Corneal and conjunctival findings after mitomycin C application in pterygium surgery: an in-vivo confocal microscopy study.
OBJECTIVE
To perform a qualitative assessment of the topical side-effects of mitomycin C on cornea after pterygium surgery.


METHODS
In-vivo confocal microscopy (Heidelberg Retina Tomograph II in combination with the Rostock Cornea Module) was performed in 10 patients with unilateral primary pterygium. Mitomycin C 0.02% was applied topically to seven eyes for 5 min intraoperatively and twice daily for 5 days postoperatively. Three eyes underwent surgery without application of cytostatic agent. Patient follow-up was 1 month.


RESULTS
After application of mitomycin C, complete epithelialization of the operated zone was found 2 weeks after surgery. In-vivo confocal microscopy revealed signs of superficial punctate keratitis for 2 weeks in the central cornea only after application of mitomycin C. The presence of epithelial and stromal oedema in this group was noted for up to 2 weeks in the central cornea and for up to 4 weeks in the operated zone. In the control group, complete epithelialization was found after 1 week; there were no signs of oedema after 1 week in the central cornea or after 2 weeks in the operated zone. Leucocyte infiltration and increased Langerhans cell density were noted in both groups in the operated and central zones. Analysis of the conjunctiva revealed a decrease in goblet cell density following cytostatic application.


CONCLUSIONS
Local application of mitomycin C delays corneal epithelialization, and prolongs postoperative epithelial and stromal oedema in both the centre and periphery. Moreover, signs of punctate keratitis were noted 2 weeks after surgery in central intact cornea. Nevertheless, in-vivo confocal microscopy shows that these changes are reversible 4 weeks after application of mitomycin C 0.02%.
Zhivov
Andrey
A
Department of Ophthalmology, University of Rostock, Germany. andyzhyvov@yahoo.com
Beck
Ria
R
Guthoff
Rudolf F
RF
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003228:Conjunctiva / Q000187:drug effects* / Q000503:physiopathology; D003315:Cornea / Q000187:drug effects* / Q000503:physiopathology; D015715:Corneal Edema / Q000209:etiology / Q000503:physiopathology; D004334:Drug Administration Schedule; D019573:Epithelium, Corneal / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D007634:Keratitis / Q000139:chemically induced / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D011182:Postoperative Care; D011625:Pterygium / Q000601:surgery*; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin