ABSTRACT
Isolated from Streptomyces caespitosus, mitomycin C (MMC) has various applications in the management of corneal and external disease due to its ability to modulate cellular proliferation. It has been employed in pterygium surgery, ocular surface neoplasia, and refractive surgery. Currently, there is no definite consensus on the treatment protocols for each of the aforementioned applications. Although its benefits in the management of corneal and external diseases are promising, MMC use has potential complications including endothelial cell loss, corneal perforation, scleral melt, secondary glaucoma, iritis, and endophthalmitis. This article will review the literature regarding the use of MMC in the field of cornea and external disease and describe protocols employed with corresponding outcomes.
Keywords:
Mitomycin C, pterygium surgery, photorefractive keratectomy scar, post-PRK haze
Introduction
Mitomycin C (MMC) is an antitumor antibiotic isolated from Streptomyces caespitosus.1 MMC is an alkylating agent that covalently binds to DNA, resulting in an antitumoral effect.2 MMC inhibits DNA synthesis primarily at the G1/S phase, resulting in a decrease in cell proliferation and migration.3 MMC was introduced in ophthalmic surgery in 1963 as an adjunct to pterygium surgery.4 MMC is also thought to elicit apoptosis of corneal epithelial, stromal, and endothelial cells as well as Tenon’s capsule fibroblasts and ocular tumor epithelial cells.5 In addition to its application in pterygium surgery, it has uses in ocular surface tumors, refractive surgery, glaucoma drainage surgery, oculoplastic surgery, and strabismus surgery.3 In this manuscript, we broadly review the applications of MMC in the field of cornea and external disease. More comprehensive reviews exist in the literature on each subtopic covered in this work, and thus this manuscript aims to set the groundwork for interested readers.
Conclusion
MMC has demonstrated high utility in a wide array of ocular pathologies, especially in the field of cornea and external disease, due to its ability to alter tissue remodeling. Currently, there is a need to further establish the optimum treatment protocols for each aforementioned indication. Although MMC usage has promising results, it could lead to potentially vision-threatening complications, and judicious use is therefore warranted.
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