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The toxicology of mitomycin C on the ciliary body
1Department of Ophthalmology, University of Cologne, Germany.
Abstract:
Over the past few years, the use of mitomycin C (MMC) to reduce surgical failures following filtering procedures has largely increased. After topical application, significant amounts of MMC can be detected intraocularly. In both rabbit and human eyes, a reduction of the normal and elevated intraocular pressures could be achieved with subconjunctival injections of MMC without filtering procedures. Histopathologic examination of the ciliary body in a human eye shortly after surgery with MMC revealed moderate, diffuse toxic changes of the two layers of the ciliary epithelium. By fluorophotometry, eyes after trabeculectomy with MMC had a decreased production of aqueous humor compared with eyes that underwent trabeculectomies without antimetabolites. Independent studies suggest that the toxicity of MMC for the ciliary epithelium may be a significant factor contributing to postoperative hypotony.
Insights
Mitomycin C (MMC) reduces intraocular pressure but can cause toxic changes to the ciliary epithelium. This toxicity may lead to hypotony after glaucoma surgery.
Area of Science:
- Ophthalmology
- Pharmacology
Background:
- Mitomycin C (MMC) is increasingly used to improve success rates of glaucoma filtering surgery.
- Intraocular MMC levels can be significant after topical application.
- MMC has demonstrated intraocular pressure-lowering effects in both normal and elevated pressure models.
Purpose of the Study:
- To investigate the effects of mitomycin C on intraocular pressure and ciliary body in ocular tissues.
- To evaluate the impact of MMC on aqueous humor production.
Main Methods:
- Histopathologic examination of ciliary body tissue from human eyes post-MMC surgery.
- Fluorophotometry to measure aqueous humor production in eyes with and without MMC treatment.
- Subconjunctival injections of MMC in rabbit and human eyes to assess pressure reduction.
Main Results:
- Subconjunctival MMC injections reduced intraocular pressure in both normal and elevated states.
- Histopathology revealed moderate toxic changes in the ciliary epithelium following MMC surgery.
- Eyes treated with MMC after trabeculectomy showed decreased aqueous humor production compared to controls.
Conclusions:
- Mitomycin C exhibits ocular hypotensive effects.
- Toxic changes in the ciliary epithelium are associated with MMC use.
- Reduced aqueous humor production due to ciliary epithelium toxicity may contribute to postoperative hypotony.