Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments

Abstract

Purpose: To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). Methods: The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. Surgical technique: After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. Results: The mean follow-up time was 19.6 ± 6 months (range 12–27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 ( p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. Conclusion: Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.