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Complications of Cosmetic Wide Conjunctivectomy Combined With Postsurgical Mitomycin C Application

Rhiu, Soolienah MD; Shim, Jongwoo MD; Kim, Eung Kweon MD, PhD; Chung, Sung Kun MD, PhD; Lee, Jong Soo MD, PhD; Lee, Jong Bok MD; Seo, Kyoung Yul MD, PhD

doi: 10.1097/ICO.0B013E3182343073
Clinical Science

Purpose: To raise awareness among clinicians about the risk of severe complications after cosmetic conjunctivectomy plus postsurgical topical mitomycin C (MMC) treatment.

Methods: We retrospectively reviewed the medical records of 48 consecutive patients who received cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment to eliminate conjunctival injection and visited our outpatient clinic between January 2009 and January 2011.

Results: Forty-four patients (91.67%) developed complications after cosmetic wide conjunctivectomy plus postsurgical topical MMC treatment. Complications included chronic conjunctival epithelial defects (22 patients), scleral thinning with (19 patients) or without (2 patients) calcified plaques, fibrovascular conjunctival adhesion at the muscle insertion site (15 patients), chronic dysfunctional tear syndrome (11 patients), avascular zones (10 patients), abnormal vessel growth (5 patients), lymphangiectasis (3 patients), adhesions of Tenon capsule and the conjunctiva at the extraocular muscle insertion site (1 patient), extraocular muscle fiber exposure (1 patient), and diplopia (9 patients). The mean time between surgery and the onset of diplopia was 1.67 months (range, 1–3 months), and the mean deviation was 11.0 prism diopters (range, 0–25 prism diopters) in the primary position. Three patients underwent strabismus surgery due to incomitant esotropia. Eight patients underwent calcified plaque removal because of severe progression of the calcification. Five patients underwent conjunctival flap operation because of severe progressive scleral thinning.

Conclusions: Cosmetic wide conjunctivectomy, which has been advertised as a simple and effective surgical option for the treatment of conjunctival injection, has caused disruption in the normal physiology of the ocular surface, which leads to various devastating complications.

From the *Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea; †Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; and ‡Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, Republic of Korea.

Received for publication April 19, 2011; revision received June 13, 2011; accepted June 17, 2011.

Supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A084790).

The authors state that they have no financial or conflicts of interests to disclose.

Reprints: Kyoung Yul Seo, Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea (e-mail:

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