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Rosalind M K Stewart, Nihal Kenawy, Heinrich Heimann, Bertil E Damato; Prevalence of ptosis after topical mitomycin C therapy for conjunctival neoplasia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1602.
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Topical mitomycin C (MMC) is well established as a primary or adjunctive therapy for ocular surface neoplasia. Adverse effects include allergic reactions, epiphora secondary to punctual stenosis, and limbal stem cell deficiency. Ptosis is reported rarely (1%). We suspected that the true incidence was under-reported and therefore studied the prevalence of this complication in our patients who had received topical MMC therapy.
A retrospective clinical study was undertaken. All patients treated with topical MMC between September 2009 and November 2014 at the Liverpool Ocular Oncology Centre, UK, were identified from a clinical database. Patient demographics, diagnosis, treatment dates and dose/number of cycles of MMC therapy were recorded. Patients were contacted by telephone and asked if they had noted any difference to the eyelids following treatment and if they had undergone or been offered lid surgery. Statistical analysis was performed using the 1-way ANOVA test.
Fifty-four patients were identified; with a mean age of 62 years (range, 27-90) at the time of treatment. Thirty-one were male and 25 female. Twenty-seven patients (50%) were treated for conjunctival melanoma, 22 (41%) for conjunctival melanocytic intraepithelial neoplasia, 4 (7%) for conjunctival squamous cell carcinoma, and 1 (2%) for conjunctival papilloma with severe dysplasia. MMC 0.02 or 0.04% was prescribed 2 weeks following tumour excision and complete healing of the conjunctiva, for weekly courses with 3 week rest periods, for 1-12 (mean,4.2) cycles.<br /> Three patients were known to be deceased. Of the remaining 51, 45 (88%) were contacted. Follow up was 1-63 (median 23) months post-treatment. Nineteen patients (42%) reported ptosis, with 7 (16%) having been offered ptosis surgery and a further 1 (2%) actually undergoing surgery. There was no correlation with patient age (p>0.1), number of cycles of MMC (p>0.3), or co-existence of other severe side effects (p>0.7).
Ptosis after topical MMC therapy at a standard dose and regime is vastly under-reported. Patients should be warned of this potential adverse event.
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