Application Of MMC Research Articles

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.

Incidence of pterygium recurrence following bare sclera technique with MMC in comparison to conjunctival autograft

Background: The gоal of this study is to compare incidence of recurrence of pterygium following bare sclera technique with mitomycin C in comparison to conjunctival autograft Methods: Our study included 40 cases subdivided into 2 groups; 20 cases managed by pterygium excision and intraoperative application of MMC 0.02% for 2 minutes and 20 cases managed by pterygium excision and limbal conjunctival auto graft transplantation ranged from 25 to 65 years old, with mean age of 44.2 years in 1st group, 43.8 years in 2nd group. SD in 1 st group +/- 10.2 and in 2nd group +/-11.3, in 1st group 14 cases (70%) were male and 6 cases (30%) were female, in 2nd group 15 cases (75%) were male and 5 cases (25%) were female. In 1st group the average of recurrence after two months is 3 cases with conjunctival recurrence. In 2nd group, the average of recurrence after two months is 1 case with episcleral vessels with p value <0.05. Results: It was found that recurrences of pterygium in patients managed with MMC are significantly higher than in patients managed with LCAG. Conclusion: LCAG is a good method in management for primary pterygium with low recurrence rate.

Histopathological Changes of the Anterior Surface Structures of Rabbit Eye after Subconjunctival Injection of Different Doses of Mitomycin C

Background: The use of topical mitomycin C in ophthalmology is increasing in all sub-specialties, but the risk-benefit ratio should be considered, taking into account its complications. The dose and duration of application of MMC depends on the surgery in which it is used but is still controversial. Objective: To evaluate the changes in the normal histology of the anterior surface structures of the rabbit eye “conjunctiva, cornea and sclera” after subconjunctival injection of different doses of Mitomycin C (0.1, 0.2 and 0.4 mg/ml) after different periods (1, 7 and 14 days). Material and Methods: A comparative prospective case-control animal study included eighteen eyes of eighteen healthy New Zealand rabbits conducted at Faculty of Medicine, Al-Azhar University. Results: Group B and C rabbits' eyes clinically throughout the study revealed significant findings in the form of severe congestion, severe chemosis, lid edema and lacerations while group A showed non-significant clinical findings. Histopathological results showed significant decrease of the conjunctival goblet cells and scleral elastic tissues with MMC administration at different doses even the low dose from the 1st to the 3rd sacrifice in dose and time-dependent manner. Scleral thickness showed significant decrease after 2 weeks of MMC administration. Corneal thickness showed non-significant decrease within the different sacrifices. Conclusion: Preoperative subconjunctival injection of MMC by 0.1 mg/ml concentration one day before, is mainly do not affects the cornea and have the least effects on the conjunctiva and the sclera.

Study of mechanical characteristics of stir cast AA7050-B4C metal matrix ceramic composites

The AA7050 is one of the few alloys of aluminium which is used in almost all alloy related products in defense and aviation sector. Boron carbide (B4C) is relatively cheap, light weight, chemically stable material and has been known to be used in MMC applications. This study uses systematic stir casting of B4C as ceramic in AA7050. The alloy of interest was heated to molten state, further, modified technique for preparation of metal matrix composite was used, where in the B4C ceramic is added to the generated vortex and subsequently stirred for additional 3–4 min before casting to the appropriate structures and shapes for the mechanical studies. The B4C percentage are 2, 4, 6 and 8% (w/w) and the parameters studied are tensile strength (ASTME8-82), hardness (ASTM E10), density, compression, apart from the typical optical and SEM studies. The results indicate that resultant uniform composites of AA7050-B4C have 20–50% higher Brinell hardness, 20–50% higher ultimate tensile strength and yield strength as the ceramic percentage is increased. This result is significant, not common for the MMC of AA7050 and offers new insights into the extensive use of zinc rich aluminium alloys. The increase in performance of AA7050-B4C composite with increase in B4C percentage is an indication of uniformity of the composite. The linear relation between the mechanical parameter and the percentage of B4C is unique.

