Intraoperative Application Of Mitomycin Research Articles

Comparative study of dacryocystorhinostomy with and without intraoperative application of Mitomycin C

Aims and objectivesTo compare the outcome of dacryocystorhinostomy surgery with and without the intraoperative use of Mitomycin C. MethodsOur study is a prospective comparative case study in which 50 patients of primary acquired nasolacrimal duct obstruction were divided on the basis of random sampling into the conventional dacryocystorhinostomy group and the Mitomycin C group in which Mitomycin C 0.2mg/ml was used intraoperatively. Patients were followed on 1st postoperative day, 1st, 3rd, 6th weeks, 3rd and 6th months. Patient symptoms and satisfaction were noted. Patency of lacrimal passage was assessed by lacrimal syringing and tear meniscus height was recorded on each follow-up. ResultsAt the end of 6months of follow-up, 96% of patients were asymptomatic in the Mitomycin C group whereas 80% patients in the conventional group were asymptomatic. On lacrimal syringing 24 (96%) eyes had patent passage in the Mitomycin C group where as only 1 (4%) patient had complete block with regurgitation of mucopurulent fluid. In the conventional group 20 (80%) eyes had patent passage, 4 (16%) eyes had complete block with regurgitation of mucopurulent fluid and 1 (4%) eye had partially patent passage on lacrimal syringing. Out of 25 eyes, 24 had normal tear meniscus height, and 1 had high tear meniscus height in the Mitomycin C group in comparison to the conventional group in which out of 25 eyes 20 eyes had normal, 1 had moderate and 4 eyes had high tear meniscus height. Intraoperative and postoperative complications in both the groups were identical. ConclusionAlthough the difference between the two groups was not statistically significant, a distinctly higher success was achieved in patients undergoing dacryocystorhinostomy with intra operative Mitomycin C as compared to conventional dacryocystorhinostomy.

Moderne Filtrationschirurgie

Preoperative treatment with steroids and nonsteroidal anti-inflammatory drugs increases the success of filtration surgery. Surgery with the patient under subconjunctival anesthesia is safe. Intraoperative application of mitomycin C is state of the art and enhances success rates. Perioperative use of bevacizumab seems to attenuate postoperative fibrosis. Postoperative hypotension is avoided by stable fixation of the scleral flap followed by stepwise controlled suturelysis or release. Transconjunctival flap suturing allows fast and simple treatment of overfiltration. The shorter the time lag between trabeculectomy and subsequent cataract surgery the higher the probability of bleb failure will be. The number of antiglaucomatous drugs and severity of glaucomatous damage before surgery correlate with the probability of failure and blindness.

Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon

BackgroundTreatment of recurrent pterygium associated with symblepharon usually involves the use of tissue grafting and/or the intraoperative application of mitomycin C (MMC). For the graft, a conjunctival/limbal autograft and/or amniotic membrane may be used. This generally requires extra technical skills and assistance, an increase in the cost and duration of surgery, and a more extensive anesthesia (a complete eye block or general anesthesia). Although widely used, safety concerns have been raised over MMC in the treatment of pterygia.ObjectiveThe objective of this case report is to report the successful use of preoperative subconjunctival injection of low-dose (0.02%) MMC one month before bare sclera excision of a multirecurrent pterygium, as well as the concomitant intraoperative application of MMC to the conjunctival fornix of the same eye after the excision of an associated symblepharon.Case reportA 31-year-old man from Kano, Northern Nigeria, presented to the eye clinic with a recurrent pterygium associated with an upper lid symblepharon in his right eye. He has had five previous pterygium excisions, with the last surgery involving conjunctival autografting and subconjunctival steroid injection. He was subsequently given 0.1 mL of 0.02% MMC as a subpterygial injection; one month later he had an alcohol-assisted bare sclera pterygium excision and a symblepharolysis with the intraoperative application of 0.02% MMC for 1 minute to the upper conjunctival fornix. Except for a Tenon granuloma that was simply excised, there has been no recurrence or other complications up to a year after surgery.ConclusionAs a cheaper and technically easier treatment option, a preoperative subconjunctival MMC injection followed by bare sclera pterygium excision was found to be effective in this patient with a recurrent pterygium. As at one-year follow-up, low-dose preoperative MMC a month prior to surgery also appeared safe and effective when combined with its intraoperative application to the conjunctival fornix for the treatment of associated symblepharon.

Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery

Purpose:To determine the efficacy of preoperative subconjunctival injection of mitomycin C a day before surgery in the management of recurrent pterygium.Materials and Methods:Randomized comparative case series. Fifty eyes with recurrent pterygium were randomly divided into two groups; the mitomycin injection group (25 eyes) and the mitomycin application group (25 eyes). The mitomycin injection group underwent preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before bare sclera pterygium excision surgery. The mitomycin application group underwent bare sclera pterygium excision with topical application of mitomycin C (same concentration).Results:At one year of follow-up, 24 of 25 eyes (96%) in the mitomycin injection group and 23 of 25 (92%) eyes in the mitomycin application group were free of recurrence. The difference was statistically insignificant. As regards postoperative complications, delayed epithelization (more than two weeks) occurred in two eyes (8%) in the mitomycin injection group and in one eye (4%) in the mitomycin application group. Scleral thinning was reported in one eye (4%) in the mitomycin application group which resolved within three weeks after surgery, no other serious postoperative complications were reported.Conclusion:Preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before pterygium surgery is a simple and effective modality for management of recurrent pterygium. It has the advantage of low recurrence and complications’ rate.

Intraoperative Mitomycin C Versus Intraoperative 5-Fluorouracil for Trabeculectomy: A Systematic Review and Meta-Analysis

The aim of this study was to assess the intraoperative application of mitomycin C (MMC) compared to 5-fluorouracil (5-FU) on the outcome of trabeculectomy and to examine the balance of risk and benefit. Pertinent studies were selected through systematic searches of major literature databases, including the Cochrane Library, PubMed, Embase, and Chinese Biomedicine Database. Internet searches of search engines, the professional associations' websites, and the manufacturers' databases were also performed. Clinical controlled trials comparing 5-FU with MMC in trabeculectomy were selected. The primary efficacy measure was the weighted mean difference (WMD) in percentage intraocular pressure reduction (IOPR%) at follow-up end point. The secondary efficacy measure was the relative risk (RR) for "qualified" (with or without medical therapy) success of trabeculectomy at follow-up end point. The third efficacy measure was RR for "complete" (without medical therapy) success of trabeculectomy at follow-up end point. The fourth efficacy measure was RR for adverse events, including wound leak, hypotony, endophalmitis, and shallow anterior chamber (AC). The pooled effects were calculated using the random effects model by RevMan version 5.0 software. Eight studies enrolling a total of 536 patients were included in the meta-analysis. MMC was associated with significantly more IOPR% compared with 5-FU, with a WMD of 7.09 [95% confidence interval (CI) 1.47-12.70] at follow-up end point (P=0.01). MMC was comparable with 5-FU in qualified success rate, with a RR of 1.09 (0.99-1.20) at follow-up end point (P=0.09). MMC was comparable with 5-FU in complete success rate, with a RR of 1.17 (0.79- 1.75) at follow-up end point (P=0.43). Rates of adverse events did not differ significantly between 5-FU and MMC, with an RR of 0.71 (0.22-2.28) for bleb leakage, 1.40 (0.72-2.72) for hypotony, 1.63 (0.27-9.75) for endophthalmitis, and 0.95 (0.41-2.21) for shallow AC. Intraoperative MMC is more effective in lowering IOP in trabeculectomy compared with intraoperative 5-FU, but is comparable with intraoperative 5-FU in both qualified and complete success rate. Intraoperative use of both agents may contribute equally to adverse events.

