The Effect of Mitomycin C on Corneal Endothelium in Pterygium Surgery

PURPOSE: To evaluate the changes in endothelial cell counts in patients after pterygium surgery with mitomycin C (MMC) 0.02% and to compare them with patients undergoing pterygium excision without MMC. DESIGN: Prospective nonrandomized study. METHODS: Forty-three consecutive patients were included in this study. Sixteen patients underwent pterygium surgery with conjunctival autograft and MMC for recurrent pterygium and 27 patients underwent pterygium excision without MMC for primary pterygium removal (control group) at the Toronto Western Hospital. Endothelial images were acquired at the center of the cornea with a specular microscope before surgery and at one week, one month, and three months following surgery. RESULTS: Mean preoperative endothelial cell counts were 2330 +/- 318 cells/mm(2) in the pterygium excision without MMC group and 2486 327 cells/mm2 in the pterygium excision with MMC group (P = .13). One month after surgery, the pterygium with MMC group showed a significant endothelial cell loss of 6% which was not present in the control group (P = .03). Three months after surgery, endothelial cell loss was reduced to 4%. (P = .08 compared with the control). In the pterygium excision with MMC group, endothelial poly, meghatism was increased (at one and three months) and the percentage of hexagomal cells was reduced (at one month). CONCLUSIONS: The use of topical MMC during recurrent pterygium surgery was found to have a deleterious effect on corneal endothelium one month following surgery. Judicious use of this drug is therefore recommended. (Am J Ophthalmol 2009;147:447-452. (C) 2009 by Elsevier Inc. All rights reserved.)