PRESUMED MITOMYCIN C-INDUCED RETINAL TOXICITY AFTER COMBINED CATARACT AND XEN GEL STENT SURGERY

Area of Science:

• Ophthalmology
• Retinal Surgery
• Glaucoma Surgery

Background:

• Combined cataract and Xen gel stent surgery is a common procedure for managing glaucoma and cataracts.
• Mitomycin C (MMC) is frequently used as an adjunct to enhance filtration in glaucoma surgery.
• Retinal toxicity is a known but rare complication associated with MMC use.

Purpose of the Study:

• To report a case of presumed Mitomycin C (MMC)-induced retinal toxicity.
• To describe the clinical presentation and visual outcomes following combined cataract and Xen gel stent surgery with intra-tenon MMC injection.

Main Methods:

• Observational case report.
• Detailed ophthalmological examination including visual acuity, funduscopy, and electroretinography.
• Documentation of intraoperative and postoperative course.

Main Results:

• A 66-year-old male experienced progressive vision loss from 20/25 to light perception (LP) in the operated eye.
• Examination revealed vessel attenuation, sclerotic vessels, and optic nerve pallor without hemorrhage.
• Electroretinogram showed a flat line, indicating severe retinal dysfunction, with no improvement at 125 days postoperatively.

Conclusions:

• Intraocular administration of MMC, particularly via intra-tenon injection during combined cataract and Xen gel stent surgery, poses a risk of severe retinal toxicity.
• Ophthalmologists should exercise caution when using MMC in this surgical context.
• Awareness of this complication is crucial for patient counseling and surgical planning.