Mitomycin C Application Research Articles

Study on the optimal concentration of topical mitomycin-C in preventing postlaminectomy epidural adhesion

There is increasing evidence that topical application of mitomycin-C can be beneficial in reducing epidural scar adhesion. However, the ideal concentration of mitomycin-C is unknown. The purpose of this study was to verify its efficacy for preventing epidural adhesion and the immediate electrophysiological responses caused by it in a laminectomy model. Seventy rats underwent laminectomy at L-1 and L-2. Cotton pads soaked with saline and various concentrations of mitomycin-C (0.1 mg/ml, 0.3 mg/ml, 0.5 mg/ml and 0.7 mg/ml) were applied to the exposed dura for 5 min. Spine somatosensory evoked potentials (SSEP) were monitored in preoperative and the immediate electrophysiological responses of mitomycin-C used. Four weeks postlaminectomy the rats were killed. The area of epidural scar tissue and degree of epidural adhesion were determined by 7.0T Micro MR imaging. Macroscopic evaluations were performed according to the Rydell standard. The results showed that severe epidural adhesion was formed in the saline group and no dural adherence or incomplete adhesions were found in the mitomycin-C group. The Rydell classification and the degree of epidural adhesion and the area of the scar in 0.5 mg/ml group and 0.7 mg/ml mitomycin-C group revealed a significant decrease compared with the control group and 0.1 mg/ml group and 0.3 mg/ml mitomycin-C group. The spine sensory evoked potentials did not alter obviously in both preoperative and the immediate electrophysiological responses of mitomycin-C used. In conclusion, locally applied mitomycin-C in a concentration of 0.5 mg/ml and 0.7 mg/ml mitomycin-C may be the optimal concentration in preventing postlaminectomy epidural adhesion.

Mitomycin C Does Not Inhibit Exacerbation of Granular Corneal Dystrophy Type II Induced by Refractive Surface Ablation

To evaluate the effect of mitomycin C (MMC) on the exacerbation of corneal opacity that occurs in patients with granular corneal dystrophy type II (GCD II) after refractive corneal surface ablation. Ten eyes of patients with GCD II who underwent refractive corneal surface ablation with MMC were compared with 10 eyes that were not treated with MMC. Best spectacle-corrected visual acuity, the degree of corneal opacity, and contrast sensitivity were evaluated at least 3 years after surgery. Corneal opacities were quantified using Pentacam densitometry maps. No measured between-group value showed a statistically significant difference. Simultaneous application of MMC does not prevent exacerbation of GCD II after refractive corneal surface ablation.

Reduced Application Time for Prophylactic Mitomycin C in Photorefractive Keratectomy

To determine whether the duration of mitomycin C (MMC) 0.02% application affects visual outcome or the incidence of subepithelial haze in patients undergoing photorefractive keratectomy (PRK) with prophylactic administration of MMC. Retrospective, comparative case series. Two hundred sixty-nine eyes undergoing PRK. This was a retrospective comparative case series that included 269 eyes that underwent PRK with prophylactic MMC application for 120 seconds (group 1, n = 74), 60 seconds (group 2, n = 36), or 12 seconds (group 3, n = 159). The mean preoperative spherical equivalent was -6.49 diopters (D) in group 1, -6.77 D in group 2, and -7.10 D in group 3. Photorefractive keratectomy was performed using a modified nomogram. All eyes received a single intraoperative application of MMC (0.02%) after laser ablation for the above specified durations. Best-corrected visual acuity and corneal haze score. Best-corrected visual acuity was 20/23 in group 1, 20/20 in group 2, and 20/21 in group 3. The mean haze score+/-standard deviation (scale, 0.00-4.00) was 0.11+/-0.31 in group 1, 0.14+/-0.28 in group 2, and 0.07+/-0.20 in group 3 throughout a mean follow-up of 31 months in group 1, 16 months in group 2, and 10 months in group 3. No eyes had a haze score of more than 1.00. There was no statistically significant difference in postoperative best-corrected visual acuity or haze scores among the 3 groups. Administration of prophylactic MMC 0.02% for 12 seconds after PRK seems to be equally efficacious for haze prophylaxis when compared with longer application times of 60 and 120 seconds.