Postoperative Conjunctival Inflammation After Pterygium Surgery With Amniotic Membrane Transplantation Versus Conjunctival Autograft

To compare the postoperative conjunctival inflammation around the surgical site after pterygium surgery using either amniotic membrane transplantation (AMT) or free conjunctival autograft. Prospective, randomized, interventional study. Forty-two eyes of 42 patients with primary pterygium underwent surgical excision followed by removal of subconjunctival fibrovascular tissue and intraoperative application of 0.02% mitomycin C. Then, the patients were randomized to receive either AMT (21 eyes) or free conjunctival autograft (21 eyes), with sutures used in both groups. Main outcome measures included presence of host conjunctival inflammation around the surgical site at 1 month after surgery and also recurrence of pterygium. Twelve-month follow-up was completed in 39 eyes of 39 patients (19 in the AMT group and 20 in the conjunctival autograft group). At 1 month after surgery, different grades of host conjunctival inflammation were present in 16 eyes (84.2%) in the AMT group and in 3 eyes (15%) in the conjunctival autograft group (P = .02). Subconjunctival injection of triamcinolone was performed in eyes with moderate or severe inflammation, which included 12 eyes (63.1%) in the AMT group and 2 eyes (10%) in the conjunctival autograft group (P < .001). Conjunctival recurrence of pterygium was seen in 2 eyes (10.5%) in the AMT group and in 2 eyes (10%) in the conjunctival autograft group (P = .92). After surgery, pyogenic granuloma developed in 3 eyes (15.8%) in the AMT group and in 1 eye (5%) in the conjunctival autograft group (P = .31). After pterygium surgery, conjunctival inflammation was significantly more common with AMT than with conjunctival autograft. However, with control of such inflammation and intraoperative application of mitomycin C, similar final outcomes were achieved with both techniques.

Superficial keratectomy, PTK, and mitomycin C as a combined treatment option for Salzmann's nodular degeneration: a follow-up of eight eyes

To analyze the treatment outcomes (safety and efficacy) of manual superficial keratectomy, phototherapeutic keratectomy (PTK), and intraoperative application of mitomycin C (MMC) for Salzmann nodular degeneration (SND). In this retrospective study, we analyzed the records of eight eyes of five patients with Salzmann nodular degeneration (SND) who were treated between December 2006 and May 2008 at the University Eye Clinic Hamburg, Eppendorf, Germany. This case study includes data previously published within a single case report. Patients were followed-up pre- and postoperatively by slit-lamp biomicroscopy, digital photography, and corneal topography. All of the eight eyes were followed-up for at least 12 months, whereas in four eyes, follow-up was done for more than 24 months. PTK was performed with a 193-nm Ar-F excimer laser (Allegretto 200; WaveLight AG, Erlangen, Germany) within a 7-mm optical zone. Mitomycin C 0.02% was applied after PTK for 30 s. Postoperatively, a therapeutic contact lens was administered until corneal epithelial healing, which occurred usually at the forth postoperative day. Then local steroid therapy (prednisolone 1%) eye drops fours times per day was given for the following 4 weeks. Mean BCVA preoperatively was 0.61 logMAR (i.e., 20/80 Snellen equivalent or 0.25 decimal). There was a significant increase of BCVA by average of four reading lines (far distance) up to ten reading lines (p < 0.001). Mean BCVA postoperatively was 0.2 logMAR (i.e., 20/32 Snellen equivalent or 0.63 decimal). Treatment of SND led to a dramatic reduction of hyperopia (myopic shift) corresponding to a marked increase of best-corrected visual acuity (BCVA). Preoperatively documented hyperopic progression was stopped and refraction remained stable during the follow-up period in all eyes. Corneal topography showed regular astigmatism. During follow-up after treatment, the corneas appeared clear on slit-lamp examination. Our follow-up and the small treatment numbers are not sufficient to finally prove the superiority of the combined treatment modality (superficial keratectomy, PTK, and MMC) for SND, but the results of our study are promising. Longer follow-up and a larger cohort are warranted for proving MMC to be an effective, successful, and safe method in the armamentarium for treating and preventing Salzmann degeneration.

Treatment of Recurrent Eyelid Margin Verruca Vulgaris With Mitomycin C

A 62-year-old male presented with multiple bilateral eyelid margin verruca vulgaris. Treatment with surgical excision and cauterization of the bases was done twice, but the lesions recurred rapidly with more extensive involvement of the eyelid margins. Excision and intraoperative application of mitomycin C (0.2 mg/ml) for 3 minutes using Weck-Cel sponges resulted in no recurrence seen at the 8-month follow-up.

