Effect of Trans-PRK combined with 0.02% MMC on corneal density in patients with moderate myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the effect of 0.02% mitomycin-C(MMC)on the corneal density after transepithelial photorefractive keratectomy(Trans-PRK). METHODS: Retrospective case analysis. Selected 28 patients with 56 eyes in moderate myopia who underwent Trans-PRK surgery from January 2021 to June 2021 in our hospital. They were divided into MMC group in 28 eyes with a combination of 0.02% MMC 20s during the surgery and the control group in 28 eyes was not use MMC during the surgery. The Pentacam anterior segment analyzer was used to measured the corneal density in different diameter ranges and different thickness layers before and after surgery at 14d, and after surgery at 1 and 3mo.RESULTS: The total corneal density value of MMC group was 16.60(15.70,17.10 )before the surgery, after the surgery at 14d was 16.63(15.90,17.50 ), at 1mo was 16.57(15.10,16.70 ), at 3mo was 16.04(14.60,16.60 ). The total corneal density value of control group was 16.30(15.50,17.30 )before the surgery, after the surgery at 14d was 16.20(15.20,17.10 ), at 1mo was 16.08(14.90,16.40 )and at 3mo was 15.60(14.60,16.40 ). In the zone of 0-2mm diameter was centered on the corneal vertex, the corneal density of the two groups at 14d after the surgery was higher than those before surgery(P<0.001 ). In the zone of 2-6mm diameter, the corneal density of the two groups at 1mo and 3mo after surgery was higher than those before the surgery(P<0.001). In the zone of 6-10mm, the corneal density of the two groups at 14d, 1 and 3mo after surgery was higher than those before the surgery(P<0.001). In the layer of anterior 120 μm, the corneal density of the two groups at 1mo and 3mo after the surgery was decreased than that before surgery(P<0.01). In the middle layer, the corneal density of the two groups at 1mo after the surgery was decreased than those before surgery(P<0.01).CONCLUSION:The use of 0.02% MMC during the operation can reduce the corneal density and increase the corneal light transmittance in the early postoperative period. The occurrence and prognosis of haze can be effectively quantified by observing the changes of corneal optical density in different ranges in different time periods after operation.

Topical 002% Mitomycin C for management of primary corneal-conjunctival intraepithelial neoplasia as primary therapy: A long term follow up

Background: The corneal-conjunctival intraepithelial neoplasia (CCIN) is an ocular surface neoplasia commonly found among populations exposed to strong UV light. Although surgical excision is mainstay treatment, topical Mitomycin-C (MMC) 0.02% has been tried as a sole therapeutic treatment of non- invasive Ocular Surface Squamous Neoplasia (OSSN). Aim: The aim of this study was to report the long term outcome of treatment of non invasive ocular surface squamous neoplasia with topical Mitomycin C (0.02%) as primary therapy. Materials and methods: Total six eyes of six patients with CCIN were treated with topical mitomycin C (0.02%) alone as a sole therapy. All patients received topical MMC (0.02%) four times daily as a cycle therapy of two week ON and two week OFF for 12 weeks. The patients were followed up to two years. Results: All patients showed total cure with no recurrence during 2 years follow up period. Ocular irritation and mild conjunctival hyperemia were observed in 4 eyes during treatment with MMC. There were no serious complications noted at the end of the follow-up period. Conclusion: We concluded that Topical Mitomycin C (0.02%) may be used as a sole therapeutic treatment of non invasive Ocular surface squamous neoplasia with close on going follow-up.

Results of Trabeculectomy Using Modified Scleral Flap Suture Technique in Comparison with Standard Trabeculectomy

PURPOSE: To evaluate the efficacy of trabeculectomy using modified scleral flap suture technique METHODS: We retrospectively reviewed the medical records of 52 patients (55 eyes) who had undergone trabeculectomy from January 2003 to January 2007. Standard trabeculectomy was performed for 29 eyes of 27 patients, modified trabeculectomy for 26 eyes of 25 patients. We changed suture site of scleral flap corner about 1mm medially from original site and added tight suture to both lateral margins of scleral flap to prevent overflow in modified group. In both groups, most of patients were injected 0.1 ml of 0.02 mg/ml mitomycin-C (MMC) subconjunctivally and the others 0.1 ml of 0.04 mg/ml MMC. We evaluated intraocular pressure (IOP), complication, morphology of filtering bleb, cumulative success rates. RESULTS: Argon laser suturelysis was performed postoperatively in about half cases of both groups. The IOPs of modified group were consistently lower than those of standard group for 24 months except postoperative 1 day and 1 week. There was a significant difference of IOP at postoperative 2 months and 12 months (p<0.05). No significant difference of complications was found between two groups. The diffuse bleb with microcyst was found in 19 eyes (73%) of modified group and 17 eyes (59%) of standard group. From Kaplan-Meier survival analysis, cumulative success rates of modified group were higher than those of standard group (p<0.05). CONCLUSIONS: Trabeculectomy using modified scleral flap suture appears to give better IOP control than standard trabeculectomy.

