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Photorefractive keratectomy with 0.02% mitomycin C for treatment of residual refractive errors after LASIK
Sathish Srinivasan1, Antony Drake, Sheldon Herzig
1Herzig Eye Institute, Toronto, Ontario, Canada. sathish.srinivasan@gmail.com
Purpose:
To evaluate the efficacy and safety of prophylactic mitomycin C (MMC) during photorefractive keratectomy (PRK) over LASIK flaps for the treatment of residual refractive errors following LASIK.
Methods:
In this single center, retrospective clinical study, 30 eyes of 33 patients (mean age 37.2 years) who had MMC (0.02%, 30 to 120 seconds) during PRK for the treatment of residual refractive errors following myopic LASIK were evaluated. The retreatment procedures were performed with a VISX S4 laser with iris registration. All patients underwent slit-lamp microscopy, manifest and cycloplegic refraction, corneal topography, pachymetry, pupillometry, and wavefront analysis pre- and postoperatively. All patients underwent follow-up at 1 day, 1 week, and 1, 3, and 6 months and thereafter as required.
Results:
Mean time between LASIK and PRK retreatment was 67.3 months (range: 7 to 113 months). No intra- or postoperative complications occurred during primary LASIK or PRK retreatment. Mean spherical equivalent refraction of attempted correction with PRK was -0.94 diopters (D) (range: -2.38 to +0.75 D). At mean 7.1-month follow-up, the average uncorrected visual acuity (UCVA) improved from 20/50 (range: 20/30 to 20/200) to 20/28 (range: 20/15 to 20/70). Twenty-seven of 30 eyes showed improvement in UCVA. Two eyes had subjective improvement of glare symptoms (and objective improvement in higher order aberrations), and one eye lost one line of best spectacle-corrected visual acuity due to unrelated corneal abrasion in the postoperative period. None of the eyes in the cohort developed postoperative haze.
Conclusions:
Photorefractive keratectomy with prophylactic MMC (0.02%) is a safe and effective option for treating myopic regression following LASIK. A single intraoperative application of 0.02% MMC for as few as 30 seconds was effective in preventing postoperative haze formation.
Insights
Prophylactic mitomycin C (MMC) during photorefractive keratectomy (PRK) effectively treats residual refractive errors after LASIK without causing haze. This safe and effective treatment improves uncorrected visual acuity in most patients.
Area of Science:
- Ophthalmology
- Refractive Surgery
- Corneal Surgery
Background:
- Laser-assisted in situ keratomileusis (LASIK) is a common procedure for correcting refractive errors.
- Residual refractive errors or myopic regression can occur after LASIK, necessitating retreatment.
- Photorefractive keratectomy (PRK) is an option for retreatment, but concerns about haze formation exist.
Purpose of the Study:
- To evaluate the efficacy and safety of using prophylactic mitomycin C (MMC) during photorefractive keratectomy (PRK) for retreatment of residual refractive errors after LASIK.
- To determine if MMC can prevent the formation of postoperative haze following PRK retreatment.
- To assess the visual acuity outcomes and safety profile of MMC-assisted PRK.
Main Methods:
- A retrospective clinical study involving 30 eyes of 33 patients who underwent PRK with prophylactic MMC (0.02% for 30-120 seconds) for residual refractive errors post-myopic LASIK.
- Procedures were performed using a VISX S4 laser with iris registration.
- Comprehensive pre- and postoperative evaluations included visual acuity, refraction, corneal topography, pachymetry, pupillometry, and wavefront analysis, with follow-up up to 6 months.
Main Results:
- No intra- or postoperative complications were reported during the LASIK or PRK retreatment procedures.
- Mean uncorrected visual acuity (UCVA) improved from 20/50 to 20/28 at a mean follow-up of 7.1 months, with 27 of 30 eyes showing improvement.
- No eyes in the cohort developed postoperative haze, and two eyes experienced subjective improvement in glare symptoms.
Conclusions:
- Prophylactic mitomycin C (MMC) at a 0.02% concentration is a safe and effective adjunct to photorefractive keratectomy (PRK) for treating myopic regression after LASIK.
- A single intraoperative application of MMC for as short as 30 seconds effectively prevents postoperative haze formation.
- MMC-assisted PRK offers a viable and safe option for visual rehabilitation in patients with residual refractive errors post-LASIK.