Phototherapeutic Keratectomy in Macular and Granular Dystrophy: Two-year Results

ABSTRACT Purpose To evaluate two-year outcomes of phototherapeutic keratectomy in granular and macular dystrophy and to investigate the effects of dystrophy type on results. Methods Sixty-three patients who underwent phototherapeutic keratectomy (PTK) for granular and macular dystrophy in the cornea funit of the University of Health Sciences Beyoglu Eye Research and Training Hospital were evaluated retrospectively. Patients under 18 years of age, patients with a follow-up period of less than 24 months, and patients who had previously undergone corneal surgery or excimer laser treatment were excluded from the study. Treatment values (ablation depth, optical zone, mitomycin-C (MMC) application time) and complications during and after treatment were recorded. Patients who had a decrease of two or more lines in their BCVA and those with recurrent or increased corneal opacities were considered to have severe recurrences. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded preoperatively and postoperatively at the 12th and 24th months. The values obtained before and after the PTK were compared with statistical methods. Results A total of 41 eyes (27 with granular dystrophy and 14 with macular dystrophy) were included in this study. There were no statistically significant differences between patients with granular dystrophy and macular dystrophy in terms of preoperative UCVA and BCVA, MMC application time, and follow-up period (p > .05). The mean age of patients with macular dystrophy was statistically smaller than that of patients with granular dystrophy (p = .04). The amount of ablation applied to macular dystrophy was statistically higher than for granular dystrophy (p = .03). The mean UCVA and BCVA showed statistically significant improvements at the 24th postoperative month (p < .5). There was no statistically significant difference between the UCVA and BCVA values of the patients with granular and macular dystrophy at the 12th and 24th months after the procedure. No recurrence was observed in any patient after 24 months. However, when the follow-up continued, severe recurrence was encountered in 2 patients with macular dystrophy at 26th and 40th months. Re-treatment procedures were needed in these two patients who had severe recurrence. Conclusions Phototherapeutic keratectomy is an effective and safe option for treatment in both granular and macular corneal dystrophy. Recurrence is a more common problem in patients with macular dystrophy, and recurrent therapies or keratoplasty methods are needed more frequently.

Improved Coverage of Mouse Myelomeningocele With a Mussel Inspired Reverse Thermal Gel

BackgroundMyelomeningocele (MMC) is an open neural tube defect of the spinal column. Our laboratory previously introduced a reverse thermal gel (RTG) as the first in situ forming patch for in utero MMC application. To overcome the challenges of anchoring the RTG in the wet amniotic environment to improve MMC coverage, we modified the RTG to mimic the underwater adhesive properties of mussels. We have separated this study into three separate hypotheses-based components:1Based on mussel inspired chemistry, modification of the RTG with dopamine will increase the underwater adhesive properties to improve RTG anchoring ability in a wet environment. Methods: The dopamine-modified RTG (DRTG) was synthesized using carbonyldiimidazole chemistry and characterized with proton nuclear magnetic resonance, Fourier transform infrared spectroscopy, and ultraviolet-visible spectroscopy. Rheology and underwater adhesive tests measured mechanical properties. Results: DRTG synthesis was confirmed with proton nuclear magnetic resonance, Fourier transform infrared spectroscopy, and ultraviolet-visible spectroscopy. Rheology demonstrated increased elasticity. Underwater adhesion testing revealed DRTG has similar wet adhesive strength to Tisseel fibrin sealant.2The DRTG will support in vitro skin cell growth and will be safe for injection in a mouse animal model. Methods: Biocompatibility testing included 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, DRTG-fibroblast and keratinocyte cultures, and subcutaneous injections to quantify macrophages stained with immunohistochemistry. Results: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and DRTG cell cultures revealed no cytotoxicity and demonstrated the growth of fibroblasts and keratinocytes. Subcutaneous injections cause a macrophage response that decreases after 4 wk.3In utero injection of novel DRTG into a mouse MMC model will be effective with improved patch coverage of the MMC defect. Methods: MMC coverage by DRTG was assessed using in utero mouse injections in the Grainy head-like 3 (Grhl3) mouse model. Results: In utero Grhl3 mouse injections demonstrate statistically significant (P = 0.012) improved MMC coverage of DRTG compared with previous RTG coverage with no significant macrophage response. ConclusionsThe DRTG demonstrates increased elasticity, cellular scaffolding properties, and improved MMC coverage in the Grhl3 mouse model. Future studies will be translated to the preclinical ovine model to evaluate this novel gel.

