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Alterations in endothelial cell density after photorefractive keratectomy with adjuvant mitomycin
Vasilios F Diakonis1, Aristophanis Pallikaris, George D Kymionis
1Institute of Vision and Optics, University of Crete, Heraklion, Crete, Greece. diakonis@gmail.com
Purpose:
To elucidate the distinct role of the intraoperative use of mitomycin C (MMC) on endothelial cell density after photorefractive keratectomy (PRK) in human eyes.
Design:
Prospective, double-masked, randomized clinical trial.
Methods:
One eye of 15 patients was treated with PRK with intraoperative use of topical 0.02% MMC (15 seconds), whereas the fellow eye was treated with Epipolis laser in situ keratomileusis (Epi-LASIK) in random order. Corneal confocal microscopy was performed in all eyes preoperatively and at one, three, six, and 12 months after the surgery. Moreover, three endothelial images were acquired in each of 15 preoperative-normal eyes to evaluate the repeatability of measuring endothelial cell density. Repeated measures analysis of variance was used to compare the temporal variations of endothelial cell density between the two techniques and the changes of endothelial cell density over time.
Results:
The coefficient of repeatability of endothelial cell count was 148 cells/mm(2). Preoperative endothelial cell density was not significantly different between the two groups (P = .82). Moreover, the effect of the treatment on the temporal variation of endothelial cell density was insignificant (P = .83), whereas the differences between the preoperative and the postoperative endothelial cell densities reached statistical significance (P
Conclusions:
The prophylactic intraoperative application of MMC (up to 15 seconds) after PRK does not seem to affect the endothelial cell density.
Insights
Intraoperative mitomycin C (MMC) used during photorefractive keratectomy (PRK) does not appear to impact endothelial cell density. This study found no significant long-term effects on corneal endothelial cells after PRK with MMC.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Cell Biology
Background:
- Photorefractive keratectomy (PRK) is a common refractive surgery.
- Mitomycin C (MMC) is sometimes used during PRK to prevent haze.
- The effect of intraoperative MMC on corneal endothelial cells requires further elucidation.
Purpose of the Study:
- To determine the specific role of intraoperative mitomycin C (MMC) on endothelial cell density following photorefractive keratectomy (PRK).
- To compare the impact of MMC-assisted PRK versus Epi-LASIK on corneal endothelial cells.
Main Methods:
- A prospective, double-masked, randomized clinical trial involving 15 patients.
- One eye per patient underwent PRK with topical 0.02% MMC (15 seconds), while the fellow eye had Epi-LASIK.
- Corneal confocal microscopy assessed endothelial cell density preoperatively and at 1, 3, 6, and 12 months post-surgery.
Main Results:
- The repeatability of endothelial cell count measurement was 148 cells/mm(2).
- No significant difference in preoperative endothelial cell density was observed between the two groups.
- While initial postoperative differences were statistically significant, accounting for instrument repeatability diminished these findings, indicating no significant effect of MMC on endothelial cell density over time.
Conclusions:
- Prophylactic intraoperative application of MMC (up to 15 seconds) after PRK does not appear to affect endothelial cell density.
- The study suggests that MMC use in PRK is safe concerning corneal endothelial cell health.
