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Mitomycin C-Associated Scleral Stromalysis After Pterygium Surgery

Lindquist, T. Peter MD; Lee, W. Barry MD

doi: 10.1097/ICO.0000000000000384
Clinical Science

Purpose: To describe complications after use of mitomycin C (MMC) as a surgical adjuvant in pterygium surgery.

Methods: This is a retrospective chart review of patients presenting to a tertiary referral center over a 7-year period with a diagnosis of scleral stromalysis after previous pterygium removal.

Results: Sixteen eyes of 15 patients were identified with scleral stromalysis after pterygium surgery with the use of adjuvant MMC. Three eyes were excluded because of insufficient chart information or previous beta-irradiation treatment. Twelve of 13 eyes underwent surgical treatment for primary pterygium, and 1 eye was treated for recurrent pterygium. Time from initial pterygium surgery to presentation ranged from 1 month to 10 years. Dosage and routes of MMC administration included 0.02% intraoperative application to either the bare sclera or Tenon capsule with a range of 30 seconds to 3 minutes or topical administration 4 times daily for 2 weeks. In some cases, the dose and route of MMC administration were unknown. Four of 13 patients (31%) required a scleral patch graft with 1 patient (8%) requiring multiple patch grafts.

Conclusions: Use of MMC in various forms and concentrations can cause devastating complications including scleral stromalysis. Scleral stromalysis may present anywhere from months to years after application. We suggest that MMC should be used with extreme caution when used as a surgical adjuvant for pterygium surgery. Patients must be urged to continue long-term follow-up after MMC use because of the potential for future anterior segment complications.

Division of Ophthalmology, Piedmont Hospital; Cornea Service, Eye Consultants of Atlanta, Atlanta, GA.

Reprints: W. Barry Lee, MD, Eye Consultants of Atlanta, 3225 Cumberland Boulevard, Suite 900, Atlanta, GA 30339 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received July 10, 2014

Received in revised form November 26, 2014

Accepted December 28, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.