A Comparison of Trabeculectomy Surgery Outcomes With Mitomycin-C Applied by Intra-Tenon Injection Versus Sponge

To compare the outcomes of mitomycin-C (MMC) delivered by intra-Tenon injection vs sponge application during trabeculectomy surgery. We retrospectively reviewed 566 patients with primary and secondary glaucoma diagnoses who received trabeculectomy surgery with MMC in an academic medical center. Exclusion criteria were age less than 18 years, no light perception vision, combined surgery, previous glaucoma incisional surgery, intraoperative 5-fluorouracil, or follow-up <1month. Subjects were divided into 2 cohorts: MMC delivered by sponge application or by intra-Tenon injection. Main outcome measures were postoperative intraocular pressure (IOP) level and secondary measures were survival rate for IOP control, glaucoma medication use, complication rate, and vision. After inclusion/exclusion criteria, 316 eyes were available for analysis; 131 eyes had MMC delivered via sponge and 185 eyes via injection. Mean postoperative IOP was not significantly different between treatment groups but change in IOP from baseline was lower in the sponge vs the injection group 24months after surgery (P= .038). The MMC sponge group had significantly more tense, vascularized, or encapsulated blebs as a late complication (P= .046). Time to failure for postoperative IOP control was not significantly different between MMC treatment groups, but older patient age and limbus-based conjunctival incision were associated with significantly longer time to fail. The application of MMC by injection was similar to application by sponge in lowering IOP in patients with glaucoma and the safety of both techniques appears to be comparable. Limbus-based conjunctival incision had longer time to failure for postoperative IOP control vs fornix-based incision. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

SPARC Levels Modulate the Capacity of Mitomycin to Inhibit the Proliferation of Human Tenon's Capsule Fibroblasts.

Purpose To evaluate the role of SPARC in the antiproliferation effect of MMC on human Tenon's fibroblasts (HTF). Method Sixteen PACG patients aged 59 ± 10 years (31–72 years), including 6 males and 10 females, were recruited. Tenon tissue was harvested during filtering surgery. Cell density was evaluated after MMC application with different concentrations and application times, by which the optimized MMC application modality was determined. MMC, si-SPARC, or SPARC protein was used when needed to evaluate the cell densities under different conditions, by which the role of SPARC in MMC-mediated antifibrotic process was identified. Results Considering that the cell densities, as well as SPARC expression on mRNA and protein levels, are relatively stable when the MMC concentration is higher than 0.02% and exposure time longer than 90 s, we chose the MMC application pattern with 0.02% and 90 s as an optimized pattern for the downstream work. Compared to control, the si-SPARC and MMC downregulated the SPARC protein by 91% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (Conclusion This study demonstrates that in HTF, (1) MMC downregulates the expression of SPARC in protein and mRNA levels; (2) SPARC depletion has synergistic effect on the antifibrotic effect of MMC; and (3) reactive oxygen species are the possible mediator in the antifibrotic effect of MMC and si-SPARC.

Comparative evaluation of decellularized bovine omentum alone and in combination with mitomycin-C in the management of corneal injuries in dogs.

Background and Aim:Ulcerative corneal lesions are common ocular affections encountered in veterinary ophthalmology, having a higher incidence in dogs with brachycephalic conformation. Prompt and effective diagnosis and repair are necessary to avoid corneal perforation and restore vision. Corneal wound healing is a complex phenomenon often resulting in vision impairment as a consequence of corneal fibrosis and pigmentation. The present study investigated the efficacy of decellularized and gamma-irradiated bovine omentum as an extracellular matrix scaffold in the reconstruction of extensive and full-thickness corneal defects, and the cytotoxic effects of mitomycin-C (MMC) to prevent corneal fibrosis and pigmentation.Materials and Methods:Twelve injured corneas of eleven dogs irrespective of breed, age, and sex were randomly divided into Groups I and II, consisting of six corneas each. Under general anesthesia, corneal grafting with decellularized and gamma-irradiated bovine omentum was carried out in Group I, whereas Group II corneas underwent single time intra-operative application of topical MMC for 2 min before corneal grafting with the same material. Epithelialization of cornea and observations including corneal edema, neovascularization, the extent of pigmentation, corneal clarity, and scarring was recorded on days 7, 14, 21, and 60 postoperatively.Results:All corneas in Group I showed early epithelialization by day 7 compared to Group II where the MMC delayed epithelialization in 50% of the corneas. Visual function scores improved greatly from 0.17±0.17 in Group II on the day of presentation to 1.0±00 by the end of the observation period compared to Group I (from 0.33±0.15 to 0.88±0.11). Although epithelialization and corneal healing were delayed, 50% of the corneas recovered with undetectable corneal scar and melanosis at the end of the observation period in Group II due to the anti-fibrotic effect of MMC.Conclusion:From the present study, it was concluded that re-epithelialization of the cornea was enhanced by corneal grafting with decellularized bovine omentum, and application of MMC was effective in delaying corneal fibrosis and pigmentation.

