient from group II did not complete the follow-up period and were excluded. There were no statistically significant differences between the two groups regarding age, sex, laterality, or follow-up period. Recurrence occurred in 2 eyes in group I (3.92%) and 1 eye in group II (1.85%); (P=0.52). All recurrences occurred in male patients of less than 30 years of age. No significant complications were encountered in both groups. Both preoperative MMC injection followed 1 day later by pterygium excision with CAG, and pterygium excision and intraoperative local application of MMC on the medial rectus tendon are successful in treating primary pterygium with low recurrence rate and few complications.

Safety and complications after three different surface ablation techniques with mitomycin C: a retrospective analysis of 2757 eyes.

To evaluate the safety and spectrum of complications of three excimer laser surface ablation techniques (SATs) with an intraoperative application of mitomycin C (MMC) 0.02%. A retrospective, non-comparative large case series. SATs were performed on 2757 eyes with a preoperative spherical equivalent (SE) of - 4.41 ± 2.44 and a Wavelight Allegretto 200 platform. Ablation zone diameters between 6.0 and 7.0mm were used according to mesopic pupil size. All patients were treated with an intraoperative application of MMC for 30 to 90s depending on refractive error. The mean follow-up time was > 3months (107 ± 24days). Complication range and incidence were analyzed retrospectively and safety index was calculated. Two thousand seven hundred and fifty-seven eyes met the inclusion criteria for surface ablation. Two thousand five hundred and seventy-three eyes were assigned to alcohol-assisted photorefractive keratectomy (APRK), 135 eyes to transepithelial photorefractive keratectomy (TPRK), and 49 eyes to off-flap epithelial laser in situ keratomileusis (EpiLASIK/EpiK). Overall, the safety index was 1.06 ± 0.28. Haze was graded according to the Fantes scale. Haze incidence rates were highest in the TPRK group (14.81%) and comparably low in APRK (2.95%) and EpiK (4.08%) groups. Intraoperative topical application of MMC (0.02%) results in good safety and no severe side effects. However, highest incidence of haze was observed after TPRK. The more frequent peripheral localization of haze might be attributed to large ablation zones and the wavefront optimized ablation profile especially in the PTK modus of the laser platform.

Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C.

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6months, 1 and 2year. Success rate was 100% at 3 and 6months follow-up in both the groups. At the end of 1year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure. Level of evidence Individual prospective cohort study, level 1b.

A Study of Efficacy of Intraoperative Application of Mitomycin-C in Endoscopic Dacryocystorhinostomy

Introduction&#x0D; Common cause for failure of endonasal dacryocystorhinostomy is closure of the intranasal ostium usually due to granulation tissue formation. Attempts have been made to improve the success rate of lacrimal surgery by using different methods like using balloon catheters, lasers and antimetabolites. This study aims to see change in success rate with and without the use of using Mitomycin-C in endonasal Dacryocystorhinostomy (DCR) surgery.&#x0D; Materials and Methods&#x0D; Sixty patients of acquired chronic dacryocystitis with nasolacrimal duct blockage, in the age group of 11-50 yrs were taken for study. Patients were alternatively divided into two groups A &amp; B (30 patients in each group). Endoscopic dacryocystorhinostomy with Mitomycin-C application was performed in Group A and without Mitomycin-C application in Group B patients. Subjective assessment for symptomatic improvement and objective analysis obtained from results of syringing. The result data was subjected to Student’s t test and x2analysis.&#x0D; Result&#x0D; Age of patients varied from 11 to 50 yrs. The male to female ratio was 7:8 in group A while 2:3 in group B. The commonest age group was between 21 -30 years in both the groups. After 12 month follow up the success rate was 93% in both the groups. The results between the groups were found to be statistically not significant (p&gt;0.05).&#x0D; Conclusion &#x0D; Mitomycin C was used in this study to assess its efficacy in improving the results of endoscopic DCR. Mitomycin C did not have significant effect on the outcomes of endoscopic DCR surgery for chronic dacryocystitis.