Effect of mitomycin C instilled immediately after TUR added with low dose BCG maintenance therapy to prevent recurrence of superficial bladder cancer / 中国康复理论与实践

@#Objective To observe therapeutic effects of intravesical instillation of mitomycin C (MMC) immediately after TUR added with low dose BCG maintenance therapy to prevent recurrence of superficial bladder cancer. Methods 83 patients with superficial bladder cancer were randomly divided into two groups, 50 cases were managed with intravesical instillation of mitomycin C immediately after TUR added with low dose BCG maintenance therapy (group A), 33 cases were treated with traditional method of MMC therapy (group B) to prevent recurrence of superficial bladder cancer. Results After 12-66 months (mean 32 months) following up, 3 patients had tumor recurrence in the group A and 7 patients in the group B, the rate of tumor recurrence of the group A was 6.0% (3/50) and that of the group B was 21.2%(7/33), and there was a significantly difference between two groups (P<0.05). Side effects of the group B were obviously more than that of the group A. Conclusion Intravesical instillation of MMC immediately after TUR added with low dose BCG maintenance therapy is effective to prevent patients with superficial bladder cancer from recurrence.

Needle Revision on Failed Filtering Blebs Using Mitomycin C

PURPOSE: To determine the success rate and complications of Mitomycin C (MMC) augmented needle revision on failed filtering blebs. METHODS: We retrospectively investigated the records of 30 patients (32 eyes) who had undergone needle revision with MMC on failed filtering blebs. A mixture of 0.02 ml of MMC (0.4 mg/ml) and 0.02 ml of 2% lidocaine (20 mg/ml) was injected subconjunctivally. 5 minutes later, needle revision was done with bented 30 gauge needle. RESULTS: The mean Intraocular pressure(IOP) decreased from 28.1+/-9.4 mm Hg before surgery to 14.7+/-6.2 mmHg at the last follow-up. The mean follow-up period after the last needle revision was 23.5+/-19.4 months. In 27 eyes (84.4%), the last IOP was less than or equal to 18 mmHg. Serious complications were not found. CONCLUSIONS: MMC augmented needle revision appears to be an effective way to revive failed filtration blebs. The incidence of complications compares favorably to that of other glaucoma related surgery.

Inhibitory Effect of Mitomycin C (MMC) on the Proliferation of Human Corneal Keratocyte

PURPOSE: To evaluate the anti-proliferative effect of mitomycin C (MMC) on human corneal keratocyte, and to investigate the cellular morphology of keratocyte according to the concentration and exposure time in vitro. METHODS: Human corneal keratocytes using endothelium-free explant method were exposed to 0.005%, 0.01%, and 0.05% concentration of MMC for 3, 5, and 10 minutes. MTT based colorimetric assay was performed to assess the inhibition of cellular proliferation, and cellular morphology was evaluated by inverted phase-contrast light microscope and electron microscope. RESULTS: Use of higher concentration MMC and prolongation of exposure time resulted in greater inhibitory effect on cellular proliferation. When exposed to 0.005% MMC for 3, 5 and 10 minutes, the survival rate of keratocyte was 100%, 95.7% and 74.0% respectively. At 0.01% MMC, the survival rate was 98.6%, 92.9%, and 66.9%. At 0.05% MMC, it was 74.0%, 73.4%, and 38.8%. Exposure to the highest concentration (0.05%) among the 3 preparations for 3 or 5 minutes showed significant inhibition of keratocyte proliferation (p<0.05), and when exposed for 10 minutes, all 3 preparations showed significant inhibition of keratocyte proliferation (p<0.05). Inverted phase-contrast light microscopy showed that human corneal keratocytes lost their adherence to the bottom of the dish and assumed round and swollen shape rather than spindle shape when exposed to higher concentration of MMC for a prolonged time. The damaged keratocytes showed the degenerative changes like cellular membrane disruption, disappearance of microvilli, enlargement of rough surfaced endoplasmic reticulum and mitochondria, and vacuole formation by electronic microscope. CONCLUSIONS: When MMC is applied to inhibit the proliferation of keratocytes involved in corneal wound healing, it seems to be a valuable application at least 0.05% concentration for 3 minutes. Further studies should be followed for the biological effect of MMC including drug toxicity associated with human corneal tissue in vivo.

