title: Mitomycin C-associated scleral stromalysis after pterygium surgery.
abstract: OBJECTIVE
  To describe complications after use of mitomycin C (MMC) as a surgical adjuvant in pterygium surgery.
  
  
  METHODS
  This is a retrospective chart review of patients presenting to a tertiary referral center over a 7-year period with a diagnosis of scleral stromalysis after previous pterygium removal.
  
  
  RESULTS
  Sixteen eyes of 15 patients were identified with scleral stromalysis after pterygium surgery with the use of adjuvant MMC. Three eyes were excluded because of insufficient chart information or previous beta-irradiation treatment. Twelve of 13 eyes underwent surgical treatment for primary pterygium, and 1 eye was treated for recurrent pterygium. Time from initial pterygium surgery to presentation ranged from 1 month to 10 years. Dosage and routes of MMC administration included 0.02% intraoperative application to either the bare sclera or Tenon capsule with a range of 30 seconds to 3 minutes or topical administration 4 times daily for 2 weeks. In some cases, the dose and route of MMC administration were unknown. Four of 13 patients (31%) required a scleral patch graft with 1 patient (8%) requiring multiple patch grafts.
  
  
  CONCLUSIONS
  Use of MMC in various forms and concentrations can cause devastating complications including scleral stromalysis. Scleral stromalysis may present anywhere from months to years after application. We suggest that MMC should be used with extreme caution when used as a surgical adjuvant for pterygium surgery. Patients must be urged to continue long-term follow-up after MMC use because of the potential for future anterior segment complications.
authors.affiliation: Division of Ophthalmology, Piedmont Hospital; Cornea Service, Eye Consultants of Atlanta, Atlanta, GA.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Lindquist
authors.forename: W Barry
authors.initials: WB
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000009:adverse effects*; D013508:Ophthalmologic Surgical Procedures; D011625:Pterygium / Q000188:drug therapy / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012590:Sclera / Q000187:drug effects*; D015422:Scleral Diseases / Q000139:chemically induced*
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin