Intraocular application of Mitomycin C to prevent proliferative vitreoretinopathy in perforating and severe intraocular foreign body injuries

• Published in: Eye (London) 2019-08, Vol.33 (8), p.1261-1270
• Main Authors: Assi, Alexandre, Khoueir, Ziad, Helou, Charles, Fakhoury, Henry, Cherfan, Georges
• Format: Article
• Language: English
• Subjects: 692/699/3161/3175; 692/699/578; Acuity; Adolescent; Adult; Child; Choroid - diagnostic imaging; Eye; Eye Foreign Bodies - complications; Eye Foreign Bodies - diagnosis; Eye Foreign Bodies - surgery; Female; Humans; Injections, Intraocular; Injuries; Intraoperative Period; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Mitomycin - administration & dosage; Mitomycin C; Nucleic Acid Synthesis Inhibitors - administration & dosage; Ophthalmology; Pharmaceutical Sciences/Technology; Prospective Studies; Retrospective Studies; Surgery; Surgical Oncology; Trauma; Trauma Severity Indices; Visual Acuity; Vitrectomy - methods; Vitreoretinopathy, Proliferative - etiology; Vitreoretinopathy, Proliferative - prevention & control; Young Adult
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/s41433-019-0408-0

Aim To assess the long-term anatomical and functional outcomes in addition to complications of a new surgical technique of localized intraocular application of mitomycin C (MMC) to prevent proliferative vitreoretinopathy (PVR) in eyes with open globe trauma. Methods Prospective non-comparative interventional case series of 16 consecutive eyes with perforating and deep choroidal impact foreign body injuries presenting over a 2-year period. Patients underwent vitrectomy with intraocular application of MMC at the site of the chorioretinal injury and were followed-up for 1 year. The primary outcome measure was the rate of postoperative PVR. Secondary outcome measures were number of vitreoretinal surgeries (VRS) required, best corrected visual acuity (BCVA), final anatomical success rate and globe survival rate (GSR). Results Patients underwent VRS at a mean time of 8.5 ± 4.6 days after the injury. Postoperative PVR developed in 2 (13 %) eyes and required only one additional VRS each. One other eye underwent further peeling of an epimacular membrane. BCVA improved from mean LogMAR 3.08 ± 0.72 preoperatively to 0.66 ± 0.79 at 1 year. All 10 eyes without a macular injury had a final BCVA of LogMAR 0.40 or better. The final anatomical success rate was 94% and GSR rate was 100%. There were no complications related to the intraocular use of MMC. Conclusions Vitrectomy and intraocular application of Mitomycin C may have a potential role in reducing the rate of post traumatic PVR and improving anatomical and functional outcomes in eyes with perforating and deep choroidal impact foreign body injuries.