Angiogenesis, fibrinogenesis and presence of synechiae after exeresis of a swine vocal fold mucosal microflap and use of topical mitomycin-C

To evaluate swine vocal fold healing in a period of 30 days after topical mitomycin-C application. Twelve swine underwent exeresis of mucosal flaps from the free edge of the anterior third of both vocal folds with a cold instrument (laryngeal scissors). The animals were divided into two groups: EG (Experimental Group), consisting of 6 animals undergoing topical MMC application (4 mg/dL) on the operated area for 4 minutes; CG (Control Group), 6 animals undergoing topical saline solution application on the operated area for 4 minutes. After 30 days, the animals were sacrificed and the larynges were collected and examined for the presence of synechiae as well as a histological immunohistochemical assessment of immature and mature collagen deposition, number of blood vessels and myofibroblasts. Mature collagen deposition in the EG was 452.12 microm(2) and 1332.31 microm(2) in the CG; immature collagen deposition was 1511.73 microm(2) in the EG and 1020.61 microm(2) in the CG. The number of myofibroblasts was 1.556 in the EG and 3.583 in the CG. The number of blood vessels was 2.565 in EG and 6.917 in the CG. There were no synechiae in the two studied groups. There was an increase in immature collagen deposition in the experimental group when compared with the control group. There was a decrease in mature collagen deposition in the experimental group when compared with the control group. There was a decrease in the number of myofibroblasts in the experimental group when compared with the control group. A decrease in blood vessels was observed in the experimental group when compared with the control group. There was no synechia formation in either studied group.

Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma

This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG). Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were > or = 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 +/- 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan-Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups. Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group. This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG.

Effectiveness of intra-operative Mitomycin-C in reducing the recurrence of pterygium in Irrua, Nigeria

To evaluate the effectiveness of intra-operative Mitomycin-C application after pterygium surgery in Irrua, Nigeria. The medical records of all patients who had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C between June 2002 and May 2007 and followed up for at least a year were reviewed. Two hundred and forty three eyes (196 patients) had pterygium excision with intra-operative application of 0.4mg/ml Mitomycin C over this period. Male to female ratio was 2:1. The mean age of the patients was 47.1years (SD+ 15.4) Eleven eyes had recurrence after a minimum follow up period of one year. Six (54.5%) out of the eleven eyes that had recurrence had conjunctival granuloma and in such cases recurrence was early (between 2 to 3 months of surgery). Conjunctival granuloma was the main complication occurring in 35 eyes (14.4%). Occurrence of granuloma was significantly associated with recurrence (P =0.0006). Delayed wound healing occurred in 5 eyes (2.1%). There was no case of either scleral or corneal melting. Intra-operative application of 0.4mg/ml Mitomycin C is very effective in reduction of recurrence of pterygium after excision. Hence patients should be given the benefit of intra-operative use of Mitomycin C during pterygium surgery.

Topical mitomycin-C for the treatment of anal stricture

Background Anal stricture is a well-known and feared consequence of anorectal surgery. Daily dilatations are often prescribed in the immediate postoperative period to avoid stricture of the anus. Nonetheless, stricture may still occur and, particularly in older children, may require multiple dilatations under anesthesia. Topical mitomycin-C has been found to be effective in the treatment of strictures at various anatomical locations. In this article, we review our experience with topical mitomycin-C as an adjunct to anal dilatation for children with anal stricture. Materials and methods Cases of children with anal stricture who were treated with a single application of topical mitomycin-C as an adjunct to anal dilatation between 2000 and 2008 were analyzed retrospectively. Anal diameter was measured with Hegar dilators. Cottonoid swabs soaked in mitomycin-C were placed on the anal mucosa for 5 minutes after dilatation. Treatment success was defined by sustained improvement in anal size, decrease in symptoms, parental satisfaction, and need for additional intervention. Results Ten children with anal stricture who underwent anal dilatation with application of topical mitomycin-C were identified. All children presented with severe constipation. Average increase in anal size after dilatation under sedation was 5.7 mm (±3.2 mm). Average improvement in anal diameter on first clinic visit after mitomycin-C application was 3.7 mm. On follow-up, only 1 child required repeated intervention for stricture after treatment with mitomycin-C. No complications were associated with the use of mitomycin-C. Conclusions All children treated with mitomycin-C showed early improvement in their anal size after dilatation under sedation. A single application of topical mitomycin-C allowed them to retain an increased anal diameter over time and avoid additional dilatations. Furthermore, the application of mitomycin-C in our population was straightforward and safe. Therefore, we advocate its use as an adjunct to anal dilatation under sedation in the treatment of severe anal stricture.

