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Endothelial cell loss during pterygium surgery: importance of timing of mitomycin C application
Rahamim Avisar1, Itiel Apel, Inbal Avisar
1Rabin Medical Center, Petah Tiqva, Isreal. avi-sar@hotmail.com
Purpose:
To determine if the timing of mitomycin C (MMC) application during pterygium surgery affects endothelial cell loss.
Methods:
A retrospective, nonrandomized, case-series design was used. The study group included 40 patients who underwent pterygium surgery with the bare sclera technique. MMC 0.02% was applied intraoperatively for 5 minutes, either before (16 patients) or after (24 patients) excision of the head of the pterygium. Endothelial images were acquired at the center of the cornea with a specular microscope before surgery and at 3 intervals during follow-up (average of 3 measurements each). Differences in cell loss from baseline were analyzed by paired t test.
Results:
In the group in which MMC was applied post excision, mean preoperative endothelial cell count was 2254 +/- 128 cells per square millimeter. Mean postoperative values were 1775 +/- 63 cells per square millimeter at 1 week (percentage cell loss, 21.25% +/- 2.8%), 1707 +/- 41 cells per square millimeter at 1 month (24.26% +/- 1.8%), and 1780 +/- 72 cells per square millimeter at 3 months (21.05% +/- 3.2%). The difference in cell count from the preoperative value was significant at all time points (P < 0.02). In the group in which MMC was applied before excision, mean preoperative endothelial cell count was 2352 +/- 118 cells per square millimeter, and mean postoperative values were 2345 +/- 120 cell per square millimeter at 1 week, 2260 +/- 162 cells per square millimeter at 1 month, and 2230 +/- 144 cells per square millimeter at 3 months. No endothelial cell loss was documented in this group.
Conclusion:
The endothelial cell loss associated with the use of MMC during pterygium surgery might be avoided by applying MMC before excision of the pterygium head, so that it does not come into contact with the corneal surface.
Insights
Applying mitomycin C (MMC) before pterygium excision prevents endothelial cell loss. This timing ensures the drug does not contact the cornea, safeguarding corneal health during pterygium surgery.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Corneal Health
Background:
- Pterygium surgery often involves adjunctive treatments like mitomycin C (MMC) to prevent recurrence.
- The use of MMC can be associated with potential side effects, including corneal endothelial cell loss.
- Optimizing the application timing of MMC is crucial for patient safety and surgical outcomes.
Purpose of the Study:
- To investigate the impact of mitomycin C (MMC) application timing on corneal endothelial cell loss during pterygium surgery.
- To compare endothelial cell counts following MMC application before versus after pterygium head excision.
Main Methods:
- Retrospective case-series study involving 40 patients undergoing pterygium surgery with the bare sclera technique.
- Mitomycin C (0.02%) was applied intraoperatively for 5 minutes either before (16 patients) or after (24 patients) pterygium head excision.
- Corneal endothelial cell counts were measured using specular microscopy preoperatively and at 1 week, 1 month, and 3 months postoperatively.
Main Results:
- Patients receiving MMC after excision showed significant endothelial cell loss (21-24%) at all follow-up intervals (P < 0.02).
- In contrast, patients receiving MMC before excision exhibited no significant endothelial cell loss compared to baseline.
- Mean endothelial cell counts remained stable postoperatively in the group where MMC was applied pre-excision.
Conclusions:
- Applying mitomycin C (MMC) before pterygium head excision can effectively prevent associated corneal endothelial cell loss.
- This strategic timing minimizes direct contact between MMC and the corneal endothelium.
- Pre-excision MMC application appears to be a safer approach for preserving corneal health in pterygium surgery.