Comments by: Nathan Radcliffe, MD and Eytan Blumenthal, MD: Late-onset Bleb Leakage

CASE REPORT A 75-year-old man presents for routine follow-up examination 6 years after uncomplicated primary trabeculectomy with a 2minute intraoperative application of mitomycin C (MMC, 0.4mm/ mL). Although progression had occurred when the intraocular pressure (IOP) was in the mid teens, the visual fields have remained stable since filtration surgery was performed. The IOP is 8mm Hg and a large, thin-walled avascular filtration bleb is present at the superior limbus. A conjunctival epithelial hole is visible in the center of the bleb overlying the scleral flap and leakage is noted when fluorescein is applied (positive Seidel test). No infiltrate is observed within the bleb, and there is no evidence of intraocular inflammation, choroidal effusion, or chorioretinal folds in the macula. The visual acuity is 20/40 due to an early nuclear cataract.

Efficacy and Safety of Intraoperative Mitomycin C as Adjunct Therapy for Pterygium Surgery

The primary objective of this study was to determine if intraoperative application of mitomycin C (MMC) is safe as an adjunct for pterygium surgery. The secondary objectives of the study were to determine if MMC reduces pterygium recurrence rate and to evaluate the effect of MMC on intraocular pressure. We conducted a nonconcurrent prospective study of 68 patients with primary or recurrent pterygium. Patients underwent a comprehensive eye examination preoperatively and postoperatively to evaluate for possible complications associated with the use of MMC. The recurrence rate of pterygia was also included in the data. We examined a total of 68 patients (68 eyes). The follow-up time ranged from 12 to 98 months (mean = 27.7 +/- 28.8 months). Only 2 postoperative complications were reported: a scleral dellen and a conjunctival cyst. Eight patients (12.0%) with primary pterygium had a recurrence of pterygia after surgery. However, no recurrences occurred in patients with previous recurrent pterygia. Findings in our study suggest that MMC is efficacious in preventing recurrences and a safe adjunct therapy during pterygium surgery. Findings in our study suggest that intraoperative MMC application leads to few complications while providing a significant reduction in the recurrence rate.

Role of Conjunctival Inflammation in Surgical Outcome After Amniotic Membrane Transplantation With or Without Fibrin Glue for Pterygium

To determine the clinical significance of postoperative conjunctival inflammation noted at the third or fourth week after intraoperative application of mitomycin C and amniotic membrane transplantation for pterygium. This retrospective study included 27 eyes of 23 patients with primary (n = 12) or recurrent (n = 15) pterygia. All cases were operated by extensive removal of subconjunctival fibrovascular tissue and intraoperative application of 0.04% mitomycin C in the fornix, followed by amniotic membrane transplantation by using either fibrin glue (14 eyes) or sutures (13 eyes). Main outcome measures included development of conjunctival inflammation, pyogenic granuloma, and pterygium recurrence after surgery. For a follow-up of 29.6 +/- 17.2 months (range, 6-56 months), 16 (59.3%) eyes without postoperative conjunctival inflammation resulted in favorable outcomes. Conjunctival inflammation around the surgical site was noted in the remaining 11 (40.7%) eyes and was significantly more common in eyes with sutures than those with fibrin glue (61.5% vs. 21.4%, respectively; P = 0.05). Among those with this inflammation, 7 eyes receiving subconjunctival injection of triamcinolone resulted in complete resolution and a good aesthetic outcome. Four eyes without this injection gradually developed conjunctival (n = 1) or corneal (n = 1) recurrence and/or pyogenic granuloma (n = 3). Host conjunctival inflammation is still common after intraoperative application of mitomycin C and amniotic membrane transplantation, especially when sutures are used in pterygium surgery. If left untreated, persistent inflammation may lead to a poor surgical outcome.

