Corneal Rehabilitation After Firework Injury: Mitomycin-C–Guided Mice Technique

To report cornea-oriented surgical management of severe post-traumatic corneal neovascularization (CNV) with secondary ocular surface failure following firework injury, with focus on Mitomycin-C–guided Minimally Invasive Corneal Epitheliectomy (MICE) as a strategy for controlled vascular modulation rather than aggressive excision. The aim was pragmatic: stabilize the surface and reduce angiogenic drive sufficiently to allow functional visual rehabilitation.

Tertiary referral center for anterior segment reconstruction with multidisciplinary involvement when required.

A 32-year-old male sustained combined thermal, chemical, and blunt ocular trauma from a high-velocity firework projectile. On presentation, the eye showed periocular burns, ankyloblepharon, symblepharon, distorted fornices, and extensive deep stromal corneal neovascularization (CNV) with lipid deposition. The corneal surface was partially conjunctivalized and mechanically unstable, with suspected partial limbal dysfunction.

Management was staged. Cicatricial adhesions were released, followed by conjunctivoplasty and fornix reconstruction with symblepharon ring placement to reduce tractional stress on the limbus. Corneal intervention was deferred until surface inflammation decreased.

MICE was then performed to remove fibrovascular pannus and abnormal epithelium in a conservative manner. Low-dose, time-limited Mitomycin C was applied intraoperatively to modulate stromal activation and angiogenic drive. Selected feeder vessels were interrupted when accessible. A cryopreserved amniotic membrane was placed to support epithelial recovery.

Follow-up demonstrated gradual reduction in vessel caliber and perfusion with improved corneal clarity. Residual stromal haze persisted, but epithelial integrity and fornix stability were maintained without recurrent symblepharon.

Severe firework-related trauma may produce deep stromal CNV combined with cicatricial surface instability, a scenario in which immediate keratoplasty would carry a high likelihood of failure. In this case, staged reconstruction with Mitomycin-C–guided MICE appeared to reduce angiogenic activity sufficiently to restore a more stable and optically functional cornea. The effect was modulatory rather than ablative.

Long-term durability remains uncertain. Still, in similarly inflamed and structurally compromised corneas, this approach may offer a tissue-sparing alternative before considering transplantation.