Mitomycin C Application After Corneal Cross-linking for Keratoconus Increases Stromal Haze

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Keratoconus is a progressive thinning disorder of the cornea.
• Corneal cross-linking (CXL) is a standard treatment to halt keratoconus progression.
• The role of adjunctive mitomycin C (MMC) in CXL for haze formation requires further investigation.

Purpose of the Study:

• To compare corneal haze development after CXL with and without MMC in mild to moderate keratoconus.
• To evaluate the impact of MMC on corneal reflectivity and haze using optical coherence tomography (OCT).

Main Methods:

• Retrospective analysis of 87 eyes with mild to moderate keratoconus.
• Two groups: CXL alone (n=44) and CXL with MMC (CXL+MMC) (n=43), both following the Dresden protocol.
• Corneal reflectivity and haze measured by OCT at 1, 3, 6, and 12 months postoperatively.

Main Results:

• The CXL+MMC group showed significantly higher anterior corneal reflectivity and stromal haze reflectivity at 1 month and 1 year postoperatively compared to CXL alone.
• Both groups demonstrated significant increases in corneal reflectivity and haze over 1 year.
• Simulated keratometry changes were similar between groups, but CXL+MMC achieved greater maximum keratometry flattening.

Conclusions:

• Mitomycin C application following CXL significantly increases corneal haze.
• Despite increased haze, CXL+MMC demonstrates comparable efficacy to CXL alone in improving simulated keratometry.
• Further research is needed on MMC's role in haze formation during simultaneous CXL and photorefractive keratectomy.