Two routes of administration of mitomycin C in a trabeculectomy

Background: The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Purpose: Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Synopsis: Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. Highlights: injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates

Outcomes of bleb needling in primary glaucoma: A prospective interventional study in a South Indian population

Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow?up of six months. Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best?corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit?lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications. Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically. Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries

Comparative evaluation of outcomes of novel approach of subconjunctival Mitomycin C (MMC) injection at the end of trabeculectomy versus intraTenon injection of MMC prior to the initial conjunctival incision – A pilot study

Purpose: To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection. Methods: This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra?ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ?21 mmHg without antiglaucoma drugs. Results: The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg (P ? 0.001) in group A and 13.65 ± 2.76 mmHg in group B (P ? 0.001) at last follow?up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group. Conclusion: A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%)

Evaluation of a Protocol for Diagnosis and Treatment of Primary Congenital Glaucoma in Tanta University Eye Hospital

Background: Primary congenital glaucoma is the most common type of glaucoma in infancy. It manifests within the first few years of life and is not associated with any other systemic or ocular abnormalities. This study aimed to evaluate a protocol for diagnosis and treatment of primary congenital glaucoma at Tanta University Eye Hospital.Methods: The study was prospective interventional on 60 eyes of 36 infants and children who presented between December 2018 to March 2021 at Tanta University Eye Hospital in Egypt. All patients were presented with primary congenital glaucoma and were managed according to specific diagnostic, therapeutic and follow up regimen. Pre- and Post-operative clinical data were recorded, and results were studied.Results: The mean of age±SD (range) at first presentation was 11.33±21.76 (0.5-120) months and of follow-up period was 7.85±2.71 (4-13) months. The mean of pre-operative IOP, corneal diameter, C/D ratio and AxL was 24.1±5.9 (12–41.5) mmHg, 12.97±0.69 (11–14.5) mm, 0.57±0.18 (0.2–0.9) and 21.87±1.28 (19.1–26.8) mm respectively, and post-operatively was 14.4±3.09 (8.5–20.5) mmHg, 12.71±0.89 (11–14.5) mm, 0.48±0.22 (0.2–1) and 22.16±1.53 (19–25.9) mm respectively. Surgical interventions included 1ry surgeries (trabeculotomy in 21 eyes and CTT with MMC in 39 eyes), 2ry surgeries (CTT with MMC in four eyes) and 3ry surgery (Ahmed valve implantation in one eye). Complete success was achieved in 38 eyes (63.3%) and qualified success in 22 eyes (36.7%).Conclusions: The current protocol applied at Tanta University Eye Hospital for diagnosis and treatment of primary congenital glaucoma proved efficacy and safety. Primary surgical intervention in the form of trabeculotomy (for mild cases) and combined trabeculotomy-trabeculectomy with MMC (for moderate to advanced cases) is a successful regimen for management of these eyes.

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Pterygium management and comparison of different surgical approaches with supportive treatment in Rural Maharashtra

Background:Numerous surgical procedures and changes have been ineffective in preventing the recurrence of pterygium. Aprospective clinical observational analysis of 205 individuals with primary pterygium was conducted where patients were treated with various surgical procedures. The patients were observed for two to five years in order to examine the frequency of recurrences and consequences. Result: Patients were divided into four groups and treated using a variety of surgical methods. Straightforward excision of pterygium was the treatment of choice in group 1. Excision with conjunctival rotation pedicle graft was used on patients in Group 2. Excision and conjunctival autograft were used to treat Group 3 patients. Patients in Group 4 received excision and a 0.02 percent solution of mitomycin c drops as a postoperative treatment. Age varied from 22 to 58, with a median of 34. All four groups had an equal number of men and women. Hemorrhage, astigmatism, symblepheron, foreign body feeling, and a corneo-scleral ulcer were among complications that were reported. There were 12 percent complications in group 1, 16 percent complications in group 2, 6 percent complications in group 3, and 8 percent complications in group 4. Criteria for recurrence was defined as the regrowth of fibrovascular tissue or the appearance of an aesthetic flaw. It's 30 percent for group 1; 14 percent for group 2, 9 per cent for group 3, and 8 per cent for group 4. Conclusion: The least rate of recurrence was noted in patients of Group 4 who had pterygium excision with postoperative mitomycin c instillation, and complications were least common in patients in Group 3 who had pterygium resection with conjunctival autograft

