Purpose: To assess the efficacy and safety of intraopertive application of a single dose Mitomycin-C in the prevention of reproliferation and redetachment after vitreous surgeries for retinal detachment cases complicated by proliferative vitreoretinopathy (PVR).
Methods: In a prospective randomized study, 35 patients with complex forms of retinal detachment and advanced stages of PVR were operated upon using standard three-port pars plana vitrectomy with peeling of preretinal membranes and vitreous base dissection. Patients were randomized for either receiving Mitomycin-C or not. In patients randomized for the drug, Mitomycin-C 0.3 microgram/ml was applied in the infusion fluid for 5 minutes followed by irrigation of the vitreous cavity. This was followed by injection of perfluorocarbon liquid, fluid-silicone exchange, endolaser photocoagulation and scleral buckle when necessary.
Results: After a minimum follow-up period of three months, successful reattachment of the retina was achieved by a single opertion in 85.7% of cases in the Mitomycin group and in 42.9% in the control group (p=0.007). In the Mitomycin group limited reproliferation occurred in 19% of cases in the form of macular pucker and fixed retinal folds. In the control group reproliferation occurred in 50% of cases in the form of diffuse posterior retinal contraction and anterior proliferations (p=0.053).
Conclusion: The dose of Mitomycin-C used partially prevented reproliferation in complex cases of PVR. A limited form of PVR developed in the form of macular pucker. No toxic effects on ocular tissues were noticed using this dose. Further studies are needed to select the proper dose that completely and safely prevent reproliferation. |
