Mitomycin C use during glaucoma surgery has played an important role in improving our rates of surgical success. However, surgical complications related to the use of mitomycin C have been a cause of great concern. In this report we describe an unusual complication in two cases related to retained sponge fragments used to apply mitomycin C on the ocular surface. Both patients in this report presented with bleb-related inflammation 4 months after surgery. In the first patient the presentation was suggestive of an infection and, even though cultures were negative, a concurrent infection could not be excluded. The timing of the bleb-related inflammation seen in both patients was, however, not typical of filtering surgery after anitimetabolite use. Most bleb-related inflammation is seen either in the late postoperative period secondary to infections in thin or leaking blebs or, less commonly, in the early postoperative period.
2.Scleral punch method with topical mitomycin c for safe revision of failed deep sclerectomy in nanophthalmic uveal effusion syndrome
Nelson A. Sabrosa & Henry B. Smith & Robert E. MacLaren. Graefes Arch Clin Exp Ophthalmol (2009) 247:999–1001
We also applied mitomycin c (MMC) to inhibit further scarring, and we propose that this might be used more widely in UES, as has been recommended by others. Re-exploration in this case confirmed that the previous full-thickness sclera windows had become occluded by fibrosis and scarring. Trabeculectomy is now almost uniformly performed with anti-mitotics to prevent bleb failure, and a major difference here is that MMC is applied more posteriorly, over the sclerectomy at the globe equator. This may limit the anterior segment complications associated with MMC, such as cystic bleb formation. The aetiology of nanophthalmic UES remains unclear, although sclerectomy does appear to be effective when performed successfully. Here we describe a scleral punch method combined with mitomycin c (MMC) for successful revision of scarred sclerectomy. We believe that knowledge of this technique may be useful to other surgeons operating on similar eyes.