Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes.

PURPOSE To evaluate the role of topical mitomycin C in corneal wound healing (CWH) after photorefractive keratectomy (PRK) in highly myopic eyes. DESIGN Prospective, double-masked, randomized clinical trial. PARTICIPANTS Seventy-two eyes of 36 patients affected by high (>7 diopters) myopia. METHODS In each patient, one eye was randomly assigned to PRK with intraoperative topical 0.02% mitomycin C application, and the fellow eye was treated with a placebo. Postoperatively, mitomycin C-treated eyes received artificial tears (3 times daily, tapered in 3 months), whereas the fellow eye was treated with fluorometholone sodium 2% and artificial tears (3 times daily, tapered in 3 months). MAIN OUTCOME MEASURES Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity, manifest refraction, and biomicroscopy. Contrast sensitivity was determined using the Pelli-Robson chart. Corneal confocal microscopy documented CWH. RESULTS Mean follow-up was 18 months (range, 12-36). No side effects or toxic effects were documented. At 12-month follow-up examination, UCVAs (logarithm of the minimum angle of resolution) were 0.4+/-0.48 and 0.5+/-0.53 (P = .03) in mitomycin C-treated eyes and corticosteroid-treated eyes, respectively. At 1 year, corneal haze developed in 20% of corticosteroid-treated eyes, versus 0% of mitomycin C-treated eyes. At 12, 24, and 36 months, corneal confocal microscopy showed activated keratocytes and extracellular matrix significantly more evident in untreated eyes (Ps = 0.004, 0.024, and 0.046, respectively). CONCLUSION Topical intraoperative application of 0.02% mitomycin C can reduce haze formation in highly myopic eyes undergoing PRK.

[1]  W M Petroll,et al.  Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease. , 1993, Ophthalmology.

[2]  T. Møller-Pedersen,et al.  Quantification of stromal thinning, epithelial thickness, and corneal haze after photorefractive keratectomy using in vivo confocal microscopy. , 1997, Ophthalmology.

[3]  D. Ponzin,et al.  Use of amino acids in refractive surgery. , 2002, Journal of refractive surgery.

[4]  S. Siano,et al.  Prevention of Corneal Keratocyte Apoptosis after Argon Fluoride Excimer Laser Irradiation with the Free Radical Scavenger Ubiquinone Q10 , 2000, European journal of ophthalmology.

[5]  B. Becker,et al.  CORTICOSTEROIDS AND INTRAOCULAR PRESSURE. , 1963, Archives of ophthalmology.

[6]  J. Chen,et al.  Comparison of laser in situ keratomileusis and photorefractive keratectomy to correct myopia from -1.25 to -6.00 diopters. , 1997, Journal of refractive surgery.

[7]  Nancy I Fan-Paul,et al.  Night vision disturbances after corneal refractive surgery. , 2002, Survey of ophthalmology.

[8]  Y. Tsai,et al.  Acute Scleral Thinning After Pterygium Excision with Intraoperative Mitomycin C: A Case Report of Scleral Dellen After Bare Sclera Technique and Review of the Literature , 2002, Cornea.

[9]  S. Tuft,et al.  A morphological study of rabbit corneas after laser keratectomy , 1992, Eye.

[10]  Francesco Carones,et al.  Evaluation of the prophylactic use of mitomycin‐C to inhibit haze formation after photorefractive keratectomy , 2002, Journal of cataract and refractive surgery.

[11]  M. Vetrugno,et al.  A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy , 2001, The British journal of ophthalmology.

[12]  J. Marshall,et al.  Keratocyte density and size in conscious humans by digital image analysis of confocal images , 1998, Eye.

[13]  P. Dilly,et al.  Advances in confocal microscopy of the cornea. , 1998 .

[14]  C. Foster,et al.  Serious complications of topical mitomycin-C after pterygium surgery. , 1992, Ophthalmology.

[15]  H. Garzozi,et al.  Serious corneoscleral complications after pterygium excision with mitomycin C , 2002, The British journal of ophthalmology.