Recurrence Rate in Primary Pterygium Managed by Surgical Excision of Pterygium with Application of Mitomycin-C over Bare Sclera and Free Conjunctival Autografting

Background: To study recurrence rate in 50 cases of primary pterygium managed by surgical excision of pterygium along with application of mitomycin-C 0.02% over bare sclera for 2 minutes and ipsilateral free conjunctival autografting. Methods: This prospective observational study was carried out on 50 patients of primary pterygium operated between 25.05.2016—10.08.2016. Pterygium excision was done, 0.02% mitomycin-C was applied over bare sclera for 2 minutes and ipsilateral free conjunctival autografting was done using sutures. Patients were followed up for a mean period of 13.27 months for recurrence. Results: 55 eyes of 50 patients were operated by above technique by a single surgeon1. Three (3) patients were lost in follow up. In an average follow-up time of 13.27 months, recurrence was found in only 1 case (1.92%). No serious side effects were observed in this study. Conclusions: Primary Pterygium managed by excision of pterygium followed by intraoperative mitomycin-C application and conjunctival autografting is an easy, reproducible and cost effective method which helps in reducing recurrence with minimal complications.

Case report of ocular Kaposi\u2019s sarcoma

BackgroundKaposi’s sarcoma (KS) is generally considered a neoplastic disorder of vascular origin and occurs in patients with acquired immunodeficiency syndrome (AIDS) or who have received immunosuppressive treatments after an organ transplant (Soulier et al., Blood 86(4):1276–80, 1995; Viejo-Borbolla and Schulz, AIDS Rev 5(4):222–9, 2003; Schulz, J Antimicrob Chemother 45(Suppl T3):15–27, 2000; Aversa et al. Crit Rev Oncol Hematol 53(3):253–65, 2005; Mbulaiteye and Engels, Int J Cancer 119(11):2685–91, 2006; Tessari et al., Eur J Dermatol 16(5):553–7, 2006). Several Kaposi’s sarcoma case reports involving eyelids and conjunctiva have been published (Bavishi et al., Int J STD AIDS 23(3):221–2, 2012; Baumann et al., Ger J Ophthalmol 4(4):239–45, 1995).Case presentationwe report a 13 years old asian male patient rare case of ocular KS that was initiated from the sclera and progressed into the cornea and conjunctiva without an human Immunodeificiency Virus (HIV) or HHV-8 infection after a peripheral blood stem cells transplantation. In this case, anti- vascular endothelial growth factor (VEGF) therapy was attempted to stop the advance of ocular lesions and failed. Eventually, the KS was cured by a limbo-corneal lamellar graft, an amniotic membrane and scleral allograft transplantation plus intraoperative mitomycin C(MMC) after the complete excision of the tumors.ConclusionA compete surgical excision combined with the intraoperative application of MMC, as well as grafts to repair the scleral, conjunctival, and corneal surfaces, could prevent a recurrence of KS.

Corneal Breakthrough Haze After Photorefractive Keratectomy With Mitomycin C: Incidence and Risk Factors

To identify preoperative and intraoperative factors affecting breakthrough corneal haze incidence after photorefractive keratectomy (PRK) with mitomycin C (MMC). In this retrospective study of PRK performed at the Care Vision Refractive Laser Center, Tel Aviv, Israel, a total of 7535 eyes (n = 3854 patients; mean age ± SD, 26 ± 6 years; 55% men) underwent PRK with intraoperative MMC application. Patients with histories of corneal pathology or surgery were excluded. Incidence, time of onset, and corneal haze severity were documented on follow-up of 118 ± 110 days. Eyes were grouped by preoperative refraction [low (≤-3D), moderate (-3D to -6D), or high (>-6D) myopia; low (≤3D) or high (>3D) astigmatism; low or high hyperopia]; by intraoperative time (above or below 40 seconds); and by MMC application time (above or below 40 seconds). The main outcome measures were incidence, onset time, and severity of corneal haze. The haze incidence was 2.1% in eyes with high myopia versus 1.1% in those with low to moderate myopia (P = 0.002), and 3.5 times higher in eyes with high than with low astigmatism (P < 0.05). The overall incidence was higher in eyes treated for hyperopia (10.8%) than for myopia (1.3%) (P = 0.0001). In eyes with moderate myopia, the haze incidence was lower in MMC application time ≥40 seconds (0%) than in <40 seconds (1.3%) (P = 0.03). After surgery, a mild early haze incidence peaked at 68.8 ± 6 days and severe late haze at 115 ± 17 days (P = 0.02). Hyperopic and large myopic or astigmatic corrections carry higher risk of haze. Longer MMC application might have beneficial haze prevention.