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A. Lichtinger, J. Pe'er, T. Jaouni, J. Frucht-Pery, A. Solomon; Limbal Stem Cell Deficiency After Topical Mitomycin C Therapy aor Primary Acquired Melanosis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2364.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the characteristics, risk factors and clinical outcomes of patients with limbal stem cell deficiency (LSCD) resulting from topical treatment with mitomycin C (MMC) for primary acquired melanosis (PAM) with atypia.
Retrospective chart review of 5 patients with LSCD after topical treatment with MMC. Impression cytology was performed to confirm the diagnosis of LSCD.
LSCD was noted in 5 (4 females and 1 male, mean age 62) out of 21 patients who were managed with topical MMC for PAM with atypia between 2000 and 2007. Impression cytology demonstrated goblet cells on the corneal epithelium. Treatment protocol consisted of topical MMC at a concentration of either 0.02% or 0.04%, applied four times a day for 2 weeks, with a minimal interval of two weeks between consecutive courses. The number of MMC courses ranged from 3 to 12 (mean 5.6), which was a total of 42 to 120 days of treatment. LSCD developed between 1 to 24 months after last MMC course (mean 7.6 months). All patients who developed LSCD received a concentration of 0.04% MMC at least once during their treatment period. None of the patients who were treated exclusively with a concentration of 0.02% has developed LSCD. Follow-up after the diagnosis of LSCD ranged from 2 to 64 months (mean 22.4 months). BSCVA before MMC therapy ranged from 0.6 to 0.9. The BSCVA at the last visit ranged from 0.1 to 0.7. All patients were treated with topical corticosteroids and tear supplements. In addition, all except one had bandage contact lenses to manage recurrent corneal erosions.
Topical MMC for PAM with atypia may be associated with a high incidence of LSCD, specifically with concentrations of 0.04% and with prolonged treatment time. The MMC concentrations and length of treatment should be re-evaluated in order to improve the safety of this treatment protocol.
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