Conjunctival–Limbal Autograft, Amniotic Membrane Transplantation, and Intraoperative Mitomycin C for Primary Pterygium

We evaluated and compared the safety and efficacy of the conjunctival-limbal autograft, amniotic membrane transplantation, and intraoperative application of mitomycin C in 94 patients undergoing primary pterygium surgery and concluded that conjunctival-limbal autografting and amniotic membrane methods were more effective and safer than intraoperative mitomycin C.

A pilot study on slit lamp-adapted optical coherence tomography imaging of trabeculectomy filtering blebs

Our study aims to identify anatomical characteristics of glaucoma filtering blebs by means of slit lamp-adapted optical coherence tomography (SL-OCT) and to identify new parameters for the functional prognosis of the filter in the early post-operative period. Patients with primary open-angle glaucoma, aged 18 years and older, scheduled for primary trabeculectomy at the Department of Ophthalmology, Radboud University Nijmegen Medical Centre, were considered for our study. All patients underwent standardized trabeculectomy with intra-operative application of mitomycin C. The filtering blebs were evaluated clinically and with SL-OCT on day 1 and 1, 2, 4 and 12 weeks following surgery. The resulting data were analysed and weighed against surgical success. To better understand the SL-OCT data a small comparative histologic study was performed. The study included 20 eyes of 20 patients. After completion of our study, 15 eyes of 15 patients (mean age+/-SD 67 +/- 16 years) were eligible for data analysis and 5 eyes missed at least one follow-up visit. Filtering surgery was considered successful (intraocular pressure < or = 21 mmHg without antiglaucomatous medication) in 11 of 15 eyes. SL-OCT frequently demonstrated multiple hypo-reflective layers within Tenon's capsule ("striping" phenomenon) in the first post-operative week. Presumably, these layers corresponded with drainage channels in the histological specimen. These channels were present in functional filters but not in the failures. In addition, the visualisation of the sclera below the filtering zone was better defined in failures compared with successful filtering blebs ("shading" phenomenon). We observed no differences in the volume and clinical aspect of the blebs in the successful group compared with the unsuccessful group. Successful filtering blebs show characteristic optical properties on SL-OCT. These phenomena suggest a diffusely enhanced fluid content and the presence of intra-bleb drainage channels in functional filtering blebs.

Trabeculectomy with mitomycin C in the treatment of post-traumatic angle-recession glaucoma

目的 观察小梁切除术术中联合应用丝裂霉素C(Mitomycin C,MMC)治疗外伤性房角退缩性青光眼的效果.方法 小梁切除术联合术中应用MMC治疗外伤性房角退缩性青光眼22例(22眼).术后对眼压、视力和并发症进行了分析.以Kaplan-Meier寿命表判断成功率.结果 成功标准为:不用或用局部抗青光眼药物,眼压在6～21 mmHg之间;不需要再进行抗青光眼手术;并且未发生严重的并发症.6月累积成功率为86.36%(n=22),12月为78.57%(n=14),18月为66.67%(n=6).术后视力与术前相同或稍有提高17例(77.27%),视力下降5例(22.73%).并发症包括浅前房6眼、薄壁滤过泡3眼、低眼压1眼和白内障1眼.结论 小梁切除术联合MMC是治疗外伤性房角退缩性青光眼一种有效的方法.术后大部分病人眼压被控制,保存了有用的视力。

Oral Cimetidine Adjuvant Therapy for Recalcitrant, Diffuse Conjunctival Papillomatosis

To describe a case of recurrent, advanced conjunctival papillomatosis, treated by oral cimetidine (CIM) combined with secondary surgical intervention and an application of intraoperative mitomycin C. Case report and literature review. A 9-year-old boy suffered from recurrent, progressive, diffuse multifocal conjunctival papillomatosis over the left upper and lower palpebral and the fornical conjunctiva. He underwent 3 separate surgeries; however, they did not prevent tumor recurrence. The recurrent lesions were more severe and extensive than before the surgeries. To avoid postoperative symblepharon, ankyloblepharon, dry eye, and possible corneal neovascularization after extensive lesion excision, oral CIM at a dosage of 200 mg 4 times daily was administered for 4 months before surgery. A debulking excision of the residual tumor with an intraoperative application of mitomycin C was performed as a secondary therapy after the main mass decreased in size. Postoperative oral CIM was continued for 6 months. The papillomatosis cleared without recurrence or symblepharon, ankyloblepharon, conjunctival scarring, or corneal neovascularization after 4 years of follow-up examinations. Oral CIM can be used as an initial, nonsurgical strategy for treating cases of massive, recalcitrant conjunctival papillomatosis. If there is tumor shrinkage, surgical debulking with applications of mitomycin C may be sufficient to eliminate any residual tumor tissue without inducing conjunctival scarring or corneal neovascularization.

