Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application.
OBJECTIVE
To raise awareness among clinicians about the risk of severe complications after cosmetic conjunctivectomy plus postsurgical topical mitomycin C (MMC) treatment.


METHODS
We retrospectively reviewed the medical records of 48 consecutive patients who received cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment to eliminate conjunctival injection and visited our outpatient clinic between January 2009 and January 2011.


RESULTS
Forty-four patients (91.67%) developed complications after cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment. Complications included chronic conjunctival epithelial defects (22 patients), scleral thinning with (19 patients) or without (2 patients) calcified plaques, fibrovascular conjunctival adhesion at the muscle insertion site (15 patients), chronic dysfunctional tear syndrome (11 patients), avascular zones (10 patients), abnormal vessel growth (5 patients), lymphangiectasis (3 patients), adhesions of Tenon capsule and the conjunctiva at the extraocular muscle insertion site (1 patient), extraocular muscle fiber exposure (1 patient), and diplopia (9 patients). The mean time between surgery and the onset of diplopia was 1.67 months (range, 1-3 months), and the mean deviation was 11.0 prism diopters (range, 0-25 prism diopters) in the primary position. Three patients underwent strabismus surgery due to incomitant esotropia. Eight patients underwent calcified plaque removal because of severe progression of the calcification. Five patients underwent conjunctival flap operation because of severe progressive scleral thinning.


CONCLUSIONS
Cosmetic wide conjunctivectomy, which has been advertised as a simple and effective surgical option for the treatment of conjunctival injection, has caused disruption in the normal physiology of the ocular surface, which leads to various devastating complications.
Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea.
Soolienah
S
Rhiu
Jongwoo
J
Shim
Eung Kweon
EK
Kim
Sung Kun
SK
Chung
Jong Soo
JS
Lee
Jong Bok
JB
Lee
Kyoung Yul
KY
Seo
D000328:Adult; D001252:Astringents / Q000008:administration & dosage*; D003228:Conjunctiva / Q000187:drug effects* / Q000601:surgery*; D003229:Conjunctival Diseases / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity
D001252:Astringents; D016685:Mitomycin