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Prophylactic use of mitomycin-C in the management of a buttonholed LASIK flap
Howard A Lane1, Jerome A Swale, Parag A Majmudar
1Cornea Service, Department of Ophthalmology, Rush Medical College, Chicago, Illinois, USA.
Abstract:
We report a case in which prophylactic mitomycin-C (MMC) was used to prevent haze and scarring after photorefractive keratectomy (PRK) in an eye with a previous laser in situ keratomileusis flap buttonhole. During the patient's primary procedure, a 3.5 mm central buttonhole was created during the microkeratome pass. The flap was repositioned without laser application. Follow-up examinations revealed a moderate central buttonhole scar. Twelve months later, the patient had PRK with adjunctive MMC 0.02% application in the eye. At the 1-year examination, the uncorrected visual acuity was 20/20 and the cornea was clear with no evidence of scarring or haze.
Insights
Prophylactic mitomycin-C (MMC) successfully prevented haze and scarring after photorefractive keratectomy (PRK) in an eye with a prior laser in situ keratomileusis (LASIK) flap buttonhole complication. This case demonstrates MMC
Area of Science:
- Ophthalmology
- Corneal Surgery
- Refractive Surgery
Background:
- Photorefractive keratectomy (PRK) is a common refractive surgery procedure.
- Complications such as corneal haze and scarring can occur post-PRK.
- Laser in situ keratomileusis (LASIK) flap buttonholes are a known complication.
Observation:
- A patient presented with a history of a LASIK flap buttonhole complication.
- This patient subsequently underwent PRK.
- A moderate central buttonhole scar was noted prior to PRK.
Findings:
- Prophylactic mitomycin-C (MMC) at 0.02% was applied during PRK.
- The patient achieved uncorrected visual acuity of 20/20 one year post-PRK.
- Corneal examination revealed no evidence of scarring or haze.
Implications:
- Prophylactic MMC may be a viable strategy to prevent haze and scarring after PRK in eyes with prior LASIK complications.
- This approach could improve visual outcomes and reduce long-term corneal opacity.
- Further studies are warranted to confirm the efficacy and safety of MMC in similar cases.