Low-Dose Mitomycin-C for Mucosal Overgrowth Treatment in Boston Type 1 Keratoprosthesis With Autologous Buccal Mucosa Overlay in a Patient With Severe Stevens-Johnson Syndrome.

PURPOSE: To describe the management of fast mucosal overgrowth by trimming it and application of a low concentration of mitomycin C (MMC) in a Boston Keratoprosthesis type I with buccal autologous mucosa overlay (B1KProM).

METHODS

We report a single-patient case in which low-dose, short-duration MMC was used. A review of the literature was performed to identify previously reported dosing strategies. A 21-year-old woman developed ibuprofen-induced Stevens-Johnson syndrome at age 5, resulting in severe ocular surface disease. Multiple surgeries performed on the right eye (RE) failed because of persistent epithelial defects and recurrent infections. The best-corrected visual acuity was 0.08 (decimal) in the RE. A B1KProM was implanted on the RE but after 2 weeks mucosa overgrown, partially obstructing the visual axis. A resection of the mucosal excess plus application of a sponge soaked in MMC 0.01% for 1 minute was performed to prevent recurrence.

RESULTS

The intervention successfully restored the visual axis preserving buccal mucosa integration during the 12 months of follow-up. In this period, no MMC complications were found and the best-corrected visual acuity improved to 0.6. The prosthesis remained in place without additional postoperative complications.

CONCLUSIONS

Mucosal overgrowth is a frequent complication after B1KProM, particularly in eyes with Stevens-Johnson syndrome. This report provides initial evidence that the complication could be successfully treated with mucosal excision and a lower dose of MMC, to prevent recurrence, avoiding side effects, and to improve prosthesis retention, usually shorter in patients with autoimmune disease.