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Cosmetic eye whitening with mitomycin C poses high complication, retreatment rates
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Regional cosmetic conjunctivectomy with postoperative topical mitomycin C with or without bevacizumab injection had high complication and retreatment rates, according to a study.
“We recommend longer follow-up of this population that is at risk for future complications and continued search for a better treatment of chronic conjunctival hyperemia,” the study authors said.
The retrospective study included 1,713 patients with a mean age of 39.2 years who underwent cosmetic wide conjunctivectomy for conjunctival hyperemia with mitomycin C and with or without injections of Avastin (bevacizumab, Genentech). Mean follow-up was 10.9 months.
Investigators conducted telephone interviews with 557 patients who agreed to participate in the study. The primary outcome measures were complications, recurrences and patient satisfaction. They used a five-point subjective scale to rate patients’ satisfaction with eye whitening and improvement in dry eye symptoms.
Patients who participated in the study had a mean 1.6 procedures.
Among the 557 participants, 387 (69.5%) reported postoperative complications and 187 (33.6%) reported severe complications. The complication rate was 61.8% with bevacizumab injection and 70.6% with no injection; the difference was statistically significant (P = .001).
The retreatment rate associated with postoperative complications was 34.5%.
Of 539 patients reporting satisfaction, 307 (56.9%) were satisfied or very satisfied with cosmetic outcomes. Of 494 patients reporting dry eye symptoms, 264 (56.9%) saw no improvement.
Disclosure: The study authors report no relevant financial disclosures.
Perspective
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David R. Hardten, MD
We are learning more and more that the conjunctiva is a complex tissue. Pterygia are difficult to manage with the problems of recurrence or restriction with diplopia. In excess conjunctiva, we see problems with recurrent subconjunctival hemorrhages and tearing and dry eye. There needs to be just the right amount of tissue and flexibility to provide motility and comfort. These authors show that with aggressive removal of tissue and adjunctive medications that there can be a high rate of complications, high enough where the surgeon and patient must be very motivated to plan surgical removal of conjunctiva. Surgical procedures solely for cosmetic purposes should be combined with careful patient counseling.
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