A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

Effects of Mitomycin C on Corneal Endothelium in Pterygium Surgery: Role of Application Location A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M JabbarvandMD, H Hashemian MD Farabi Eye Hospital, Tehran, Iran The authors have no financial interest in the subject matter of this presentation. E-mail: akheirkh@yahoo.com

Introduction Mitomycin C (MMC) is commonly used in pterygium surgery to reduce the recurrence rate. It has been used either on the bare sclera or under conjunctiva deep in the fornix (to avoid scleral melting). It has been shown that MMC application on the bare sclera during pterygium surgery is associated with significant corneal endothelial cell loss. (Avisar 2008, Bahar 2009) However, it is not clear whether application of MMC under conjunctiva deep in the fornix results to same degrees of endothelial cell loss as its application on the bare sclera.

Purpose • To compare the changes in corneal endothelial cell counts after pterygium surgery with application of mitomycin C either on the bare sclera or under conjunctiva deep in the fornix.

Method Controlled prospective study. 56 eyes with primary pterygium underwent excision followed by mitomycinC 0.02% application and then amniotic membrane transplantation. These were randomly stratified into 2 groups. In one group (n=28), MMC was applied on the bare sclera; and in the other group (n=28), MMC was applied under the conjunctiva deep into the fornix.

Method Duration of mitomycin C application: 1 minute for 3 minutes for 5 minutes for atrophic pterygium intermediate pterygium fleshy pterygium episcleral vessels episcleral vessels episcleralvessels un-obscured* partially obscured* totally obscured* * Tan DT. Arch Ophthalmol 1998;116:552.

Method • Corneal endothelial cell counts were evaluated before and after surgery (1 week,1 month, 3 months and 6 months). • Endothelial cell were counted by specular microscopy. An average of three measurements was recorded. • Independent sample t-test and ANOVA were used to compare the values between the groups.

Results • No difference in preoperative characteristics between the 2 groups.

Results • No difference in endothelial cell counts (ECC) after surgery between the 2 groups. * Percentage of reduction of ECC compared to preoperative values

Results • Longer durations of MMC application were associated with greater endothelial cell loss in both groups, but without significant difference between the 2 groups.

Conclusion • Mitomycin C use during pterygium surgery can cause a significant decrease in endothelial cell count regardless of its application either on the bare sclera or under conjunctiva deep in the fornix.

Contact Information Ahmad Kheirkhah MD Ocular Surface Clinic Farabi Eye Hospital Tehran University of Medical Sciences Tehran, Iran Akheirkh@yahoo.com

A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

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