Fluoroscopy-guided Topical Application of Mitomycin-C in a Case of Refractory Esophageal Stricture

Esophageal strictures refractory to conservative treatment (balloon dilation, bouginage) are difficult to manage. Recently, some investigators reported great success using endoscopy-guided topical application of mitomycin-C to prevent scar formation and restenosis in children with benign esophageal strictures unresponsive to balloon dilation. Herein, the authors report a fluoroscopic approach for topical application of mitomycin-C in a case of refractory esophageal stricture after surgical repair in a child with congenital esophageal atresia. This technique is a feasible alternative to endoscopic techniques.

Topical use of MMC in the upper aerodigestive tract: a review on the side effects

Not much is known about the side effects of mitomycin C (MMC), an anti-fibrogenetic agent, in the upper aerodigestive tract. However, its use in ophthalmology is widely known and without quantitatively important side effects. A literature review was performed for side effects of MMC in the upper aerodigestive tract. Forty-six articles, describing the use of MMC to prevent scarring, were retracted from PubMed. Thirty-two are human studies. MMC is used in different concentrations (0.1–10 mg/ml) with different application times (2–5 min) and frequencies (up to 4 times). Five hundred and thirty-eight patients were included in those publications, of whom 19 developed side effects (3.53%). No side effects developed in studies, where post-application irrigation with saline was reported. The longest mean follow-up period is 75.5 months. Direct relations between the reported side effects and MMC seem absent in most studies. Serious complications seem to occur when MMC is used in high concentrations. Unfortunately, sometimes crucial information is lacking. One patient was described who supposedly developed laryngeal carcinoma after repeated treatment of hyperkeratosis and anterior commissure webbing. Animal studies show that excessive fibrin production can lead to acute airway obstruction. In conclusion, topical application of MMC on a wound with consecutive irrigation with saline can be performed safely to prevent scar formation in circular structures of the upper aerodigestive tract. Long-term yearly control of the application site seems advisable.

Mitomycin C Aqueous Humor Concentration after Photorefractive Keratectomy: An Experimental Study

To evaluate mitomycin C (MMC) aqueous humor concentration after photorefractive keratectomy (PRK). In this experimental study, twenty-four eyes of 12 male pigmented rabbits were divided into 4 groups and studied at the Institute of Vision and Optics, Department of Medicine, University of Crete, Greece. Eyes in groups 1 and 2 underwent PRK to correct -5 diopters (D) in a 6-mm optical zone, while sponges soaked with 0.02% MMC were applied on the exposed corneal stroma for 60 and 120 seconds, respectively. Similarly, eyes in groups 3 and 4 underwent PRK to correct -10 D in a 6-mm optical zone, while sponges soaked with 0.02% MMC were applied on the exposed corneal stroma for 60 and 120 seconds, respectively. Aqueous humor was extracted from all rabbit eyes 10 minutes after MMC application and high-performance liquid chromatography was performed immediately to detect and quantify MMC levels. The mean aqueous humor concentration of MMC was 0.23+/-0.03 microg/mL, 0.39+/-0.05 microg/mL, 0.28+/-0.04 microg/mL, and 0.52+/-0.16 microg/mL in groups 1, 2, 3, and 4, respectively. The effect of application time and correction on aqueous humor MMC concentration was significant (p<0.0001 and p=0.019), while the exposure time had a greater impact on aqueous humor MMC concentration when compared with the attempted correction. Both exposure time of MMC on the corneal stroma and the attempted correction was correlated with MMC aqueous humor concentrations.