Postoperative application of mitomycin c improves the complete success rate of primary trabeculectomy: a prospective, randomized trial

The intraoperative application of mitomycin c for primary trabeculectomy is associated with potentially sight-threatening side-effects. This study was performed to evaluate the pressure-lowering effect of postoperative application of mitomycin c for primary trabeculectomy and to evaluate the complications of this new technique. A randomized, prospective clinical trial with 52 consecutive patients scheduled for glaucoma surgery in one large surgical center was performed. Patients underwent routine trabeculectomy. In group 1, mitomycin c (0.05 mg/ml) was applied topically to the filtering bleb for 5 min on the 3 days after surgery (postoperative application). In group 2, no mitomycin c was applied (controls). The IOP values, visual acuity, number of antiglaucomatous medications and complications were evaluated. Follow-up was evaluated up to 24 months for all patients. The mean intraocular pressure decreased from 31.1 to 15.4 mmHg in group 1 and from 24.8 to 15.6 mmHg in group 2 (P=0.79; t-test). The average number of medications decreased from 2.5 and 2.4 to 0.4 and 0.6 (P=0.53; t-test) in groups 1 and 2, respectively. No cases of hypotony maculopathy occurred. An individual decrease of more than 25% of the IOP was present in 84.6% in group 1 and in 53.8% in group 2 (P<0.017). Survival analysis for eyes with a complete surgical success revealed a better outcome of eyes in group 1 as compared to the eyes in group 2 (P<0.013; log-rank test). To our knowledge, this is the first prospective, randomized clinical trial to evaluate the efficacy of postoperative mitomycin c application in primary trabeculectomy. The application of mitomycin significantly reduced the IOP while not increasing the rate of complications.

Evaluation of Mitomycin C in Reducing Postoperative Adhesions in Strabismus Surgery

The aim of this study was to evaluate the efficacy of mitomycin C in reducing postoperative adhesions following strabismus surgery. This study was a prospective, single-center, interventional case series. We randomized 14 patients with restrictive strabismus to the mitomycin C group (7 patients) or to the control group (7 patients). We used mitomycin C intraoperatively for 5 min at a concentration of 0.2 mg/mL in the mitomycin group after adhesion release. We compared postoperative results using the forced duction test. Compared to the control group, the mitomycin C group exhibited a better range of passive duction at all postoperative follow-up times; however, mitomycin C did not completely eliminate the problem of postoperative adhesions. Patients receiving mitomycin C did not report any complications during this study. The intraoperative application of mitomycin C is a safe and effective adjunct to surgery in the treatment of restrictive strabismus.

Intraoperative Mitomycin C and Amniotic Membrane Transplantation for Fornix Reconstruction in Severe Cicatricial Ocular Surface Diseases