The Toxic and Morphologic Effects of Mitomycin-C, 5-FU and Genistein on Rabbit Corneal Endothelium

PURPOSE: We determined the toxic and morphologic effects of the anti-proliferative drugs, mitomycin-C (MMC), 5-fluorouracil (5-FU) and genistein on rabbit corneal endothelium. METHODS: After intramuscular anesthesia, each drug of different concentrations (MMC at 0.05, 0.1, and 0.2 mg/ml; 5-FU at 5, 10, and 50 mg/ml; and genistein at 0.013, 0.027, and 0.054 mg/ml) was perfused into the anterior chamber of 54 white rabbits (108 eyes). The same amount of balanced salt solution was perfused into control eyes. The corneal thickness was measured before perfusion and 15 min, 30 min, 45 min, 1 h, and 24 h after perfusion. Corneal samples were prepared at 24 h after perfusion to determine the changes in corneal thickness and to observe morphologic changes of corneal endothelium under scanning electron microscope (SEM). RESULTS: A significant increase in corneal thickness was observed. Destruction of corneal endothelial cell structure was seen under scanning electron microscope at 24 h after perfusion with MMC at 0.2 mg/ml for 1, 3, and 5 min, and at 0.1 mg/ml for 5 min; and 5-FU at 50 mg/ml for 5 min into the anterior chamber. However, no significant difference was seen in corneal thickness or in corneal endothelial morphology at 24 h after perfusion with genistein. CONCLUSIONS: To avoid morphologic changes of the cornea, we recommend the anterior chamber perfusion of MMC at 0.1 mg/ml between 1 and 2 min, 5-FU at 10 mg/ml between 3 and 5 min, and genistein at 0.027 mg/ml for 5 min. Genistein at low concentrations showed no morphologic change in the cornea, suggesting the possible clinical use with safety.

Clinica study comparing HMVP and MVP regimens in the treatment of advanced non-small cell lung cancer / 中国癌症杂志

0.05). No significant differences were detected in the median time of remission, median survival time and 1-, 2-year survival rates between the groups. Moreover, no significant differences were detected in the grade Ⅲ～Ⅳ leukopenia, grade Ⅲ～Ⅳ thrombocytopenia, grade Ⅲ～Ⅳ nausea and vomiting and grade Ⅲ～Ⅳ constipation between the groups. Conclusions:The response rate of the MVP regimen is slightly lower than the HMVP regimen, but the HMVP regimen is not noticeably superior. It may increase the toxicity such as leukopenia, nausea/vomiting and constipation, as wellas being more expensive. In short, MVP regimen should be selected between the regimens in the chemotherapy of advanced NSCLC.

The Effect of MMC on Chick Lens and its Mechanism

Mitomycin C (MMC)is used in trabeculectomy to promote the intraocular pressure control, but at the same time it also seems to increase the risk of cataract. In this study, we investigated the mechanism by which MMC causes lens opacity.The whole lenses were extracted from fertilized eggs of 11~13 days and cultured in M199 media supplemented with fetal bovine serum (FBS)at 38 degrees C.Levels of Lipid peroxidation (LPO)and Glutathione (GSH)were measured 24 hours and 5 minutes after treatment with 1 mg/ml MMC for 5 minutes.Changes of lenses by MMC were examined by light microscopy, and the modification of lens proteins was analyzed by SDS-PAGE and size exclusion column. Lens opacity was induced by MMC treatment in concentration of 1 mg/ml for 5 min, and MMC treated lenses showed 3 times higher LPO level and 2 times lower GSH level than normal lenses.In ultrastructure of opaque lenses, many vacuole formations in cortical area near equatorial zone were found.In electrophoresis followed by silver staining and size exclusion column profile, high molecular weight formation of lens proteins by MMC treatment was mainly due to disulfide bond.Also, when we treated the lens with antioxidants, the extent of opacity was decreased. In this study, we demonstrated that lenses treated with MMC became opaque mainly due to oxidative stress resulting in HMW formation of lens proteins by disulfide formation as well as irreversible oxidation.

