Mietz Holger, Roters Sigrid, Krieglstein Günter K
Aschaffenburg Eye Center, Aschaffenburg, Germany.
Graefes Arch Clin Exp Ophthalmol. 2005 Dec;243(12):1284-7. doi: 10.1007/s00417-005-1170-5. Epub 2005 Jun 7.
The routine use of mitomycin C to enhance glaucomatous filtering surgery has found wide acceptance. Complications of the application of mitomycin C have been repeatedly noticed. We now report a previously undescribed complication showing a toxic effect of mitomycin C to the corneal endothelium.
Patients underwent routine trabeculectomy with mitomycin C. Following surgery, the eyes were examined by biomicroscopy and specular microscopy of the corneal endothelium.
In two cases, we observed a partial decompensation of the corneal endothelium resulting in a well-demarcated clear zone of the cornea and a second zone with thickening of the cornea and a bullous keratopathy adjacent to the filtering bleb. The specular microscopy showed marked irregularities of the endothelial cells and areas of necrosis in those parts of the cornea close to the filtering bleb.
The two cases described here demonstrate that if the corneal endothelium is already compromised before surgery, the application of mitomycin C may have an additional toxic effect on the endothelium and may result in a partial bullous keratopathy. Surgeons should be aware of this complication.
丝裂霉素C常规用于增强青光眼滤过手术已被广泛接受。丝裂霉素C应用的并发症已被反复注意到。我们现在报告一种先前未描述的并发症，显示丝裂霉素C对角膜内皮有毒性作用。
患者接受含丝裂霉素C的常规小梁切除术。术后，通过生物显微镜检查和角膜内皮镜检查对眼睛进行检查。
在两例患者中，我们观察到角膜内皮部分失代偿，导致角膜出现界限清晰的透明区，以及第二个区域，该区域角膜增厚并伴有与滤过泡相邻的大泡性角膜病变。内皮镜检查显示靠近滤过泡的角膜部位内皮细胞明显不规则且有坏死区域。
这里描述的两例病例表明，如果术前角膜内皮已经受损，丝裂霉素C的应用可能会对内皮产生额外的毒性作用，并可能导致部分大泡性角膜病变。外科医生应意识到这种并发症。
