结膜黑色素瘤切除术中应用丝裂霉素C后迟发性巩膜软化和结膜下滤过泡形成
Delayed Onset Scleromalacia and Conjunctival Bleb Formation Following Intraoperative Mitomycin C Application during Conjunctival Melanoma Excision.
作者信息
Ahmed Syed Naqib, Shahid Syed Mohammed, Nanavaty Mayank A
机构信息
Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
Moorfield Eye Hospital, City Road, London EC1V 2PD, UK.
出版信息
Vision (Basel). 2020 May 6;4(2):24. doi: 10.3390/vision4020024.
PURPOSE
To present a case of delayed onset scleromalacia and conjunctival bleb formation one year after conjunctival melanoma excision with intraoperative use of mitomycin-C (MMC) and double-freeze-thaw technique.
METHODS
Case report.
RESULTS
A 69-year-old woman had a conjunctival melanoma excised by the 'no touch technique' with intraoperative application of 0.02% MMC for 3 min on bare sclera, freeze-thaw cryotherapy and amniotic membrane transplant performed elsewhere. Three months later, she presented to us with a red, sore and painful right eye. Examination revealed severe scleritis. She was treated with lubricants and oral steroids for 6 weeks. She settled well with no recurrence of melanoma. At one year, she developed scleromalacia and conjunctival blebs in the inferonasal quadrant of right eye. She remains under closer observation as she is at high risk of perforation.
CONCLUSION
Caution should be exercised with intraoperative use of MMC on bare sclera during excision and cryotherapy of conjunctival melanoma. As published in the literature, when using MMC, it is recommended to use the lowest dose topically in the form of eye drops in the postoperative period for the shortest time to avoid any sight-threatening complications.
目的
报告1例结膜黑色素瘤切除术中使用丝裂霉素C（MMC）及双重冻融技术后1年出现迟发性巩膜软化和结膜下积液的病例。
方法
病例报告。
结果
一名69岁女性采用“无接触技术”切除结膜黑色素瘤，术中在裸露的巩膜上应用0.02%的MMC 3分钟，在其他地方进行了冻融冷冻疗法和羊膜移植。3个月后，她因右眼发红、疼痛前来就诊。检查发现严重巩膜炎。她接受了6周的润滑剂和口服类固醇治疗。病情好转，黑色素瘤未复发。1年后，她右眼鼻下象限出现巩膜软化和结膜下积液。由于她有很高的穿孔风险，仍在密切观察中。
结论
结膜黑色素瘤切除及冷冻治疗术中在裸露巩膜上使用MMC时应谨慎。正如文献中所报道的，使用MMC时，建议在术后以滴眼液的形式局部使用最低剂量，并在最短时间内使用，以避免任何威胁视力的并发症。
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