Limbal stem cell deficiency after subconjunctival mitomycin C injection for trabeculectomy

PURPOSE: To report on severe limbus cell insufficiency after trabeculectomy with subconjunctival injection of mitomycin C. DESIGN: Interventional small case-series. METHODS: Seven consecutive Caucasian patients (seven eyes) underwent penetrating trabeculectomy that included subconjunctival injection of 0.1 to 0.2 ml of mitomycin C (0.2 mg/ml) at the 12 o'clock position. RESULTS: All patients with a follow-up time of > 1.5 years (n = 3 eyes; 43%) experienced marked ocular surface problems that included corneal thinning (n = 1) and scleral melting (n = 2). Four patients (57%) with a follow-up time of < 14 months did not show complications that were attributable to the subconjunctival application of mitomycin. CONCLUSIONS: Because limbal stem cell deficiency may be a late complication of subconjunctival mitomycin C injection, subconjunctival injection of mitomycin C may be avoided in routine antiglaucomatous filtering surgery.