Effect of topical application of mitomycin-c as an adjuvant treatment of laryngotracheal stenosis

Background Laryngotracheal stenosis (LTS) has become more frequent because of prolonged endotracheal intubation (PEI). The endoscopic treatment of LTS is often associated with high recurrence rate owing to excessive fibrosis. Mitomycin-c (MMC) inhibits fibroblast proliferation, so it is used at the time of endoscopic dilation to improve outcomes. Objective The aim was to assess the effect of application of topical MMC in the treatment of LTS to prevent recurrence of stenosis. Patients and methods A prospective study was carried out on 20 patients with LTS subjected to endoscopic dilatation. All patients were divided to two groups: group A (case group) included 10 patients with LTS who were subjected to endoscopic dilatation with topical application of MMC (0.5 mg/ml), and group B (control group) included 10 patients with LTS who were subjected to endoscopic dilatation without topical application of MMC. A neck computed tomography scan was done for all patients to detect the site and length of stenotic area. Results In group A, LTS was due to PEI in six (30%) patients, due to laryngoscleroma in three (30%) patients, and due to Wegener’s granulomatosis in one (10%) patients, whereas in group B, it was due to PEI in four (40%) patients, due to rhinoscleroma in four (40%) patients, and due to Wegener’s granulomatosis in two (2%) patients. The most common site of stenosis was subglottic and trachea in both groups. Most of the patients in case group ended up with grade 2 dyspnea (mild dyspnea with no limitation to daily activities), whereas three patients in control group achieved this outcome, with a statistically significant difference (P=0.043). None of the patients in the case group developed postoperative stridor 6 months after surgery, compared with four patients in the control group. Conclusion Topical application of MMC as an adjuvant treatment for endoscopic management of LTS has shown good results, low recurrence rate, and high success rate.

Application of asymmetric full-bridge flying-capacitor MMC in marine propulsion motor

Application of asymmetric full-bridge flying-capacitor MMC in marine propulsion motor

Prediction of Ethylene Production Rate of Barangan Banana Using Kinetic Enzymatic Michaelis-Menten

MM is a model that describes the rate of reaction of product ethylene towards the substrate concentration and MMC is an enzymatic kinetics model to see the effect of the increase of O2 on the rate of reaction. The objective of the study was to estimate ethylene production rate in bananas by applying the Michaelis-Menten enzymatic kinetics equation. Barangan Banana with harvest age 11 and 10 weeks were measured respiration rate with continuous gas analyzer in temperature 10, 20, and 28 °C with 3 replications along measurement of ethylene production rate using ethylene meter obtained from a closed system method and represented by Michael-Menten equation. The temperature dependence was represented base on Arrhenius law. The model parameters (KmC2H4 dan rC2H4 max) are calculated using Lineweaver-Burk linier graph method. MM and MMC applications can be used to estimate ethylene production rate of Barangan banana. MM equation resulted that 11-week harvest age obtaining R2 was higher than 10 weeks 0.95 while the 10-week harvested R2 0.94. MMC equation, the 11-week harvest age R2 0.95 was higher compared to 10 weeks R2 0.94. It could be predicted that MM and MMC equations can predicted the rate of ethylene production of Barangan banana

A randomized controlled trial of adjuvant mitomycin-c in endoscopic surgery for laryngotracheal stenosis.

