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Editors Selection IGR 23-1
Surgical Treatment: Effect of Mitomycin C on Corneal Endothelial Cell Loss
Comment by Jose-Maria Martinez de la Casa on:
76854 Comparison of Mean Corneal Endothelial Cell Loss after Trabeculectomy with and without Mitomycin C, Shaheer M; Amjad A; Ahmed N, Journal of the College of Physicians and Surgeons Pakistan, 2018; 28: 301-303
Trabeculectomy has been the gold-standard surgery for glaucoma since the mid-20th century. Its results have been improved by the use of antimetabolites, especially Mitomycin C (MMC). However, MMC has been linked to multiple adverse effects including the decreases in endothelial cellularity.
MMC has been linked to multiple adverse effects including the decreases in endothelial cellularity
In this article, Shaheer et al. studied the endothelial cell loss produced by the use of MMC as an adjuvant to trabeculectomy in a prospective and randomized study. They compared two groups of 30 patients each with primary open-angle glaucoma who underwent a trabeculectomy for the first time. In one of the groups, MMC was used and in the other one not. The conclusion of the study was that the use of MMC produced a three times higher endothelial cell loss 283 (66.50) vs 72.50 (19.25) cel / mm2 (p < 0.001). This loss represented a decrease of 12.4% in the MMC group and 3.2% in the control group, without the authors specifying when the measurements were made along the postoperative period.
These results are in line with previous studies1-3. Sihota et al.1 studied three groups of patients who were operated on trabeculectomy. They found that the endothelial cell loss was 3.73% (2.73) in the group without MMC and 13.9% (4.7) and 14.5% (7.8) in the MMC groups 0.2 mg/ml and 0.4 mg/ml respectively. Storr Paulsen et al.2 found a decrease of 9.5% and 10% at 3 and 12 months after surgery, showing that the cytotoxic effect of MMC on the endothelium is limited to the moment of surgery and the immediate post-partum without a progressive loss later.
The use of MMC should therefore be extremely careful both in concentration and exposure time and always trying to minimize the passage of it to the anterior chamber to avoid its cytotoxic effects on the endothelium.4
References
- Sihota R, Sharma T, Agarwal HC. Intraoperative mitomycin C and the corneal endothelium. Acta Ophthalmol Scand. 1998;76(1):80-82.
- Storr-Paulsen T, Norregaard JC, Ahmed S, Storr-Paulsen A. Corneal endothelial cell loss after mitomycin C-augmented trabeculectomy. J Glaucoma. 2008;17(8):654-657.
- Dreyer EB, Chaturvedi N, Zurakowski D. Effect of mitomycin C and fluorouracilsupplemented trabeculectomies on the anterior segment. Arch Ophthalmol. 1995;113(5):578-580.
- Hernández-Galilea E, Sánchez F, Guzmán K, et al. [Effect of mitomycin C on corneal endothelium cells. In vitro study]. Arch Soc Esp Oftalmol. 2000;75(8):515-521.
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