Short term adjunctive mitomycin treatment after pterygium excision

The most common complication following pterygium excision is recurrence. Although several adjunctive therapies are available, the use of mitomycin-C, an alkylating agent that inhibits DNA synthesis, has recently been popularized due to ease of use and a low recurrence rate. With the initial recommended dosage of 1.0 mg/ml QID for two weeks, or when used in the setting of concomitant ocular surface disorders such as severe blepharitis or keratoconjunctivitis sicca, significant complications have been reported. We report the results of a clinical trial of 12 eyes of 10 patients without co-existing ocular surface disease, who underwent bare sclera pterygium excision and adjunctive therapy with low dose mitomycin-C [0.4 mg/ml TID 3 days] therapy between July 1991 and January 1992. Four were recurrent pterygia, while eight were advanced primary pterygia. In the 12-18 month follow up period there have been no recurrences, or significant complications [i.e., persistent epithelial defects, sterile corneal or scleral ulceration, glaucoma, leveitis, or cataract]. Seven out of 12 eyes [58%] developed pyogenic granulomas, all of which were excised successfully. Published reports of significant complications with topical mitomycin-C therapy mandate continued efforts to identify the lowest total dose of this adjunctive therapy that can effectively prevent recurrence of pterygia

Corneal neovascularization in pellucid marginal degeneration

In the classic descriptions of pellucid marginal degeneration, as the name implies, the cornea is free of both scarring and vascularization. We report findings of bilateral, fine, superficial vessels adjacent to the area of corneal thinning in five patients with pellucid marginal corneal degeneration [PMCD]. In two patients, both the extension into the cornea and the width of the vessels progressed during an episode of corneal hydrops, with subsequent regression of the vessel width. After resolution of hydrops due to the development of hard contact lens intolerance, one of these patients underwent a crescentic wedge resection. Histopathology of the excised cornea revealed fine, superficial vessels in Bowman's layer immediately posterior to the epithelial basement membrane

Decision making in superficial keratectomy: manual vs phototherapeutic techniques

Superficial keratectomy is the surgical removal of subepithelial fibrous membranes and/or anterior corneal opacities that occur in a variety of corneal degenerative and dystrophic conditions. Superficial keratectomy may be performed manually or by phototherapeutic ablation with a 193 nm excimer laser. Manual superficial keratectomy is particularly applicable for disorders of the epithelium and basement membrane zone where mechanical removal is technically easy and is not associated with significant postoperative scaring. While phototherapeutic keratectomy has afforded the ability to remove anterior corneal pathology that is not easily amenable to manual keratectomy, this does not automatically make phototherapeutic keratectomy the surgical treatment of choice for every anterior corneal disorder. Appropriate recommendations regarding the treatments of choice can only be made after analyzing the horizontal [optical zone, paracentral zone, peripheral zone] and vertical [pre-Bowman's, Bowman's anterior stromal, stromal] distribution of the pathology, the pattern [nodular, segmental, diffuse, complete] of the pathology, the applicability of manual and phototherapeutic techniques to the pathology, and the functional [visual, nonvisual] objectives of therapy. Sound clinical evaluation and judgment will maximize the opportunity for excellent care afforded by having both of these treatment modalities in the therapeutic armamentarium for anterior corneal disorders