Topical mitomycin-C (MMC) application is a commonly accepted adjuvant therapy in the surgical treatment for laryngotracheal stenosis (LTS). However, the efficacy of MMC has not been examined in a prospective, randomized clinical trial in humans. We aimed to examine the efficacy of MMC in the treatment of LTS patients as compared to a placebo-controlled group. Prospective, randomized, double-blind, placebo-controlled clinical trial. Fifteen patients with LTS were enrolled in a 24-month trial and randomized into one of two groups: 1) endoscopic surgical treatment with topical application of MMC or 2) endoscopic surgical treatment with topical application of saline. Postoperatively, patients were evaluated at standardized intervals with a symptom questionnaire and spirometry. Subsequent surgery was performed as needed based on relapse of stenosis on exam and patient-reported symptom severity. The average interval between surgical treatments was 17.9 months in the placebo group and 17.4 months in the MMC group (P = .95). There was no difference in magnitude of peak inspiratory flow (PIF) improvement between groups. The average magnitude of PIF change was 1.3 L/sec and 1.1 L/sec for the placebo and MMC groups, respectively (P = .64). Similarly, there was no difference in magnitude of symptom improvement or duration of symptom improvement between the two groups. This prospective, randomized. double-blind. placebo-controlled trial suggests that the use of MMC as a topical adjuvant therapy has no additional benefit in the endoscopic surgical management of LTS. Further study is needed. 1b Laryngoscope, 130:706-711, 2020.

LASIK-induced corneal changes after correction of hyperopia with and without application of Mitomycin-C

BackgroundThe study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+ 1.00 D to + 6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period.MethodsThis comparative randomized control study included 68 hyperopic patients (136 eyes) divided into two groups; Group A included 34 patients (68 eyes) that had LASIK with the application of 0.02% MMC for 10 s on the stromal bed after excimer laser treatment, and group B included 34 patients (68 eyes) that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period.ResultsBetter predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of + 0.5 ± 0.31 D in group A and + 0.67 ± 0.39 D in group B at the 6 month visit, and + 0.63 ± 0.37 D in group A and + 0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B.ConclusionsIntraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year.Trial registrationthe Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

A Capacitor Voltage Balancing Approach Based on Mapping Strategy for MMC Applications

This paper proposes a new strategy to achieve balanced capacitor voltages in modular multilevel converters. Among the possible solutions, centralized arm control approaches are often adopted. These methods require a balancing technique based on a sorted list of the sub-modules according to their capacitor voltages. In order to achieve the aforementioned sorted list, different algorithms have been proposed in literature, such as: Sorting algorithms, max/min approaches, etc. However, the sorting algorithms require a long execution time, while the max/min approaches affect the converter dynamic response during faults. To overcome these issues, a new mapping strategy providing a quasi-sorted list is proposed in this paper. The suggested method is compared in simulation with both the classical bubble sorting algorithm, and the max/min method during both normal and faulty conditions. Moreover, the three methods have been implemented in a Xilinx Zynq-7000 System-on-Chip (SoC) device, in order to analyze the corresponding execution time and the required computational effort. Hardware-in-the-loop results are presented for demonstrating the superior performance of the proposed balancing strategy.

The effectiveness of colchicine combined with mitomycin C to prolong bleb function in trabeculectomy in rabbits.

PurposeTo investigate the potential of colchicine to improve bleb function after trabeculectomy.MethodsTo find the maximum usable colchicine concentration, an ocular irritation study was performed with the Draize test at concentrations of 0.001%, 0.01% and 0.1%. Additionally, the synergistic effect of topical colchicine instillation and MMC application to surgical site was evaluated in a rabbit model by measuring changes after trabeculectomy in intraocular pressure (IOP) and bleb morphology score at 3, 7, 14, 21, 28, 35, 42, and 49 days.ResultsExperiments with a rabbit model of trabeculectomy showed that 0.04% MMC plus 0.01% colchicine was more effective than saline and 0.04% MMC alone in maintaining IOP reduction at days 7–49 (P < 0.01 at all time points) and day 49 (P < 0.05), respectively, while 0.04% MMC alone was more effective than saline only at days 7–35 (P < 0.05 at all time points). 0.04% MMC plus 0.01% colchicine and 0.04% MMC alone were more effective than saline at preserving bleb score at days 7–21 and 35–49 (P < 0.05 at all time points) and at days 7–35 (P < 0.05 at all time points), respectively.ConclusionColchicine may be a promising adjuvant for strengthening the effect of MMC and improving the survival of the filtering bleb in trabeculectomy.

