title: A comparative evaluation of the efficacy of intraoperative mitomycin C use after the excision of cobblestone-like papillae in severe atopic and vernal keratoconjunctivitis.
abstract: OBJECTIVE
  To evaluate the effect of intraoperative 0.02% mitomycin-C (MMC) use after excision of cobblestone-like papillae on preventing corneal recurrences compared with simple papillary resection.
  
  
  METHODS
  Thirteen cases of atopic keratoconjunctivitis (AKC) and 6 cases of vernal keratoconjunctivitis (VKC) with a mean age of 12.0 +/- 3.4 years participated in this study. All patients had cobblestone-like papillae on the upper tarsal conjunctiva and corneal ulcers or erosions that were refractory to conventional treatment. Seventeen eyes received simple papillary excision. Papillary excision with intraoperative application of MMC was performed in 7 eyes: 0.02% MMC was applied for 2 minutes to the upper palpebral conjunctiva immediately after papillary excision. Recurrence of corneal lesions and regrowth of papillae were evaluated and compared retrospectively between the 2 groups. Postoperative follow-up ranged from 12 to 18 months.
  
  
  RESULTS
  Papillary regrowth was observed in 14 out of 17 eyes (82.4%) in the simple resection group, whereas regrowth was noted in 4 out of 7 eyes (57.1%) in the MMC group (P > 0.05). The recurrence of corneal lesions was observed in 8 out of 17 eyes (47.1%) in the simple resection group (mean onset 1.5 +/- 1.7 months) compared with 1 eye with corneal recurrence 6 months after surgery in the MMC group (14.3%). The difference was statistically significant (P < 0.05). No complications related to MMC use were observed during the follow-up period.
  
  
  CONCLUSIONS
  MMC-aided papillary resection may be rewarding in well-selected severe AKC and VKC cases in preventing recurrence of corneal complications, but the potential complications of MMC use would suggest caution in its consideration.
authors.affiliation: Department of Ophthalmology, Tokyo Dental College, Ichikawa, Chiba, Japan. maritana@xc4.so-net.ne.jp
authors.forename: Mari
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takano
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Kazumi
authors.initials: K
authors.lastname: Fukagawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Asano-Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujishima
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003233:Conjunctivitis, Allergic / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use*; D009883:Ophthalmic Solutions; D013508:Ophthalmologic Surgical Procedures; D011182:Postoperative Care; D055502:Secondary Prevention
chemical_list: D000903:Antibiotics, Antineoplastic; D009883:Ophthalmic Solutions; D016685:Mitomycin