Effect of Prophylactic Mitomycin C on Corneal Endothelium Following Transepithelial Photorefractive Keratectomy in Myopic Patients

Abstract

This study investigated the effect of prophylactic mitomycin C (MMC) on corneal endothelium to inhibit corneal haze formation post transepithelial photorefractive keratectomy (T-PRK). Methods: A total of 120 eyes of 60 patients with low, moderate, and high myopia were subjected to T-PRK with intraoperative application of MMC (0.02%) for 30-50s. Patients' files were categorized into three groups according to ablation depths (if ≥100 µm) during T-PRK as follows: (1) Group A -low myopia without MMC, (2) Group B -low myopia with MMC, and (3) Group Cmoderate/high myopia with MMC. Preoperative/surgical parameters and refractive outcomes were documented. Cell density (CD), number of cells (NUM), coefficient of variation, central corneal thickness (CCT), hexagonality (HEX/6A), average cell area (AVG), and its standard deviation (SD) were evaluated using specular microscopy preoperatively and postoperatively. Results: Overall, 119 out of 120 eyes showed significant prevention of corneal haze. Groups A and C showed no significant changes in endothelial CD and NUM. Group B showed a non-significant reduction in CD. However, all three groups showed significant variations in HEX/6A, CCT, AVG, and SD. Conclusion:The MMC application did not significantly affect corneal endothelial density or number and can be used safely and effectively to prevent corneal haze following T-PRK in myopia.

Clinical Evaluation of Corneal Endothelial Parameters following Laser Refractive Surgery in Myopic Eyes: A Review

“…In addition, an intraoperative application of MMC 0.02% for 30 s caused no significant change in ECD. A recent study by Al-Mohaimeed et al [ 71 ] also revealed the safety and efficacy of the use of MMC in reducing corneal haze after Trans-PRK in low to high order myopia. MMC exerted no effect on the number or density of corneal endothelial cells.…”

Management of Corneal Haze After Photorefractive Keratectomy

“…During the procedure, multiple slit lamp examinations of the cornea may be necessary until the surgeon feels comfortable that they have removed enough of the scar. Afterwards, a sponge can be used to apply 0.02% MMC to the surface for 2 min [ 5 , 7 , 53 , 72 ], following which the cornea will be irrigated continuously with 20–30 cc of cold or room temperature saline solution. The application of MMC and the appropriate concentration are still controversial topics, especially for low myopia eyes [ 96 ], due to MMC-related tissue toxicity.…”

“…Unfortunately, the authors of this study did not disclose the specific duration for each ablation depth . A much smaller study carried out in 2022 included 120 eyes that underwent t-PRK and then treated with 0.02% MMC for 30–50 s without specification of ablation depth [ 72 ]. In this study, one eye developed post PRK haze [ 72 ].…”

“…A much smaller study carried out in 2022 included 120 eyes that underwent t-PRK and then treated with 0.02% MMC for 30–50 s without specification of ablation depth [ 72 ]. In this study, one eye developed post PRK haze [ 72 ]. The concentration of MMC application has also been explored, with one RTC showing the effectiveness of 0.01% MMC for the prevention of post PRK haze; however, this study was limited by sample size [ 73 ].…”

Transepithelial photorefractive keratectomy without mitomycin-C for irregular astigmatism after femtosecond laser-assisted in situ keratomileusisflap complications

“…Due to its effectiveness in preserving corneal transparency and preventing the formation of opacity, it is currently used as a preventive agent for haze following high-risk PRK [7][8] . Several studies have demonstrated the potential of MMC in suppressing haze formation, but its application is also risky [9] . Research findings suggest that MMC may exert an impact on the cellularity of the anterior stroma, corneal nerves, and corneal endothelium.…”