The predictive factor for conjunctival melanoma recurrence

Conjunctival melanoma potentially deadly tumor. While many cases of conjunctival melanoma appeared to be a recurrence, there is no valid data about parameters to predict the recurrence of this tumor. This study intended to evaluate whether histopathologic features can be used as a predictor for recurrence in conjunctival melanoma. This was a retrospective study, involving patients with conjunctival melanoma by the year 2013-1017 in Dr. Sardjito General Hospital and Dr. Yap Eye Hospital, Yogyakarta. Patient’s characteristic was determined by age, sex, laterality, tumor size, tumor location, histopathological dominancy, MMC application, recurrence, and metastases. Sixteen cases were found: male (62.5%) and female (37.5%). Age from 5-79 years, mean was 56.19 years. Tumor location was in bulbar in 11 patients (68.7%), palpebral in 5 patients (31.3%).There was significant association between metastasis and the tumor recurrence (OR 13.0; 95% CI 1.9-85.4; p = 0.007). A favorable trend of association was also found between location and the recurrence of melanoma (OR 15.0; 95% CI 0.9-228.8; p = 0.06). In summary, our study showed that the patients that developing distant metastasis were at a greater risk for tumor recurrence.

Role of Topical Mytomycin C Application in Improving Outcome of Functional Endoscopic Sinus Surgery

Background: functional endoscopic sinus surgery, (FESS), is a minimally invasive surgical procedure that opens up the paranasal sinus ostia with an endoscope. Endoscopic sinus surgery is seen as the standard treatment in chronic rhinosinusitis and Sinonasal polyposis. Objective: it was to assess the efficacy of intra and postoperative topical application of Mitomycin C after endoscopic sinus surgery in reducing adhesions and scar formation and improving outcome of FESS. Patients and Methods: this study included 60 cases (24 female (40%) and 36 male (60%) ranging in age from 18 to 50 years) with mean 34 bilateral chronic rhinosinusitis with or without sinonasal polyposis undergoing functional endoscopic sinus surgery. Every patient in this study had been submitted for full history taking, general examination, full ENT examination routine preoperative laboratory investigations and computerized tomography study on the nose and paranasal sinuses. Functional endoscopic sinus surgery had been done for all patients. Results: In our study, bilateral nasal obstruction was presented in 46 patients (76.6%), anterior nasal discharge was presented in 22 patients (36.6%), posterior nasal discharge was presented in 18 patients (30%), headache was presented in 40 patients (66.6%) and facial pain was presented in 12 patients (20%). Endoscopic assessment of the patients 2 months after F.E.S.S revealed that the adhesions presented in 32 sides (26.7%) mainly occurred on the control side 25 (41.7%) while the Mitomycin C side showed minimal adhesions 7 (11.7%) with significant P value (0.04). Conclusion: Topical application of MMC at end of FESS has beneficial role in prevention of adhesion formation and synechiae without any side effects/complications.

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

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

Efficacy of Intraoperative Mitomycin-C in Vasovasostomy Procedure: A Randomized Clinical Trial.

BackgroundTwo-six percentage of vasectomized men will ultimately seek vasectomy reversal, which late stricture and obstruction after operation are relatively common. To find a method for improving vasovasostomy outcomes, we used intra-operative local mitomycin-C (MMC) preventing possible fibrosis and stricture.Materials and MethodsIn this randomized clinical trial, 44 patients were assigned to two groups randomly during a one-year study and the data of 40 patients were analyzed. The patients were followed up for 6 months after surgery. The case group (n=19) was treated by vasovasostomy with intra-operative local MMC. The control group (n=21) underwent standard vasovasostomy.ResultsMean sperm count in MMC group was significantly higher than the controls. The sperm count of more than 20 million/ml was respectively 53% and 14% in MMC and control groups. In a subgroup where the interval between vasectomy and reversal was 5-10 years, post-reversal azoospermia was absent in MMC group, but 50% of the controls were still azoospermic. In addition, 80% of MMC group had more than 20 million/ml sperms, but all of the controls had less than 20 million/ml sperms. No significant complication was seen.ConclusionIntra-operative local MMC in vasovasostomy can be regarded as a safe and efficient technique which has several advantages including lower cost. Increase of sperm count is the main effect of local MMC applica- tion that is more prominent when the interval between vasectomy and reversal is 5-10 years (Registration number: IRCT2015092324166N1).