Use of adjunctive mitomycin C in external dacryocystorhinostomy surgery compared with surgery alone in patients with nasolacrimal duct obstruction: A prospective, double-masked, randomized, controlled trial

Background: The most common cause for the failure of external dacryocystorhinostomy (DCR) surgery is the formation of granulation tissue at the osteotomy site or common canaliculus. Objectives: The aims of this study were to assess the efficacy of intraoperative adjunctive mitomycin C (MMC) treatment in external DCR surgery and to compare this procedure with the standard DCR procedure alone in the long term (1 year). Methods: In this prospective, double-masked, randomized, controlled trial, patients with primary acquired nasolacrimal duct obstruction were randomized (using a random number table) into 2 groups based on surgical procedure. In the MMC group, intraoperative adjunctive MMC 0.2 mg/mL was applied to the osteotomy site for 30 minutes. The control group underwent standard DCR procedure only. The results of the DCR surgeries were assessed using objective findings (eg, cessation of excessive tearing via nasolacrimal duct irrigation and the improvement in height of tear meniscus) and subjective symptoms (asking patients to describe the degree of tearing improvement). Both the patients and the researchers who were assessing the study outcomes were masked to treatment group. Results: One hundred eyes of 100 Turkish patients were assessed and equally randomized to the MMC (27 women, 23 men; mean [SD] age, 47.0 [7.6] years) and control (26 women, 24 men; mean age, 46.6 [8.8] years) groups. The follow-up period was not significantly different between the MMC and the control groups (13.1 [1.1] vs 13.2 [1.4] months). Significantly more eyes in the MMC group than the control group remained symptom-free throughout the 1-year follow-up period (45/50 [90%] vs 33/50 [66%]; P=0.005). Significantly more patients in the control group than the MMC group had an improvement in symptoms at the 1-year follow-up (8/50 [16%] vs 2/50 [4%] eyes; P=0.005). Based on the patency of the drainage system, the success rate was significantly greater in the MMC group than the control group (48/50 [96%] vs 42/50 [84%]; P=0.005). Based on nasolacrimal duct irrigation, significantly fewer patients in the MMC group than the control group had an enclosed naso-lacrimal duct (2/50 [4%] vs 8/50 [16%]). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed. Conclusions: In the management of these patients with primary acquired nasolacrimal duct obstruction, adjunctive intraoperative MMC application with standard DCR surgery had a significantly higher success rate than did standard DCR surgery alone. Further large, double-masked, randomized studies are needed to confirm these findings.

Die topische Applikation von Mitomycin C in der Behandlung von Stenosen und Narben in Hohlorganen in der Hals-Nasen-Ohrenheilkunde – Ein Erfahrungsbericht aus 10 Jahren

The antibiotic und antitumoral effect of Mitomycin C (MMC), a derivative of Streptomyces caespitosus, has been known since 1956. Besides its use as an adjunction in the treatment of breast, lung and prostate cancer, or as a second-line cytostatic drug for head and neck squamous cell carcinoma (HNSCC), since 1963, MMC has also been successfully used in the suppression of post-operative scar formation, particularly in the field of ophthalmology. This is due to its modulation of fibroblast activity, which enables decreased scarring and fibrosis. In this résumé, we wish to recapitulate our long years of experience in the topical application of Mitomycin C in the treatment of scar formation and stenosis in head and neck organs. A retrospective analysis on the basis of clinical disease courses and findings (image documentation, questionnaires, pulmonary function tests) covering an examination period of 10 years, was performed on 40 patients with stenosising lesions and a mean age of 54 years. The fields of application included laryngeal, tracheal, oesophageal stenosis and stenosis of the external ear canal and the choane. After combined application of MMC and surgical intervention in cases of recurrent stenosising processes in head and neck organs, especially the larynx and the trachea, a sustained improvement was achieved in the pre-operative stenosis level as well as in the pre-operative, severely limited, forced inspiratory volume in 1 second (F1V1). The topical application of MMC appears to be an effective adjunction as a concept of treatment for stenosising, scar-forming lesions. This topical application, however, is not a substitute for correct diagnosis and appropriate surgical treatment. It must be regarded as a purely adjunctive manoeuvre. During the 10 years in which it was used, the clinical findings confirmed an enhancement in the containment of complex cases without the occurrence of any complications.