Ologen implant versus mitomycin C in combined trabeculectomy and phacoemulsification

Purpose: To comparatively evaluate in Indian eyes with coexisting cataract and primary open?angle glaucoma the outcome of mitomycin C (MMC) and Ologen implant as adjunctives in combined phacoemulsification with trabeculectomy. Methods: Eyes with primary open?angle glaucoma that underwent trabeculectomy and phacoemulsification with IOL implantation with either MMC application or Ologen implant between June 2019 and February 2020 were followed up for 12 months. Thirty?four eyes of 34 participants were studied. The primary outcome was intraocular pressure (IOP), and the secondary outcomes were the number of ocular hypotensives, best distance visual acuity (BDVA), and bleb morphology. Results: In 16 eyes treated with MMC and 18 eyes treated with Ologen implant, it was observed that the mean postoperative IOP (14.62 � 2.89 mm Hg with MMC and 14.56 � 4.14 mm Hg with Ologen implant) was not significantly different in both groups (P = 0.47). Number of ocular hypotensives and BDVA were also comparable between the two groups. However, bleb morphology was better with Ologen implantation. One eye in the MMC group developed hypotony which was conservatively managed. Conclusion: MMC and Ologen are both effective adjunctives in combined phaco?trabeculectomy. However, the Ologen implant provides better bleb health and safety

Two routes of administration of mitomycin C in a trabeculectomy

Background: The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Purpose: Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Synopsis: Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large?area MMC application also seems to increase long?term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. Highlights: injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates

Outcomes and risk factors for failure of trabeculectomy with mitomycin C in children with traumatic glaucoma - A retrospective study

Purpose: To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma. Methods: Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg. Results: Seventy?one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow?up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure. Conclusion: TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.

Transcanalicular laser dacryocystorhinostomy with and without mitomycin / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate if mitomycin reduces or not the probability of developing synechiae and granulomas in transcanalicular diode laser dacryocystorhinostomy. Also, we want to clarify the usefulness of mitomycin in that procedure by searching in PubMed between 2011 and 2021. <p>METHODS: A retrospective case series study of 120 transcanalicular diode laser dacryocystorhinostomy was performed from January 2008 to July 2019. Patients were divided into two groups: one group was operated on with mitomycin and the other group was operated on without mitomycin.<p>RESULTS: The success rate was 71.9% in the mitomycin group and 71.0% in the non- mitomycin group.<p>CONCLUSION: No statistically significant differences in the outcomes of the two groups were found. Only two opposing articles regarding the use of mitomycin in transcanalicular diode laser dacryocystorhinostomy were found in PubMed between 2011 and 2021, so the use of mitomycin is still unclear.

Study on dynamic expression of IL-10 on scarring after implantation of glaucoma drainage material / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the dynamic expression characteristics of interleukin-10(IL-10)after implantation of glaucoma drainage material, and to reveal the role of IL-10 on scarring formation.METHODS:Totally 75 New Zealand white rabbits were randomly divided into three groups, which were implanted with different types of material-Polymethyl methacrylate coated Parylene C(PMMA group), silicone together with injection of Mitomycin C(MMC)(silicon-MMC group)and silicone(silicone group). Aqueous humor were collected at 1, 3d, 1, 2, 3, 4 and 8wk after operation and enzyme-linked immunosorbent assay(ELISA)were utilized to detect the expression of IL-10 in the aqueous humor. The connective tissue surrounding the material were collected at 1, 2, 3, 4 and 8wk postoperatively. Hematoxylin-eosin(HE)staining was applied to evaluate the proliferation of fibroblasts and the infiltration of inflammatory cells. The protein expression and mRNA of IL-10 in the connective tissue were detected by immunohistochemistry and real-time PCR.RESULTS:Compared with PMMA and silicon-MMC group, silicone group showed significantly increased proliferation of fibroblasts and infiltration of inflammatory cells according to the HE staining result. The result of ELISA showed the expression of IL-10 in the aqueous humor increased significantly at the early stage after surgery, and then decreased gradually,the highest appeared on the third day after operation,and in silicone group there was higher than the other two groups in the early stage postoperatively(1d-3wk)(all <i>P</i><0.05), and there was no significant difference in the late stages(4-8wk). The protein expression and mRNA of IL-10 in connective tissue were the highest in the first week after operation, decreased gradually at 2-3wk after operation, and increased again at 4-8wk after operation by immunohistochemistry and real-time PCR. And the expression was higher in silicone group than in the other two groups at each time point(all <i>P</i><0.05). Furthermore, there was a positive correlation between the expression of IL-10 protein and the proliferation of fibroblasts in the late stages(4-8wk).CONCLUSION: After implantation of glaucoma drainage material, the process of IL-10 increased first, then decreased gradually, and increased again 4wk later, thus IL-10 may be a potential target for inhibiting the scar formation.