The Effect of Mitomycin C Trabeculectomy in Neovascular Glaucoma

The authors studied retrospectively the results of mitomycin C (MMC) trabeculectomy in 19 eyes with neovascular glaucoma which could be followed up more than 4 months after surgery. Twelve eyes(63%) were classified as success group and 7 eyes(37%) were classified as failure group. In the success group, the mean intraocular pressure(IOP) was significantly reduced from 52.1+/-10.1mmHg preoperatively to 10.1+/-3.8mmHg at last follow Kaplan-Meier survival analysis, cumulative success rates at 6 and 12 months intervals were 68%, 59% respectively. In the failure group, the mean IOP was reduced significantly from 51.9+/-8.1mmHg preoperatively to 26.6+/-13.4mmHg at last follow up. The mean number of medications to reduce IOP was also reduced from 2.6+/-0.5 preoperatively to 1.3+/-0.8 at last follow up. The causes for failure were inadequate IOP control in 5 eyes(26%), loss of light perception in 1 eye(5%), and reoperation to reduce IOP(5%). Complication included hypotony in 4 eyes(21%), late bleb leakage in 2 eyes(10.5%), spontaneous hyphema in 2 eyes(10.5%), cataract progression needing extraction in 2 eyes(10.5%). We think that MMC trabeculectomy may be the first choice procedure before doing cyclocyro-therapry or cyclodestructive procedure using laser.

The Effects of Mitomycin C on Trabeculectomy

Mitomycin C (MMC) is an antimetabolite, antibiotic which prevents the proliferation of fibroblast and fibrosis by inhibition of DNA-dependent RNA synthesis. It has been used to increase the success rate of filtering surgery. We performed trabeculectomy and peripheral iridectomy with 0.4 mg/ml MMC application for 3 minutes in poor prognostic glaucoma patient, 26 eyes of 24 patients from February 1992 to December 1994. The postoperative change of intraocular pressure (IOP) and complications were followed up from 3 to 30 months (mean 12.4 months). The preoperative and postoperative mean IOP after 24 months were 32.3 +/- 11.4 mmHg and 12.7 +/- 3.1 mmHg, respectively. The decrease rate of IOP was 60.7% and the success rate was 71.7%. The postoperative complications were 15 eyes including 5 eyes of shallow anterior chamber, 5 eyes of hyphema, 2 eyes of conjunctival wound leakage, one eye of bleb rupture, one eye of choroidal detachment, and one eye of cataract formation.

The Effect of 5-Fluorouracil or Mitomycin-C in Glaucoma Filtration Surgery on the Rabbit Cornea and Sclera

The authors investigated the toxicity of two antimetabolites. 5-fluorouracil(5-FU) and mitomycin-C(MMC) on the rabbit cornea and sclera following glaucoma filtration surgery(GFS). Forty rabbits were divided into four groups; the first control group(I) was the balanced salt solution soaked group(BSS) during GFS, the second(II) was the 5-FU subconjunctival injected group(5-FU SC) after GFS, the third(III) was the 5-FU soaked group(5-FU) during GFS, and the fourth(IV) was the MMC soaked group(MMC) during GFS. At the fifth day after GFS, scanning electron microscopic findings showed that corneal epithelial cells were most seriously damaged in 5-FU SC group, slightly damaged in 5-FU group, and no change in MMC and BSS group. At six months after GFS, transmission electron microscopic observation on sclera revealed the most profound degenerative changes in 5-FU group, and followed by an order of MMC, 5-FU SC, and BSS group. These results suggest that the dosage and application method of antimetabolites should be selected with great caution to prevent ocular toxicity.

Ultrastructural Changes of The Scleral Fibroblasts after Glaucoma Filtering Surgery with Intraoperative Mitomycin-C in Rabbit Eyes

We investigated the long-term scleral toxicity after single intraoperative exposure to mitomycin-C(MMC) at 2 different exposure length of time and with or without profuse irrigation after the MMC applications during glaucoma filtering surgery(GFS) in rabbit eyes. Albino rabbits undergoing GFS received a single exposure to MMC 0.5 mg/ml for 1 or 5 minutes with placing MMC-soaked sponges between the conjunctival flap and the scleral bed. A subsequent irrigation of the exposed tissue with 250 ml of balanced salt solution(BSS) was done in one group but not in the other groups. Six months after GFS, the eyes were enucleated and fixed in glutaraldehyde for transmission electron microscopy(TEM). TEM revealed degenerative changes of the fibroblasts at the middle portion of sclera in all MMC treated groups. There were some differences between the groups with 1 minute and 5 minutes exposure to MMC. No discernible differences existed in the ultrastructural findings of the scleral fibroblasts between the groups with or without BSS irrgation after 5-minutes exposure to MMC. Our observation suggest that an exposure to MMC 0.5 mg/ml can cause longterm scleral fibroblast toxicity. There was no discernible differences in scleral fibroblast toxicity between the groups with and without profuse BSS irrigation.