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Subconjunctival mitomycin C before pterygium excision: an ultrastructural study.

Yi-Sheng Chang¹, Wen-Chung Chen, Sung-Huei Tseng

¹Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

|April 25, 2008

Summary

Subconjunctival mitomycin C (MMC) injection before pterygium surgery reduces recurrence by altering pterygium tissue. MMC causes degeneration of stromal fibroblasts, extracellular matrix, and nerve axons, confirming its effectiveness.

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Area of Science:

Ophthalmology
Cell Biology
Regenerative Medicine

Background:

Pterygium recurrence after excision remains a clinical challenge.
Mitomycin C (MMC) is explored as an adjunctive therapy to reduce recurrence.
Understanding MMC's cellular effects is crucial for optimizing treatment.

Purpose of the Study:

To investigate the ultrastructural changes in pterygium tissue following subconjunctival mitomycin C (MMC) injection.
To evaluate the impact of MMC on pterygium cellular components and extracellular matrix.

Main Methods:

Subconjunctival injection of MMC (0.15 mg/mL) administered one month prior to pterygium excision in four patients.
Two patients served as controls without preoperative MMC treatment.
Transmission electron microscopy (TEM) analysis of excised pterygium specimens.

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Main Results:

No significant changes were observed in epithelial cells.
Stromal fibroblasts showed reduced numbers, altered morphology (oval shape), and signs of degeneration or apoptosis.
Collagen and elastic fibers exhibited decreased density and disorganization; capillary endothelial cells were thickened with narrowed lumens.
Axonal swelling and demyelination were noted in the nerve fibers.

Conclusions:

Subconjunctival MMC injection effectively inhibits fibrovascular proliferation within the pterygium stroma.
MMC induces degeneration of the extracellular matrix and nerve axons, correlating with reduced vascularity.
These ultrastructural findings support the clinical efficacy of preoperative MMC in decreasing pterygium recurrence rates.