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.

Optimizing the effective doses of mitomycin C, 5-fluorouracil, and their combination on cultivated basal cell carcinoma / Otimização da dose efetiva da mitomicina C, do 5fluorouracil e da combinação de ambos em culturas de células de carcinoma basocelular

ABSTRACT Purpose: This study aimed to optimize the effective doses of mitomycin C, 5-fluorouracil, and their combination on cultivated basal cell carcinoma. Methods: Cultivated basal cell carcinoma and fibroblastic cells were treated with different concentrations of mitomycin C, 5-fluorouracil, and their combination. Cell viability, cell cycle, apoptosis, and expression levels of TP53, CDKN1A, and CDK6 were investigated. The most effective drug with its optimum dosage was administered via multiple intralesional injections to a 65-year-old woman with advanced periorbital nodulo-ulcerative BCC. Results: The concentrations of 0.00312 and 0.312 mg/mL were considered optimum for mitomycin C and 5-fluorouracil, respectively. The mean viabilities of basal cell carcinoma treated with mitomycin C alone and its combination with 5-fluorouracil were significantly less than those of the controls (p=0.002 and p=0.04, respectively). The cell cycle of all the treated basal cell carcinoma groups was arrested in the S phase. The apoptotic rates (p=0.002) of mitomycin C treated basal cell carcinoma were higher than those of the other treated cells, and their TP53 was significantly upregulated (p=0.0001). Moreover, CDKN1A was upregulated, whereas CDK6 was downregulated in basal cell carcinoma treated with either 5-fluorouracil (p=0.0001 and p=0.01, respectively) or the combination of 5-fluorouracil and mitomycin C (p=0.007 and p=0.001, respectively). Basal cell carcinoma lesions were significantly alleviated following mitomycin C injections in the reported patient. Conclusion: Our in vitro results revealed that the effective doses of mitomycin C and 5-fluorouracil on cultivated basal cell carcinoma were optimized. Mitomycin C was more effective in inducing the apoptosis of basal cell carcinoma than 5-fluorouracil and their combination. The intralesional injections of the optimum dose of mitomycin C could be proposed for the nonsurgical treatment of advanced eyelid basal cell carcinoma.

RESUMO Objetivo: Otimizar a dose efetiva de mitomicina C, 5fluorouracil e da combinação de ambos em culturas de células de carcinoma basocelular (CBC). Métodos: Culturas de células de células de carcinoma basocelular e de fibroblastos foram tratadas com diferentes concentrações de mitomicina C, 5fluorouracil e combinação de ambos. Além disto, foram investigados a viabilidade celular, o ciclo celular, a apoptose e a expressão dos genes TP53, CDKN1A e CDK6. O medicamento mais eficaz, em sua dosagem otimizada, foi administrado em últiplas injeções intralesionais em uma mulher de 65 anos com carcinoma basocelular nódulo-ulcerativo periorbital avançado. Resultados: A concentração de 0,00312 mg/mL de mitomicina C e a de 0,312 mg/mL de 5fluorouracil foram consideradas as ideias. A viabilidade média das células de carcinoma basocelular tratadas com mitomicina C isoladamente e em combinação foi significativamente menor que nas células de controle (respectivamente, p=0,002 e p=0,04). Todos os grupos de carcinoma basocelular tratados demonstraram interrupção do ciclo celular na fase S. As células de carcinoma basocelular tratadas com mitomicina C mostraram maiores taxas de apoptose (p=0,002) e significativa regulação positiva do gene TP53 (p=0,0001). Além disso, o gene CDKN1A foi positivamente regulado e o gene CDK6 foi negativamente regulado em células de carcinoma basocelular tratadas com 5fluorouracil (respectivamente, p=0,0001 e p=0,01) ou com a combinação de medicamentos (respectivamente, p=0,007 e p=0,001). Injeções posteriores de mitomicina C na paciente em questão levaram à melhora significativa da lesão do carcinoma basocelular. Conclusão: Nossos resultados in vitro otimizaram as doses efetivas de mitomicina C e 5fluorouracil na cultura de células de carcinoma basocelular e mostraram que a mitomicina C tem mais eficácia na apoptose de células de carcinoma basocelular do que o 5fluorouracil e a combinação de ambos. Injeções intralesionais de doses otimizadas de mitomicina C podem ser propostas para o tratamento não cirúrgico do células de carcinoma basocelular avançado de pálpebra.

