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Efficacy of adjuvant mitomycin-c and triamcinoloneimpregnated nasal packing for endoscopic dacryocystorhinostomy

International Journal of Ophthalmology(English edition) 2024年第3期17卷 480-484页

作者： Sang Yoon Kim christopher B chambers Jung Hyo Ahn Department of Ophthalmology Pusan National University Yangsan HospitalPusan National University School of MedicineResearch Institute for Convergence of Biomedical Science and TechnologyYangsanGyeongnam 50612Republic of Korea Department of Ophthalmology Harborview Medical CenterUniversity of Washington MedicineSeattleWashington 98109USA

●AIM:To compare the success rate and complications of adjuvant use of mitomycin c and triamcinoloneimpregnated biodegradable nasal packing(TABP)in endoscopic dacryocystorhinostomy(DcR).And to evaluate the efficacy of combining intraoperative mitomycin c and TABP for endoscopic DcR.●METHODS:A total of 198 eyes of 148 patients who underwent endoscopic DcR for acquired nasolacrimal duct obstruction were retrospectively analysed.The patients were randomly divided into three groups:Group A included patients treated without intraoperative mitomycin c but with TABP,Group B included patients treated without triamcinolone but with intraoperative mitomycin c and normal saline-impregnated nasal packing,and Group c included patients treated with intraoperative mitomycin c and TABP.●RESULTS:The results revealed no significant difference in the overall success rates between Groups A(86.8%)and B(89.2%;P=0.377).However,Group c(97.5%)showed a significantly higher overall success rate than Groups A and B.The incidence of granulomas was significantly lower in group c(5%)than in Groups A(20.8%)and B(15.2%;P=0.009).Other complications,such as crust,synechiae,and revision surgery,did not differ significantly among the three groups.●cONcLUSION:The combination of intraoperative mitomycin c and TABP effectively prevents granulomas and enhances surgical success rate.Additionally,there is no statistically significant difference observed between the use of mitomycin c or TABP alone.

关键词： dacryocystorhinostomy endoscopic mitomycin c triamcinolone biodegradable

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Short-term outcomes of mitomycin c-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 947-953页

作者： Bar Davidov Shimon Kurtz Ilona Mohilevtseva Michael Waisbourd Rony Rachmiel Glaucoma center Department of OphthalmologyTel Aviv Sourasky Medical CenterAffiliated to the Sackler Faculty of MedicineTel Aviv UniversityTel Aviv 64239Israel

AIM: To report short-term outcomes of mitomycin c-augmented excisional bleb revision with capsulectomy(ERc) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERc procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERc interval.The number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BcVA) were recorded at baseline, 1, 7, 30, 90, and 180d.Intra-and postoperative complications were also recorded.Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were included.Pseudoexfoliative glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERc interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BcVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ERc.cONcLUSION: ERc has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

关键词： glaucoma Ahmed bleb capsulectomy mitomycin c

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Posterior scleral application of a mitomycin c-soaked sponge during trabeculectomy

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International Journal of Ophthalmology(English edition) 2023年第7期16卷 1071-1077页

作者： Kun Hu Yun-He Song Feng-Bin Lin Ying-Zhe Zhang Ling Jin Meng-Yin Liang Robert N.Weinreb Xiu-Lan Zhang State Key Laboratory of Ophthalmology Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangdong Provincial Key Laboratory of Ophthalmology and Visual ScienceGuangdong Provincial Clinical Research Center for Ocular DiseasesGuangzhou 510060Guangdong ProvinceChina Hamilton Glaucoma center Shiley Eye InstituteViterbi Family Department of OphthalmologyUC San DiegoLa JollaCA 92093USA

AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin c-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin c-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin c concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.cONcLUSION:Trabeculectomy with the long side of a mitomycin c-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

关键词： glaucoma mitomycin c posterior scleral application trabeculectomy bleb morphology

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Deep sclerectomy-trabeculectomy with mitomycin c in treating glaucoma:postoperative long-term results

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International Journal of Ophthalmology(English edition) 2022年第12期15卷 1951-1959页

作者： chung Shen chean Li Jiang Gayathri Kanchana Niroshani Pati Arambage Punithawathy Ranjit Ophthalmology Department Royal Stoke University HospitalNewcastle RoadStoke-on-Trent ST46QGUnited Kingdom

