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A. Baradaran–Rafii, M.A. Di Pascuale, Y.Y. Gao, A. Elizondo, C.L. Kuo, S.C. G. Tseng; Effect of Simultaneous Intraoperative Application of Mitomycin C on Corneal Epithelial Healing by Keratolimbal Allograft in Patients With Total Limbal Stem Cell Deficiency . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4965.
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Purpose: Mitomycin C (MMC) in conjunction with amniotic membrane transplantation (AMT) is effective in reducing conjunctival inflammation and restoring deep fornix, an effect important for subsequent keratolimbal allograft (KLAL) for total limbal stem cell deficiency (LSCD). However, it remains unclear whether such a simultaneous use of MMC may affect the corneal epithelial healing by KLAL Methods: We retrospectively reviewed 17 eyes of 16 patients (11 M and 5 F, age: 44.1 ± 15.4 years) with total LSCD caused by chemical burn (n=10), Stevens–Johnson syndrome (n=2), aniridia (n=2), idiopathic (n=1), and KID syndrome (n=1). They received KLAL (n=18) together with AMT as a graft and a bandage by the same surgeon (SCGT) from January 1, 2002 to January 1, 2005. Among them, 0.04% MMC was applied simultaneously to the fornix for an average of 3 min to correct symblepharon or reduce conjunctival inflammation at the same time of 8 KLALs. We defined the duration of corneal surface epithelialization as the time (in days) of the last visit with epithelial defect plus the average (in days) between the last visit with epithelial defect and the first visit without it. Results: There was no difference in the size of epithelial defects on AM immediately after KLAL between the 10 KLALs without MMC treatment and 8 KLALs with MMC treatment (7.71 ± 0.22 mm vs. 7.53 ± 0.09 mm in diameter, p=0.07). Ten (55.5%) and 14 (66%) out of 18 KLALs healed in 1 and 2 weeks, respectively. The mean epithelial healing time was 13.6 (3 – 50) days and 15.2 (4 – 83) days for groups with and without MMC, respectively (p=0.75). Conclusions: Intraoperative application of MMC has no detrimental effect on epithelial healing by subsequent KLAL. The durations of 1 and 2 weeks can be used as a cut–off to judge whether epithelialization is mildly or severely delayed, respectively, following KLAL and to correlate the risk factors and clinical managements in the future
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