Diferentes concentraciones de mitomicina C en la prevención del haze en la queratectomía fotorrefractiva / Different concentrations of mitomycin C for haze prevention in photorefractive keratectomy

Objetivo: Evaluar la utilidad de dos concentraciones de mitomicina C para la prevención del haze en la queratectomía fotorrefractiva. Métodos: Se realizó un estudio experimental aleatorizado en 26 ojos de 17 pacientes con defectos miópicos. Los pacientes fueron asignados a dos grupos según las dosis de mitomicina C (0,02 por ciento grupo 1 y 0,002 por ciento grupo 2). La variable de respuesta principal fue la presencia de haze. Se buscó correlación entre la magnitud del haze con grado de ametropía tratada, profundidad de ablación, microscopia endotelial y resultados visuales y refractivos. Resultados: A los 6 meses la mayoría de los pacientes del grupo 1 no presentó haze (ocho ojos / 57 por ciento), y del grupo 2 mantuvieron haze 0,5 (6 ojos / 50 por ciento). En la ametropía severa el haze en el grupo 2 fue mayor que en el grupo 1 durante todo el posoperatorio, y se observó la mayor diferencia al sexto mes con 0,5 ± 0,4 vs. 1,5 ± 0,32. En ablaciones > 75 micras el grupo dos terminó con más haze que el uno, con 0,5 ± 0,44 vs. 1,75 ± 0,76. La agudeza visual sin corrección se vio más afectada en el grupo 2. No hubo daño endotelial en ningún grupo. Conclusión: La presencia de haze predomina en los casos tratados con dosis 0,002 por ciento de mitomicina C, comparada con la dosis 0,02 por ciento, aunque en este caso ambos grupos mantuvieron un resultado visual y refractivo adecuado y baja toxicidad endotelial.

Objective: Evaluate the usefulness of two concentrations of mitomycin C for haze prevention in photorefractive keratectomy. Methods: An experimental randomized study was conducted of 26 eyes of 17 patients with myopic defects. The patients were divided into two groups according to their mitomycin C doses (Group 1: 0.02 percent and Group 2: 0.002 percent). The main response variable was the presence of haze. Verification was performed of the correlation between haze magnitude and the degree of the ametropia treated, ablation depth, endothelial microscopy, and visual and refractive results. Results: At six months most patients in Group 1 did not have any haze (eight eyes / 57 percent), whereas 0.5 (6 eyes / 50 percent) in Group 2 still had haze. In severe ametropia, haze was larger in Group 2 than in Group 1 throughout the postoperative period, the greatest difference being observed in the sixth month with 0.5 ± 0.4 vs 1.5 ± 0.32. In ablations > 75 microns, Group 2 ended with more haze than Group 1, with 0.5 ± 0.44 vs 1.75 ± 0.76. Uncorrected visual acuity was more affected in Group 2. No endothelial damage occurred in either group. Conclusion: The presence of haze prevails in cases treated with 0.002 percent doses of mitomycin C, as compared with 0.02 percent doses, though in this case both groups maintained an appropriate visual and refractive result and low endothelial toxicity(AU)

Eficácia da aplicação endoscópica tópica de mitomicina C em estenoses esofágicas cáusticas na população pediátrica: uma revisão sistemática e meta-análise de ensaios clínicos randomizados / Efficacy of endoscopic topical mitomycin c application in caustic esophageal strictures in the pediatric population: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT BACKGROUND: Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures. OBJECTIVE: To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures. METHODS: We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients. RESULTS: Three randomized clinical trials were included for final analysis with a total of 190 patients. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone, with statistical significance between the two groups (RD: 0.42 - [CI: 0.29-0.56]; P-value <0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34). CONCLUSION: Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilation sessions needed to alleviate dysphagia without rising morbidity.

