Endothelial toxicity possible with adjunctive mitomycin-C during pterygium surgery

Adjunctive use of mitomycin-C (MMC) 0.02% during pterygium surgery results in statistically significant endothelial cell loss, reported Rahamin Avisar, MD.

Dr. Avisar and colleague Dov Weinberger, MD, Rabin Medical Center, Tel Aviv University, used specular microscopy (Konan SP-8800, Monocon Robo) to estimate central corneal endothelial cell counts in a series of 24 consecutive patients who underwent surgery for a primary pterygium. In all cases, MMC 0.02% was applied for 5 minutes intraoperatively.

Mean baseline endothelial cell count was 2,254 cells/mm². Follow-up measurements were obtained after 1 week, 1 month, and 3 months and the comparisons to baseline showed losses in the range of 21% to 24% that were statistically significant.

"There are no published clinical data regarding possible deleterious effects of MMC on the corneal endothelial cells after pterygium surgery," Dr. Avisar said. "Our findings suggest that its local application must result in aqueous levels great enough to cause endothelial cell loss. Long-term follow-up is needed to further evaluate this potential toxic effect on the cornea.

"Additionally, more study is needed to determine the effects of using different MMC concentrations and perhaps whether antioxidants may offer an effective preventive treatment," Dr. Avisar said.