Risk Factors for Developing Avascular Filtering Bleb After Fornix-based Trabeculectomy With Mitomycin C

To investigate risk factors for developing avascular filtering blebs after primary fornix-based trabeculectomy with mitomycin C (MMC). One-year observational case series. Ninety eyes of 90 patients who underwent primary trabeculectomy with MMC and a fornix-based conjunctival flap were examined. The appearance of the filtering bleb was classified at the last examination into 2 groups: vascular bleb or avascular bleb. Potential predictors that were entered into the model were age at surgery, sex, glaucoma diagnosis, preoperative intraocular pressure (IOP), number of antiglaucoma medications before surgery, use of topical steroid before surgery, duration of MMC application, laser suturolysis, excessive filtration, combination with cataract surgery, and needling revision. IOP was evaluated at 6 and 12 months postoperatively. Avascular blebs were seen in 28 eyes (31%) at 12 months. Logistic regression analysis revealed that the risk factors for developing avascular blebs after primary fornix-based trabeculectomy included secondary glaucoma [odds ratio (OR)=3.927, P=0.015], excessive filtration (OR=3.215, P=0.043), and not performing laser suturolysis after trabeculectomy (OR=3.597, P=0.031). The mean IOP was decreased from 30.3+/-13.4 mm Hg to 8.8+/-3.9 mm Hg in the avascular bleb group and from 24.6+/-9.9 mm Hg to 10.5+/-3.3 mm Hg in the vascular bleb group at 12 months (P<0.01, both groups, paired t test). Secondary glaucoma, excessive filtration, and no performance of laser suturolysis after trabeculectomy might be risk factors for development of avascular filtering blebs in primary fornix-based trabeculectomy.

Velopharyngeal stenosis, a late complication of radiotherapy

Choanal stenosis has recently been recognized as a late complication of radiation therapy for nasopharyngeal carcinoma. The management of velopharyngeal stenosis is challenging with high risk of restenosis. We report a case of velopharyngeal stenosis post-radiotherapy and illustrated the use of mitomycin-C to prevent restenosis. Mitomycin-C application has being shown useful adjunct to surgical technique in managing nasopharyngeal stenosis for surgeons.

Flap Amputation with Phototherapeutic Keratectomy (PTK) and Adjuvant Mitomycin C for Severe Post-Lasik Epithelial Ingrowth

To report a patient with severe post-laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC). Case report. A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D. Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.

Mitomycin C decreases the rate of stricture formation in caustic esophageal burns in rats

Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Although many agents have been tried experimentally to treat strictures, few have gained clinical application. The aim of this study was to investigate the influence of mitomycin C (MMC), which inhibits fibroblastic proliferation in treating delayed caustic esophageal strictures. Forty-two rats were allocated into 3 groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured with 10% NaOH and left untreated. Group C was injured and received topical MMC at 0.04% concentration in the fourth week. At 56 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were performed. The mean SI in group B was significantly higher than others (SI: 1.15 +/- 0.37 d/lum, P < .05). Collagen accumulation was highest in group B, followed by groups C and A, respectively. Collagen deposition in group C was statistically lower than group B (P < .018). The mean HP in group B was statistically higher than others (5.07 +/- 1.30 microg/mg tissue, P < .05), and similar between groups A and C (1.20 +/- 0.20, 1.91+/- 0.79, respectively, P = .73). In the current study, MMC treatment ameliorated caustic esophageal stricture as reflected in the significantly lower SI. We conclude that MMC application is effective in the treatment of caustic esophageal strictures.

Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: Are two applications better than one?