AIM:To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy(DST)with mitomycin c(MMc)in the treatment of glaucoma.METHODS:Patients who underwent DST with MMc between 2010 and 2017 were included in this retrospective observational study.complete success was defined as postoperative intraocular pressure(IOP)≤21 mm Hg or 30%reduction of IOP from baseline without any topical IOP-lowering agent,and qualified success defined as IOP≤21 mm Hg or 30%reduction of IOP from baseline with/without single topical agent.We evaluated the surgical success rates and complication rates of this procedure,as well as described the IOP profiles,best corrected visual acuity(BcVA)profiles and mean deviations(MD)of Humphrey visual field(HVF)24-2 performance at each follow-up time point.Mixed linear regression models were constructed to determine estimated predictive values of demographic data,use of topical IOPlowering agents,baseline and postoperative IOP and optical profiles(e.g.,BcVA and MD).RESULTS:Totally 98 eyes(mean postoperative followup 67.5mo)showed mean IOP reduction at every followup interval.Both median BcVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline.The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7(P=0.068).Totally 84(85.7%)eyes achieved complete success at final follow-up.Transient hyphaema and transient choroidal effusion developed in 15 eyes(15.3%)and 11 eyes(11.2%)respectively.Other complications included shallow anterior chamber in 5 eyes(5.1%),bleb leak in 4 eyes(4.1%),bleb revision in 7 eyes(7.1%),bleb needling in 9 eyes(9.2%)and repeat trabeculectomy in 1 eye(1.0%).There was no endophthalmitis,blebitis or macular oedema.There was no significant correlation between postoperative IOP control and postoperative BcVA.cONcLUSION:DST with MMc demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.

关键词： glaucoma surgical outcome deep sclerectomy trabeculectomy mitomycin c

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mitomycin c induces apoptosis in human epidural scar fibroblasts after surgical decompression for spinal cord injury

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Neural Regeneration Research 2017年第4期12卷 644-653页

作者： Tao Sui Da-wei Ge Lei Yang Jian Tang Xiao-jian cao Ying-bin Ge Department of Orthopedics the First Affiliated Hospital of Nanjing Medical University Department of Physiology Nanjing Medical University

Numerous studies have shown that topical application of mitomycin c after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the effect of mitomycin c on the proliferation and apoptosis of human epidural scar fibroblasts. Human epidural scar fibroblasts were treated with various concentrations of mitomycin c （1, 5, 10, 20, 40 μg/mL） for 12, 24 and 48 hours. mitomycin c suppressed the growth of these cells in a dose- and time-dependent manner. mitomycin c upregulated the expression levels of Fas, DR4, DR5, cleaved caspase-8/9, Bax, Bim and cleaved caspase-3 proteins, and it downregulated Bcl-2 and Bcl-xL expression. In addition, inhibitors of caspase-8 and caspase-9 （Z-IETD-FMK and Z-LEHD-FMK, respectively） did not fully inhibit mitomycin c-induced apoptosis. Furthermore, mitomycin c induced endoplasmic reticulum stress by increasing the expression of glucose-regulated protein 78, cAAT/enhancer-binding protein homologous protein （cHOP） and caspase 4 in a dose-dependent manner. Salubrinal significantly inhibited the mitomycin c-induced cell viability loss and apoptosis, and these effects were accompanied by a reduction in cHOP expression. Our results support the hypothesis that mitomycin c induces human epidural scar fibroblast apoptosis, at least in part, via the endoplasmic reticulum stress pathway.

关键词： nerve regeneration spinal cord injury mitomycin c fibroblasts apoptosis endoplasmic reticulum stress surgical decompressionepidural sear fibrosis cAAT/enhancer-binding protein homologous protein glucose-regulated protein 78 neural regeneration

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mitomycin c in pterygium treatment

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International Journal of Ophthalmology(English edition) 2016年第3期9卷 465-468页

作者： Thiago Goncalves dos Santos Martins Ana Luiza Fontes de A zevedo costa Milton Ruiz Alves Roger chammas Paulo Schor Federal University of Sao Paulo (UNIFESP) Sao Paulo 04023062 Brazil University of Sao Paulo (USP) Sao Paulo 01246903 Brazil

Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea.Most cases of pterygium does not cause problem or requires specific treatment.The exact cause of pterygium is not clear yet,but some factors are pointed as causes,being the most important the long-term ultraviolet ray exposure.Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment.Recurrence is the main complication of the surgery,and much has been done to avoid it.mitomycin c（MMc） has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium.This review describes the use of MMc as an adjunctive,the optimal dosage,the duration of administration of MMc and possible complications,when used during,after and before the surgery.Most studies suggest that increased exposure（dose or duration） of MMc is associated with a lower recurrence,but with higher risks of complications.

