Bullous keratopathy as a complication of trabeculectomy with mitomycin C.
BACKGROUND
The routine use of mitomycin C to enhance glaucomatous filtering surgery has found wide acceptance. Complications of the application of mitomycin C have been repeatedly noticed. We now report a previously undescribed complication showing a toxic effect of mitomycin C to the corneal endothelium.


METHODS
Patients underwent routine trabeculectomy with mitomycin C. Following surgery, the eyes were examined by biomicroscopy and specular microscopy of the corneal endothelium.


RESULTS
In two cases, we observed a partial decompensation of the corneal endothelium resulting in a well-demarcated clear zone of the cornea and a second zone with thickening of the cornea and a bullous keratopathy adjacent to the filtering bleb. The specular microscopy showed marked irregularities of the endothelial cells and areas of necrosis in those parts of the cornea close to the filtering bleb.


CONCLUSIONS
The two cases described here demonstrate that if the corneal endothelium is already compromised before surgery, the application of mitomycin C may have an additional toxic effect on the endothelium and may result in a partial bullous keratopathy. Surgeons should be aware of this complication.
Mietz
Holger
H
Aschaffenburg Eye Center, Aschaffenburg, Germany. h.mietz@augen-ab.de
Roters
Sigrid
S
Krieglstein
Günter K
GK
D000328:Adult; D003316:Corneal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D009883:Ophthalmic Solutions; D011183:Postoperative Complications; D014130:Trabeculectomy / Q000009:adverse effects* / Q000379:methods; D014792:Visual Acuity
D005938:Glucocorticoids; D019384:Nucleic Acid Synthesis Inhibitors; D009883:Ophthalmic Solutions; D016685:Mitomycin