Endoscopic treatment of laryngotracheal stenosis by airway dilation, despite short-term improvement, is often associated with long-term relapse. Mitomycin-C (MMC) inhibits fibroblast proliferation and synthesis of extracellular matrix proteins, and thereby modulates wound healing and scarring. MMC application at the time of endoscopic dilation and laser surgery has been suggested to improve outcomes, but this has not been studied in a rigorous manner. This study examines the hypothesis that two topical applications of MMC given 3-6 weeks apart will result in decreased scarring/restenosis of the airway, when compared to a single topical application. A randomized, prospective, double-blind, placebo-controlled clinical trial. Twenty-six patients with laryngotracheal stenosis due to idiopathic subglottic stenosis, postintubation stenosis, or Wegener's granulomatosis entered a protocol to receive three endoscopic CO(2) laser and dilation procedures over a 3-month interval. At the first procedure, after radial CO(2) laser incision and airway dilation, all patients received topical application of MMC (0.5 mg/mL) to the airway lesion. One month later, a second endoscopic incision and dilation was performed and the patients were randomized to either a second application of mitomycin-C or to application of saline placebo. A third dilation procedure was performed 2 months later, without MMC application. Patients were followed for up to 5 years for relapse of airway stenosis with clinical symptoms sufficient to require a subsequent procedure. The relapse rates at 1, 3, and 5 years were 7%, 36%, and 69% for patients treated with two applications of MMC compared to 33%, 58%, and 70% for patients treated with one application of MMC. The median interval to relapse was 3.8 years in the two-application group, compared with 2.4 years in the one-application group. This prospective randomized double-blind placebo-controlled trial suggests that, in the endoscopic management of laryngotracheal stenosis, two applications of MMC given 3-4 weeks apart after airway radial incision and dilation reduces the restenosis rate for 2 to 3 years after treatment when compared to a single application. However, restenosis and delayed symptom recurrence continues so that at 5 years the relapse rates are the same. Thus, MMC may postpone, but does not prevent, the recurrence of symptomatic stenosis in the majority of patients.

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.

Intraoperative Mitomycin C Use During Filtration Surgery and Lacrimal Drainage System Obstruction

To evaluate the effect of intraoperative mitomycin C (MMC) application during filtration surgery on lacrimal drainage system. Prospective, nonrandomized, comparative, observational case series. All glaucomatous patients with previous filtration surgery with or without intraoperative MMC application were included. An ophthalmology resident took a detailed history and performed a general eye examination. Patients with ocular and periocular diseases and previous procedures that could affect the lacrimal drainage system were excluded. Diagnostic probing and irrigation of lacrimal drainage system were performed by a masked oculoplastic surgeon. There were 76 eyes from 60 patients with intraoperative MMC (MMC group) and 35 eyes from 24 patients without intraoperative MMC (non-MMC group) application. Two groups were matched for all the variables except for significantly longer duration of being on topical anti-glaucoma medications in the non-MMC group. Lacrimal drainage system obstruction was found in 18.4% of MMC and 22.8% of non-MMC group (P = .61). Upper lacrimal drainage system obstruction was insignificantly more in the MMC group. Duration of MMC application (one to five minutes) did not have significant impact on lacrimal drainage system obstruction. Patients with lacrimal drainage system obstruction were significantly more symptomatic (wet eye). Intraoperative MMC application during filtration surgery did not have a statistically significant impact on the rate of lacrimal drainage system obstruction.

Adult Subglottic Stenosis: Management With Laser Incisions and Mitomycin‐C

To assess the efficacy of endoscopic laser radial incisions with mitomycin-C application (ELRM) in managing adult subglottic stenosis (SGS). Retrospective case series review. Fifteen consecutive cases of adult SGS treated with ELRM at a single tertiary referral center over three years were reviewed. Subjects with SGS secondary to Wegener's granulomatosis (WG) and idiopathic SGS were included. Patients with cartilaginous SGS were excluded. The primary outcome measure was postoperative reduction in symptoms. Secondary outcome measures included total number of procedures required to relieve symptoms, interval between procedures, and improvement in pulmonary function tests when available. In addition to surgery, 14 of 15 patients were treated medically for reflux. Ten women and five men with average age 48 years were identified. Ten patients had idiopathic SGS and five had WG. The predominant presenting symptom was dyspnea on exertion in all patients. All subjects reported at least a temporary postoperative reduction in symptoms. Six patients (40%) required only one ELRM and nine patients (60%) required repeat ELRM at an average interval of 9 months. The average interval for the six patients with idiopathic etiology requiring a second procedure was 9 months. One subject with WG required four procedures. His interval improved from 2.5 to 7 months between procedures. Evidence of extrathoracic airway obstruction resolved in three of four patients with pre and postoperative pulmonary function tests. ELRM is an effective method of managing SGS associated with idiopathic causes. In patients with WG, ELRM reduced airway associated symptoms and avoided need for tracheotomy.