RESUMO CONTEXTO: A ingestão de soda cáustica e o desenvolvimento de estenoses esofágicas são reconhecidos como importantes problemas de saúde pública na infância. Diferentes métodos terapêuticos têm sido propostos no manejo dessas estenoses. OBJETIVO: Avaliar a eficácia e o risco da aplicação endoscópica tópica de mitomicina C no tratamento de estenoses esofágicas cáusticas. MÉTODOS: Buscamos as bases de dados MEDLINE, EMBASE, Central Cochrane e LILACS. Os desfechos avaliados foram taxa de resolução da disfagia, número de dilatações realizadas nos casos resolvidos e número de dilatações realizadas em todos os pacientes. RESULTADOS: Três ensaios clínicos randomizados foram incluídos para análise final com um total de 190 pacientes. O grupo de aplicação de mitomicina C tópica apresentou aumento significativo na taxa de resolução da disfagia, correspondendo a uma resolução da disfagia 42% maior em comparação à dilatação endoscópica isolada, com significância estatística entre os dois grupos (RD: 0,42 - [IC: 0,29-0,56]; P-valor <0,00001). O número médio de dilatações realizadas em casos resolvidos foi significativamente menor no grupo de aplicação tópica de mitomicina C, em comparação com as dilatações endoscópicas isoladas, com significância estatística entre os dois grupos (MD: 2,84 [IC: 1,98-3,69]; P-valor <0,00001). Ao comparar o número de dilatações em todos os pacientes, não houve diferença estatística entre os dois grupos (MD: 1,46 [IC: -1,53-4,44]; valor de P=0,34). CONCLUSÃO: A aplicação de mitomicina C tópica com dilatações endoscópicas em estenoses esofágicas cáusticas foi mais eficaz na resolução da disfagia do que a terapia endoscópica isolada na população pediátrica. Além disso, a aplicação tópica de mitomicina C também reduziu o número de sessões de dilatação necessárias para aliviar a disfagia sem aumentar a morbidade.

Treatment strategy for bilateral severe subepithelial fibrosis after photorefractive keratectomy enhancement / Estratégia de tratamento para fibrose subepitelial grave bilateral após aprimoramento com ceratectomia fotorrefrativa

ABSTRACT A 27-year-old healthy man with a history of bilateral photorefractive keratectomy (PRK) enhancement after femtosecond laser in situ keratomileusis (LASIK) presented with decreased uncorrected distance visual acuity (UDVA) of 20/125 in the right eye (OD) and 20/300 in the left eye (OS) six months after PRK. Examination revealed bilateral dense subepithelial opacities. Both eyes (OU) were treated with superficial keratectomy combined with phototherapeutic keratectomy (PTK) and adjunctive application of mitomycin C 0.02%. At three months follow up UDVA was 20/30 OD and 20/25 OS. Superficial keratectomy combined with PTK seems to be a safe and efficient technique for treatment of dense subepithelial scar formation following PRK enhancement after LASIK.

RESUMO Um homem saudável de 27 anos de idade com história de aprimoramento com ceratectomia fotorrefrativa (PRK) bilateral, após Ceratomileuse Assistida por Excimer Laser In Situ (LASIK) com laser de femtossegundos, apresentou diminuição da acuidade visual à distância não corrigida (AVNC) de 20/125 no olho direito (OD) e 20/300 no olho esquerdo (OE) seis meses após PRK. O exame revelou opacidades subepiteliais densas bilaterais. Ambos os olhos (AO) foram tratados com queratectomia superficial combinada com ceratectomia fototerapêutica (PTK) e aplicação adjuvante de mitomicina C a 0,02%. Aos três meses de acompanhamento, o AVNC foi de 20/30 OD e 20/25 OE. A ceratectomia superficial combinada com PTK parece ser uma técnica segura e eficiente para o tratamento da formação densa de cicatrizes subepiteliais após o aprimoramento com PRK pós-LASIK.