关键词： mitomycin c pterygium surgery recurrence rate

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SmartSurf^(AcE)transepithelial photorefractive keratectomy with mitomycin c enhancement after small incision lenticule extraction

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Eye and Vision 2021年第1期8卷 276-285页

作者： Amr A.Gab‑Alla Faculty of Medicine Ophthalmology DepartmentSuez Canal UniversityRing RoadIsmailiaEgypt

Background:To evaluate predictability,stability,efficacy,and safety of transepithelial photorefractive keratectomy(TPRK)using smart pulse technology(SPT)(SmartSurface procedure)of Schwind Amaris with mitomycin c for correction of post small incision lenticule extraction(SMILE)myopic residual refractive errors.Method:This study is a prospective,non-comparative case series conducted at a private eye centre in Ismailia,Egypt,on eyes with post-SMILE myopic residual refractive errors because of undercorrection or suction loss(suction loss occurred after the posterior lenticular cut and the creation of side-cuts;redocking was attempted,and the treatment was completed in the same session with the same parameters)with myopia or myopic astigmatism.The patients were followed up post-SMILE for six months before the SmartSurface procedure,and then they were followed up for one year after that.TPRK were performed using Amaris excimer laser at 500 kHz.The main outcomes included refractive predictability,stability,efficacy,safety and any reported complications.Results:This study included 68 eyes of 40 patients out of 1920 total eyes(3.5%)with post-SMILE technique myopic residual refractive errors.The average duration between the SMILE surgery and TPRK was 6.7±0.4 months(range 6 to 8 months).The mean refractive spherical equivalent(SE)was within±0.50 D of plano correction in 100%of the eyes at 12 months post-TPRK.Astigmatism ofchieved in 100%of the eyes.The mean of the residual SE error showed statistically significant improvement from preoperative−1.42±0.52 D to 0.23±0.10 D(Pcorrected distance visual acuity(UDVA)(measured by Snellen’s chart and averaged in logMAR units)was improved significantly to 0.1±0.07(Pcorrected distance visual acuity(cDVA)remained unchanged in 79.4%of eyes.14.7%of eyes gained one line of cDVA(Snellen).5.9%of eyes gained two lines of cDVA(Snellen).co

关键词： Transepithelial PRK mitomycin c Refractive enhancement Small incision lenticule extraction Smart pulse technology SmartSurface procedure

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Potential risk of mitomycin c at high concentrations on peripheral nerve structure

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Neural Regeneration Research 2014年第8期9卷 821-827页

作者： Tao Sui Jinhong Zhang Shihao Du changhui Su Jun Que Xiaojian cao Department of Orthopedics the First Affiliated Hospital of Nanjing Medical University Department of Orthopedics the Second Hospital of NanjingAffiliated to Southeast University Department of Orthopedics Affiliated Hospital of Taishan Medical College Department of Intensive care Unit the First Affiliated Hospital of Nanjing Medical University

Although the local application of mitomycin c may prevent epidural adhesion after laminectomy, mitomycin c can induce neurotoxicity in optic and acoustic nerves at high concentrations. To determine the safe concentration range for mitomycin c, cotton pads soaked with mitomycin c at different concentrations （0.1, 0.3, 0.5, and 0.7 mg/mL） were immediately applied for 5 minutes to the operation area of rats that had undergone laminectomy at L1. Rat sciatic nerves, instead of dorsal nerves, were used in this study. The results showed that mitomycin c at 0.1-0.5 mg/mL did not damage the structure and function of the sciatic nerve, while at 0.7 mg/mL, mitomycin c signiifcantly reduced the thickness of the sciatic nerve myelin sheath compared with lower concen-trations, though no functional change was found. These experimental ifndings indicate that the local application of mitomycin c at low concentrations is safe to prevent scar adhesion following laminectomy, but that mitomycin c at high concentrations （＆gt;0.7 mg/mL） has potential safety risks to peripheral nerve structures.

