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Mitomycin-C Treatment for Conjunctival, Eyelid, Tear Duct and Corneal Disorders Indications Mitomycin-C was originally developed for the treatment of various types of cancer. It has also been found to be of value in the treatment of certain conjunctival and corneal disorders. It is applied topically as a drop or may be applied during the time of surgery. Definitive criteria for using or not using Mitomycin-C have yet to be established in conjunctival and corneal disorders, although there is an evolving consensus when these agents are of most value. Reasons to use this medicine may include recurrence of previously excised pterygia, recurrence of previously excised lesions, management of recurrent or diffuse ocular surface neoplasias, removal of corneal scars, and removal of corneal lesions with high risk for excessive corneal scarring. Mitomycin-C may be used alone or in conjunction with preoperative, operative, and post-operative medications to increase the success rate of treatment of the conjunctival or corneal disorder. It may be used as a drop applied to the surface of the eye. It may also be applied to the operative site at the time of surgery. In spite of the potential increased success rate, Mitomycin-C is not used in every case because of potential side effects and complications of the medication. The decision to use Mitomycin-C is based on the evaluation by the ophthalmologist and the potential advantages and disadvantages in each individual case. Conversely, the decision not to use MitomycinC may be valid because of the particular circumstance and risk factors involved. FDA Status of Mitomycin-C in Ocular Treatment and Surgery This medication was approved by the Food and Drug Administration(FDA) for the treatment of various types of cancer. Upon approval, the drug manufacturer produces a “label” that explains its use. Once a drug is approved by the FDA, physicians can use it for other purposes “off-label” as part of the practice of medicine if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. My ophthalmologist has informed me that this medication will be used “off-label” as part of the treatment of my conjunctival and/or corneal disorder. Risks and Complications In addition to the usual complications of conjunctival and corneal surgery, Mitomycin-C may cause blurred vision, worsened or loss of vision, ocular pain, ocular surface irritation, sensitivity to light, delayed healing, scleral or corneal melt with perforation, scarring of the conjunctiva or cornea, iritis, glaucoma, cataract, and possible need for further eye surgery. Patient Consent I understand that Mitomycin-C was approved by the FDA for the treatment of various types of cancer. Nevertheless, I wish to have Mitomycin-C applied to my eye and I am willing to accept the potential risks that my physician has discussed with me. I acknowledge that there may be other, unknown risks and that the long-term side effects and risks of Mitomycin-C are not known. I have read the above information and have discussed it with my physician and agree with the doctor’s decision to use Mitomycin-C “off-label” as may be found indicated in the treatment of my conjunctival and/or corneal disorder. ________________________________ Patient signature _______________ Date ________________________________ Witness _______________ Date