Diagnóstico citogenético de la anemia de Fanconi en pacientes cubanos con sospecha clínica de la enfermedad / Cytogenetic diagnosis of Fanconi anemia in Cuban patients with clinical suspicion of the disease

Introducción: La anemia de Fanconi es una enfermedad genética rara, de herencia autosómica o ligada al X, caracterizada por inestabilidad genómica e hipersensibilidad a los agentes de entrecruzamiento del ADN, como el diepoxibutano y la mitomicina C (MMC). La respuesta anormal a estas sustancias, que constituye un marcador celular único y se manifiesta como un incremento de la frecuencia de roturas cromosómicas, es la base de su diagnóstico. Objetivo: Realizar el análisis de roturas cromosómicas inducidas por la mitomicina C en linfocitos de sangre periférica de pacientes cubanos con sospecha de anemia de Fanconi. Métodos: Se realizó estudio de roturas cromosómicas inducidas por la mitomicina C a diferentes concentraciones en cultivos de linfocitos T provenientes de sangre venosa periférica en 32 pacientes con sospecha clínica de anemia de Fanconi e igual cantidad de sujetos controles. Resultados: Al finalizar el análisis seis pacientes (20 por ciento) fueron diagnosticados con anemia de Fanconi. De ellos, cuatro presentaron alto porcentaje de rupturas y dos un mosaicismo somático. Desde el punto de vista clínico, cuatro mostraban anemia aplásica y dos exhibían únicamente rasgos dismórficos típicos de la enfermedad. Conclusiones: El ensayo de roturas cromosómicas inducidas por la mitomicina C permitió el diagnóstico definitivo de anemia de Fanconi en pacientes con antecedentes de anemia aplásica, aún sin anomalías congénitas. Este constituye el primer estudio de este tipo en un grupo de pacientes cubanos(AU)

Introduction: Fanconi anemia is a rare genetic disease of autosomal inheritance or X-linked, characterized by genomic instability and hypersensitivity to DNA cross-linking agents like diepoxybutane and mitomycin C (MMC). The basis for its diagnosis is an abnormal response to these substances, which constitutes a unique cell marker and manifests as an increased chromosomal breakage rate. Objective: To perform the analysis of the chromosomal breakages induced by mitomycin C in peripheral blood lymphocytes of Cuban patients with suspicion of Fanconi anemia. Methods: A study was conducted of chromosomal breakages induced by mitomycin C at various concentrations in cultures of T lymphocytes from venous peripheral blood of 32 patients with clinical suspicion of Fanconi anemia and an equal number of control subjects. Results: At the end of the analysis, six patients (20 percent) were diagnosed with Fanconi anemia. Of these, four showed a high percentage of breakages and two had somatic mosaicism. From a clinical point of view, four had aplastic anemia and two only presented dysmorphic features typical of the disease. Conclusions: Evaluation of the chromosomal breakages induced by mitomycin C led to the definitive diagnosis of Fanconi anemia in patients with a history of aplastic anemia, even in the absence of congenital anomalies. This is the first study of its type in a group of Cuban patients(AU)

The action of subconjunctival cyclophosphamide in rabbits / Ação da ciclofosfamida subconjuntival em coelhos

ABSTRACT Objective: To observe clinically, in rabbits, the side effects of topical injection of subconjunctival cyclophosphamide, studying its role as an antifibrotic drug. Methods: Prospective study in 20 albino rabbits of New Zealand race. All rabbits were treated with cyclophosphamide, 10mg/ml in a volume of 0.3 ml, in the left eye through subconjunctival injection. They were evaluated for 1, 7, 30, and 60 days after the procedure. All the animals were examined for the detection of ocular reactions such as necrosis, hyperemia, chemosis, secretion, opacity, and iritis. Other side effects as changes in the behavior, in the feed, and the water consumption were also evaluated. Results: It was observed that from the 20 rabbits studied, three rabbits (15%) showed side effects only at the 24 hours analysis. One rabbit (5%) presented hyperemia, one rabbit (5%) had hyperemia associated with iritis, and one rabbit (5%) presented hyperemia associated with secretion. These reactions were not observed at 1, 7, 30, and 60 days. Conclusion: Cyclophosphamide subconjunctival injection induces minor side effects on the conjunctiva of rabbits such as hyperemia, associated with iritis and secretion.

RESUMO Objetivo: Observar clinicamente os efeitos colaterais de injeção subconjuntival de ciclofosfamida, pensando em sua ação como um agente antifibrótico. Métodos: Estudo prospectivo realizado com 20 coelhos albinos da raça Nova Zelândia. Todos os coelhos foram submetidos a 0,3 ml de injeção subconjuntival de ciclofosfamida 10mg/ml no olho esquerdo e foram avaliados de acordo com os efeitos locais no primeiro dia após a injeção, 7, 30 e 60 dias. Foram examinados para detecção de reações oculares como necrose, hiperemia, quemose, secreção, opacidade corneana, irite além de alterações comportamentais e variação no consumo de água e alimentação. Resultados: Dos 20 coelhos estudados, apenas 3 apresentaram reações oculares e somente na leitura de 24 horas. Um coelho (5%) apresentou hiperemia, 1 coelho (5%) apresentou hiperemia associada a presença de irite e 1 coelho (5%) apresentou hiperemia associada a presença de secreção. As reações não foram mais observadas durante os exames de 7, 30 e 60 dias. Conclusão: A ciclofosfamida subconjuntival causou poucos efeitos colaterais na conjuntiva dos coelhos. Os únicos efeitos encontrados foram hiperemia, irite e secreção.