[16]  Sanjay V. Patel,et al.  Keratocyte density in the human cornea after photorefractive keratectomy. , 2003, Archives of ophthalmology.

[17]  Craig Boote,et al.  Collagen fibrils appear more closely packed in the prepupillary cornea: optical and biomechanical implications. , 2003, Investigative ophthalmology & visual science.

[18]  J. Gebbers,et al.  Mitomycin C reduces scar formation after excimer laser (193 nm) photorefractive keratectomy in rabbits , 1997, Eye.

[19]  I-Jong Wang,et al.  Quality of vision after laser in situ keratomileusis: Influence of dioptric correction and pupil size on visual function , 2003, Journal of cataract and refractive surgery.

[20]  O D Schein,et al.  Photorefractive keratectomy versus laser in situ keratomileusis for moderate to high myopia. A randomized prospective study. , 1998, Ophthalmology.

[21]  W. Green,et al.  Modulation of corneal wound healing after excimer laser keratomileusis using topical mitomycin C and steroids. , 1991, Archives of ophthalmology.

[22]  J. Marshall,et al.  The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study. , 1994, Ophthalmology.

[23]  B Seitz,et al.  In vitro effects of mitomycin-C on human keratocytes. , 1996, Journal of refractive surgery.

[24]  S. Levinger,et al.  Phototherapeutic keratectomy with mitomycin C for corneal haze following photorefractive keratectomy for myopia. , 2003, Journal of refractive surgery.

[25]  R. Burde,et al.  Cataracts Induced by Topical , 1978 .

[26]  G O Waring,et al.  Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. , 1990, Archives of ophthalmology.

[27]  S. Panagopoulou,et al.  Induced optical aberrations following formation of a laser in situ keratomileusis flap , 2002, Journal of cataract and refractive surgery.

[28]  T. Møller-Pedersen,et al.  Stromal wound healing explains refractive instability and haze development after photorefractive keratectomy: a 1-year confocal microscopic study. , 2000, Ophthalmology.

[29]  J Wollensak,et al.  Myopic photorefractive keratectomy with the excimer laser. One-year follow-up. , 1991, Ophthalmology.

[30]  W. Green,et al.  Corneal healing following laser refractive keratectomy. , 1989, Archives of ophthalmology.

[31]  T. Seiler,et al.  Complications of myopic photorefractive keratectomy with the excimer laser. , 1994, Ophthalmology.

[32]  I. Pallikaris,et al.  Epi‐LASIK: Comparative histological evaluation of mechanical and alcohol‐assisted epithelial separation , 2003, Journal of cataract and refractive surgery.

[33]  S. Jain,et al.  Topical MMC for subepithelial fibrosis after refractive corneal surgery. , 2001, Ophthalmology.

[34]  B. Seitz,et al.  Ultraviolet-B enhances corneal stromal response to 193-nm excimer laser treatment. , 1997, Ophthalmology.

[35]  Francesco Carones,et al.  Scraping and mitomycin C to treat haze and regression after photorefractive keratectomy for myopia. , 2003, Journal of refractive surgery.

[36]  R. Montés-Micó,et al.  Mesopic contrast sensitivity function after laser in situ keratomileusis. , 2003, Journal of refractive surgery.

[37]  H Xu,et al.  Mitomycin C reduces haze formation in rabbits after excimer laser photorefractive keratectomy. , 2001, Journal of refractive surgery.

[38]  N. Sharma,et al.  PRK for Epithelial Ingrowth in Buttonhole After LASIK , 2003, Cornea.

[39]  S. Hamano,et al.  Effects of tranilast on cultured rabbit corneal keratocytes and corneal haze after photorefractive keratectomy. , 1999, Japanese journal of ophthalmology.

[40]  D. Gartry,et al.  The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy. A prospective, randomized, double-blind trial. , 1992, Archives of ophthalmology.

[41]  W M Petroll,et al.  In vivo confocal imaging: general principles and applications. , 1994, Scanning.

[42]  P. Majmudar,et al.  Topical mitomycin-C for subepithelial fibrosis after refractive corneal surgery. , 2000, Ophthalmology.