To investigate whether intraoperative application of mitomycin C may enhance the success of amniotic membrane transplantation in symblepharon lysis and fornix reconstruction in severe cicatricial ocular surface diseases. Noncomparative interventional case series. Sixteen patients (8 female, 8 male; 18 eyes) with a mean age of 41+/-23.4 years (range, 3-79) and suffering from severe chemical/thermal burns (7 eyes), multiple recurrent pterygia and pseudopterygia (5 eyes), Stevens-Johnson syndrome (4 eyes), and ocular cicatricial pemphigoid (2 eyes) were consecutively enrolled. All except for 2 eyes had had prior surgical attempts of surgical reconstruction, including 6 eyes with a mucous membrane graft (MMG), but still presented with symblepharon and persistent ocular surface inflammation. After excision of subconjunctival fibrovascular tissues, 0.04% mitomycin C was applied for 5 minutes in the deep fornix before amniotic membrane transplantation. Deeper fornix, noninflamed ocular surface, and full motility. The mean epithelial healing time was 4.2+/-1.9 weeks. During the follow-up of 14.16+/-5.2 months, all eyes showed a marked reduction of conjunctival inflammation, a deep fornix, and a continuous tear meniscus. Of 12 eyes with motility restriction, 2 eyes with multiple recurrent pterygia and 1 eye with severe thermal burn showed recurrence of partial motility restriction 2 months after surgery. The vision of 9 eyes was successfully restored by an additional keratolimbal allograft with subsequent penetrating keratoplasty (6 eyes). Intraoperative application of mitomycin C is an effective means to reduce chronic and deep-seated conjunctival inflammation, and helps amniotic membrane restore a deep fornix after symblepharon lysis, even in eyes that had a failed MMG. Restoration of deep fornix and tear meniscus is an important prerequisite to achieve successful reconstruction by subsequent limbal stem cell transplantation.

Discussion: Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes

This well-designed study adds to the growing body of research on the modulation of corneal wound healing after surface excimer laser ablation. The authors found that a single intraoperative application of mitomycin C 0.02% reduced haze and improved uncorrected visual acuity over 3 years of follow-up in 72 highly myopic eyes. The study design was particularly effective at controlling confounding variables with the use of fellow eye comparison, placebo topical agents, and subjective (slit-lamp grading of haze) and objective (confocal microscopy) outcome measures. Despite this, the difference found between the results in the mitomycin C and control eye groups was relatively small due, in part, to the low number of eyes that developed significant haze. The most likely explanation for this relatively low incidence of corneal haze (as compared with earlier studies of broad-beam photorefractive keratectomy of highly myopic eyes 1 Seiler T. Holschbach A. Derse M. et al. Complications of myopic photorefractive keratectomy with the excimer laser. Ophthalmology. 1994; 101: 153-160 Abstract Full Text PDF PubMed Scopus (256) Google Scholar ) involves the authors' use of a rapid small scanning spot (COMPex 300, InPro, Norderstedt, Germany) laser.

Long-term effects of mitomycin C in pterygium surgery on scleral thickness and the conjunctival epithelium

Purpose To evaluate the long-term effects of intraoperative application of mitomycin C on the scleral thickness and the conjunctival epithelium at the surgical site of pterygium excision. Design Prospective observational case series. Participants Twenty-four patients who underwent excision of primary pterygium with intraoperative mitomycin C in our department during the year 1996. Methods Patients were evaluated by slit-lamp biomicroscopy, impression cytology, and high-frequency ultrasonography. Impression cytology was performed by applying a small nitrocellulose filter paper for a few seconds at the excision area and for a few seconds at the opposite perilimbal area, and subjecting the specimens to the periodic acid–Schiff–Gill modified Papanicolaou staining protocol. The morphology of the conjunctival epithelium and goblet cell density (GCD) were recorded. High-frequency ultrasound was performed at the same sites, and the scleral thickness was measured at a distance of 1 mm from the limbus. Main outcome measures Goblet cell density, conjunctival epithelial morphology, and the scleral thickness at the operated and nonoperated sites. Results All patients had successful pterygium removal with no corneal recurrence after a mean follow-up of 77.2±3.9 months (range, 72–84). Impression cytology revealed normal nongoblet conjunctival epithelial cells at the excision area, with a 4-fold decrease in the GCD at the excision area when compared with the contralateral nonoperated site (296±120 cells/mm 2 and 1183±310 cells/mm 2, respectively; P = 0.0036). No differences were noted between the scleral thicknesses at the operated site (750±70 μm) and the opposite site (740±80 μm) ( P = 0.84). Conclusions A single application of mitomycin C after pterygium excision is not associated with reduction in scleral thickness more than 6 years postoperatively. The conjunctival epithelium retains its normal phenotype, with a marked reduction of the GCD.