Estudo comparativo da inibição da proliferação de fibroblastos in vitro na conjuntiva utilizando mitomicina C e ciclofosfamida / Comparative study of inhibition of fibroblasts proliferation in vitro in the conjunctiva using mitomycin and ciclophosphamide

RESUMO Objetivo: Avaliar a inibição da proliferação de fibroblastos in vitro das conjuntivas obtidas através de exérese de pterígios de pacientes utilizando mitomicina C (MMC) e ciclofosfamida (CF). Métodos: Os pterígios foram retirados de 7 pacientes e submetidos a cultivo celular. Após o cultivo, 3 fragmentos de dimensões iguais deste material foram colhidos de áreas adjacentes do pterígio removido de cada paciente. Eles foram randomicamente selecionados de tal forma que: um fragmento de cada paciente foi exposto: ao meio de cultura (grupo controle), a MMC e a CF por igual período de tempo nas concentrações de 0,4 mg/ml e 10 mg/ml respectivamente. Após este período realizou-se a contagem celular de fibroblastos destes 3 grupos. Cada grupo continha 7 fragmentos. Resultados: Com a utilização da MMC tivemos uma taxa de 95% da inibição da proliferação dos fibroblastos, enquanto com a CF 100%. Conclusões: Ambas as drogas apresentaram elevada taxa da inibição da proliferação de fibroblastos, porém a CF apresentou inibição maior que a MMC.

Abstract Objective: To evaluate the inhibition of fibroblast proliferation in vitro of conjunctiva obtained by excision of pterygium from patients using mitomycin (MMC) and cyclophosphamide (CF). Methods: Pterygiums were removed from 7 patients and subjected to cell culture. After cell cultivation, 3 fragments of equal dimensions of these tissues were collected from adjacent areas of each patient removed pterygium. They were randomly selected in such a way that one fragment of each patient was exposed to: the culture medium (group control), to MMC and to CF for an equal period of time at concentrations of 0,4 mg/dl and 10 mg/dl respectively. After this period, the fibroblast cell count of these groups were performed. Each group had seven fragments. Results: With the use of MMC we had a 95% rate of inhibition of fibroblast proliferation, while with CF 100%. Conclusion: Both drugs showed a high rate of inhibition of fibroblast proliferation, but CF showed greater inhibition than MMC.

Effect of intraoperative Trans-PRK combined with MMC on postoperative haze in the treatment of high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the mitomycin-C(MMC)0.02% efficacy in preventing haze after trans-epithelial photorefractive keratectomy(Trans-PRK)in the treatment of the high myopia. <p>METHODS: Retrospective case series. Trans-PRK were performed on 142 eyes with a preoperative spherical equivalent. They were divided into with 0.02% MMC(MMC group)and without MMC(control)groups. In MMC group there were 94 eyes with MMC 0.02%; in control group there were 48 eyes. Patients were treated with an intraoperative application of MMC 0.02% for 30-45s depending on refractive error in MMC group. After surgery, fluorometholone 0.1% eye drops were used for 4mo in all groups. The mean follow-up time was 6mo. The regression trees were used to analyse the relationship between different related factors and haze. <p>RESULTS:Haze was quantified with Fantes. Incidence of haze was 8.5% eyes in MMC group and 33.3% in without MMC group(<i>P</i>=0.001). In the regression trees, optical zone and ablation depth MAX were related to haze(<i>P</i><0.01). It was possibility induce haze when optical zone is ≤5.6mm. When optical zone is >5.6mm, ablation depth MAX becomes the main factor for haze.<p>CONCLUSION: The design of optical zone and ablation depth MAX in Trans-PRK should be considered for the treatment of the high myopia with thin cornea and abnormal corneal morphology. MMC 0.02% was effective in preventing haze after Trans-PRK in the treatment of the high myopia.