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Surgeon: Cosmetic regional conjunctivectomy with MMC not worth risks
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A recent study highlighted high complication rates and low patient satisfaction from cosmetic regional conjunctivectomy with topical mitomycin C for chronic conjunctival hyperemia.
In the American Journal of Ophthalmology, Kyoung Yul Seo, MD, and colleagues reported that the procedure yielded an overall complication rate of 82.9% and a re-treatment rate of 34.5%.
Terry Kim, MD, OSN Cornea/External Disease Board Member, said he agreed with the study’s conclusion that the risks of the elective procedure do not justify the benefits.
“I have very strong reservations about this cosmetic procedure for many reasons,” Kim said in an interview with Ocular Surgery News. “I commend the authors for reporting and sharing the safety concerns and efficacy results observed with this surgery. I’m concerned that the risk-benefit ratio is extremely unfavorable in terms of subjecting the patient to the high risk for significant ocular complications with an elective surgical procedure for red eyes cosmetically.”
Kim described the risks of using topical MMC on conjunctival defects with exposed sclera created during the surgical procedure.
“There’s no covering of the conjunctival defect that they create. Then they use mitomycin C drops topically at 0.02% four times a day, anywhere from 2 to 5 days postoperatively. It is a setup for disaster,” Kim said. With concomitant topical mitomycin use, a conjunctival defect should always be closed primarily or with a conjunctival autograft or amniotic membrane transplant, he said.
The most serious complications of using MMC on areas with conjunctival defects include scleral thinning and scleral melting, Kim said.
In addition, the use of topical MMC drops in this procedure postoperatively poses additional risks for epithelial toxicity and ocular surface complications.
Kim said that use of an intraoperative and/or topical antimetabolite such as MMC on bare sclera in pterygium surgery has been associated with a high rate of recurrence as well as ocular surface complications.
“We know from our experience with pterygium and other conjunctival surgery that the risk of recurrent disease and scarring exists and that this recurrence can typically be worse than the primary presentation,” Kim said. “Although the use of MMC can help mitigate this phenomenon, it has to be used with caution. If used, these patients should be monitored closely to ensure that the sclera is not exposed and that the ocular surface heals completely. The use of topical MMC drops postoperatively in this setting has shown to be much more dangerous than a single intraoperative application. Adding another adjuvant such as bevacizumab (Avastin, Genentech) simply adds to the potential cumulated toxicity and risk for ocular surface complications, as shown in this paper.”
“I have a lot of concerns about this cosmetic procedure. First of all, there have been no prospective comparative studies to demonstrate its safety and efficacy. Secondly, it involves the application of some potent and potentially dangerous medications. And finally, these patients are fairly young with the potential to develop both visually and anatomically devastating complications later in their lives,” he said. – by Matt Hasson