[43]  R. Krueger,et al.  Role of clearance and treatment zones in contrast sensitivity: significance in refractive surgery. , 1999, Journal of cataract and refractive surgery.

[44]  J. Marshall,et al.  Effect of collagenase inhibitors on corneal haze after PRK. , 2001, Experimental eye research.

[45]  W M Petroll,et al.  Quantitative three-dimensional confocal imaging of the cornea in situ and in vivo: system design and calibration. , 2006, Scanning.

[46]  J. Marshall,et al.  Confocal microscopy using oblique sections for measurement of corneal epithelial thickness in conscious humans. , 2009, Acta ophthalmologica Scandinavica.

[47]  D. Gartry,et al.  Excimer Laser Photorefractive Keratectomy: 18-month Follow-up , 1992 .

[48]  A. Ringvold,et al.  Ascorbate prophylaxis for corneal haze after photorefractive keratectomy. , 2003, Journal of refractive surgery.

[49]  P. Majmudar,et al.  Mytomycin-C for post-PRK corneal haze. , 2000, Journal of cataract and refractive surgery.

[50]  Sergio Capaccioli,et al.  Concomitant effect of topical ubiquinone Q10 and vitamin E to prevent keratocyte apoptosis after excimer laser photoablation in rabbits. , 2002, Journal of refractive surgery.

[51]  D. Gartry,et al.  Photorefractive keratectomy with an argon fluoride excimer laser: a clinical study. , 1991, Refractive & corneal surgery.

[52]  D. Uthoff,et al.  Histopathological comparison of photorefractive keratectomy and laser in situ keratomileusis in rabbits. , 1996, Journal of refractive surgery.

[53]  W M Petroll,et al.  Epithelial and corneal thickness measurements by in vivo confocal microscopy through focusing (CMTF). , 1997, Current eye research.

[54]  M. Pop,et al.  Multizone/multipass photorefractive keratectomy: Six month results , 1995, Journal of cataract and refractive surgery.

[55]  W N Charman,et al.  Choice of spatial frequency for contrast sensitivity evaluation after corneal refractive surgery. , 2001, Journal of refractive surgery.

[56]  M. Vetrugno,et al.  Contrast sensitivity measured by 2 methods after photorefractive keratectomy , 2000, Journal of cataract and refractive surgery.

[57]  W. Charman,et al.  Mesopic contrast sensitivity function after excimer laser photorefractive keratectomy. , 2002, Journal of refractive surgery.

[58]  M. Chalita,et al.  Laser epithelial keratomileusis: outcome of initial cases performed by an experienced surgeon. , 2003, Journal of refractive surgery.

[59]  R. D. Stulting,et al.  Contrast sensitivity and glare disability after radial keratotomy and photorefractive keratectomy. , 1998, Archives of ophthalmology.

[60]  A. Nesburn,et al.  A two-year experience with excimer laser photorefractive keratectomy for myopia. , 1993, Ophthalmology.

[61]  M. Maldonado.  Intraoperative MMC after excimer laser surgery for myopia. , 2002, Ophthalmology.

[62]  F. Hoffmann,et al.  Immunohistology of corneal wound healing after photorefractive keratectomy and laser in situ keratomileusis. wachtlin@ukbf.fu-berlin.de. , 1999, Journal of refractive surgery.

[63]  S. Wilson,et al.  Incidence and Prevention of Epithelial Growth Within the Interface After Laser In Situ Keratomileusis , 2000, Cornea.

[64]  K. Sung,et al.  Apoptosis in keratocytes caused by mitomycin C. , 2003, Investigative ophthalmology & visual science.

[65]  W. Culbertson,et al.  Reduction in corneal haze and apoptosis by amniotic membrane matrix in excimer laser photoablation in rabbits , 2001, Journal of cataract and refractive surgery.

[66]  Geunyoung Yoon,et al.  Separate effects of the microkeratome incision and laser ablation on the eye's wave aberration. , 2003, American journal of ophthalmology.