关键词： nerve regeneration peripheral nerve injury mitomycin c myelin sheath laminectomy electrophysiology nerve function NSFc grant neural regeneration

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Bare sclera resection followed by mitomycin c and/or autograft limbus conjunctiva in the surgery for pterygium:a Meta-analysis

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International Journal of Ophthalmology(English edition) 2015年第5期8卷 1067-1073页

作者： Tan Long Zhi Li Department of Ophthalmology Xi'an No.1 Hospital Department of Ophthalmology Xiangyang Central Hospital

AIM: To evaluate the recurrence and complications after bare sclera resection (BSR) combined with mitomycin c (MMc) treatment and/or autograft limbus conjunctiva (ALc) in the surgery for pterygium. METHODS: Meta -analysis was used to evaluate the differences in patient outcomes between BSR of pterygium with or without MMc and/or ALc. All included studies were randomized trials of patients with pterygium who received BSR followed by MMc and/or ALc in the surgery. The recurrence of pterygium and other complications resulting from different treatments were extracted for analysis. RESULTS: Thirteen studies met the inclusion criteria. The recurrence of pterygium with intraoperative (10) MMc was higher than that with ALc (OR=2.38,95% confidence interval 1.45-3.91, I-2=29%). Postoperative MMc resulted in an incidence of recurrence similar to that of ALc (OR= 0.66, 95% confidence interval 0.30-1.42, I-2=0%), and 10 MMc treatment in combination with ALc produced similar patient outcomes to ALc alone (OR =0.41, 95% confidence interval 0.16-1.01, I-2=16%). Other complications such as punctate epitheliopathy, scleral thinning and ischemia, irritation and persistent epithelium defect, were more common in patients in the MMc group as compared to those treated with ALc. cONcLUSION: The recurrence of pterygium with BSR followed by ALc is lower than that of BSR followed by MMc, and the incidence of other complications is lower. While ALc is a more effective strategy for treating pterygium, the quality of the ALc transplant should be considered when the patient has a history of glaucoma.

关键词： pterygium mitomycin c conjunctiva autogaft

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Safety and efficacy of photodynamic therapy using BcEcF-AM compared to mitomycin c in controlling post-operative fibrosis in a rabbit model of subscleral trabeculectomy

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International Journal of Ophthalmology(English edition) 2016年第3期9卷 348-356页

作者： Azza Mohamed Ahmed Said Rania Gamal Eldin Zaki Thanaa Helmy Mohamed Manal Ibraheem Salman Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo 11361 Egypt Department of Pathology Faculty of Medicine Ain Shams University Cairo 11361 Egypt

AIM： To evaluate the safety and efficacy of cellular photoablation using BcEcF-AM [2, T-bis-（2-carboxyethyl） -5-（and-6）-carboxyfluorescein, acetoxymethyl ester mixed isomersl as a method to control postoperative fibrosis in subscleral trabeculectomy （SST） compared to mitomycin c （MMc） in a rabbit model. METHODS： A comparative prospective case-control animal study was conducted. Fourteen rabbits were subjected to SST with intraoperaUve use of wound modulating agents （MMc or BcEcF-AM） of the right eye （study groups I and II respectively） and SST without use of intraoperative wound modulating agents for the left eye （control group II）. Two rabbits 4 eyes were considered as control group I with no surgical intervention. BcEcF-AM was injected subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. clinical response was assessed by measuring intraocular pressure （lOP） at day 1, 3, 5, 7, 14, 21 postoperatively, Success was defined by 〉20.0% reduction in lOP from the preoperative values without anti-glaucoma medications. RESULTS： The mean percentage of reduction was 35.0% in the study group I with only one eye （14.3%） had 12.5% reduction. The mean percentage of reduction was 28.0% in the study group U with two eyes （28.6%） in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3% with 64.3% eyes had 〈20.0% reduction. There was a highly statistically significant difference between each of the study groups （right eyes） and the corresponding control group II （left eyes） as regards the mean postoperative lOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period. Histologically, MMc treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control. Marked sub-epithelial edema was seen along

关键词： subscleral trabeculectomy mitomycin c photodynamic therapy BcEcF-AM intraocular pressure cellular photoablation

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