Mitomycin C: Biological Effects and Use in Refractive Surgery

Santhiago, Marcony R.; Netto, Marcelo V.; Wilson, Steven E.

doi:10.1097/ico.0b013e31821e429d

Cited by 90 publications

(52 citation statements)

References 171 publications

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“…Many surgeons use MMC treatment for virtually any secondary corneal surface ablation procedure in which there is a risk for significant haze. 16 Mitomycin-C is a potent mitotic inhibitor that decreases the incidence of haze after surface ablation by inhibiting the proliferation of myofibroblast presursors. 15,16 In this case, prophylactic MMC was not used in the primary PRK.…”

Section: Discussionmentioning

confidence: 99%

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Very late-onset corneal scar triggered by trauma after photorefractive keratectomy

Gomes

Smadja

Espana

et al. 2012

Journal of Cataract and Refractive Surgery

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A 54-year-old woman who had photorefractive keratectomy (PRK) more than 10 years earlier presented with a history of being hit in the eye by a tree branch and developing blurred vision a short time later. The corrected visual acuity was 20/100 with localized grade 3 stromal haze. The haze intensified despite initial response to corticosteroids and cyclosporine, and treatment with phototherapeutic keratectomy and 0.02% mitomycin-C (MMC) was effective in restoring corneal clarity and normal vision. Late-onset stromal scar can be triggered by trauma years after PRK. Phototherapeutic keratectomy with MMC can be an effective treatment for late-onset scar. Persistent haze or scar after trauma if PRK had not been performed previously is exceedingly rare.

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Section: Discussionmentioning

confidence: 99%

“…16 Mitomycin-C is a potent mitotic inhibitor that decreases the incidence of haze after surface ablation by inhibiting the proliferation of myofibroblast presursors. 15,16 In this case, prophylactic MMC was not used in the primary PRK. However, the use of MMC years earlier might not prevent late haze after trauma.…”

Section: Discussionmentioning

confidence: 99%

Very late-onset corneal scar triggered by trauma after photorefractive keratectomy

Gomes

Smadja

Espana

et al. 2012

Journal of Cataract and Refractive Surgery

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“…Many studies have suggested that MMC is safe and effective, although there continue to be concerns regarding long-term safety. 4 Other approaches have been explored on animal models, 5-7 but none have reached the stage of clinical testing in humans. An alternative approach to the prevention of corneal haze after trauma could be to use inexpensive autologous substances.…”

Section: Introductionmentioning

confidence: 99%

Platelet-Rich Plasma Prolongs Myofibroblast Accumulation in Corneal Stroma with Incisional Wound

Koulikovska

Szymanowski

Lagali

2015

Current Eye Research

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Purpose: The purpose of this study was to determine whether platelet-rich plasma (PRP) has an effect on corneal stromal cells in a rat model of wound healing following corneal incision. Materials and Methods: The effect of PRP on corneal wound healing in vivo was investigated in a corneal incision wound model in rats. 40 rats were wounded by deep corneal incision, and treated with either topically administered PRP (20 rats) or sodium chloride (20 rats). At 4 h and 1, 3, and 5 days after incision, a-smooth muscle actin (a SMA), SMAD2 and SMAD3 expression and apoptosis in stromal cells were evaluated by immunohistochemistry, and IL-1b mRNA expression was evaluated by real time PCR. Results: PRP-treated corneas exhibited reduced stromal cell apoptosis at day 3 and day 5 (p = 0.038, and 50.001, respectively) relative to controls. Interleukin-1b mRNA expression, however, was unchanged in PRP-treated corneas relative to controls. Topical PRP treatment resulted in a higher proportion of aSMA-positive myofibroblasts recruited to the wound site relative to control corneas. PRP did not affect activation of SMAD2 but activation of SMAD3 was significantly reduced at day 1 (p = 0.001) and dramatically increased at day 5 (p = 0.032). Conclusions: PRP treatment resulted in suppressed stromal cell apoptosis followed by SMAD3 activation and a greater proportion of myofibroblasts present at the wound site. Suppression of stromal cell apoptosis after corneal wounding by use of a growth factor-rich formulation may lead to myofibroblast accumulation by modulation of the TGF-b pathway.

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“…The possible formation of severe corneal subepithelial haze tended to limit the surface ablation procedures and the options to correct high refractive errors (13) .…”

Section: As Adjuvant Therapy After Prkmentioning

confidence: 99%

Mitomycin C application in refractive surgery

Piva¹,

Santhiago²

2015

Revista Brasileira De Oftalmologia

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Over the years, mitomycin C has been used by refractive surgeons to prophylactically decrease haze after surface ablation procedures and therapeutically in the treatment of preexisting haze. Development of mitomycin C treatments has had a significant role in the revival RESUMOA mitomicina C teve seu uso profilático e terapêutico estabelecido, ao longo dos anos, para diminuir o haze depois da ablação superficial. A mitomicina C é segura e eficaz como uma terapia adjuvante aplicada após um procedimento primário de ceratectomia fotorrefrativa ou após um retratamento com ceratectomia fotorrefrativa após o laser in situ keratomileusis LASIK. A mitomicina age modulando a cicatrização após a cirurgia. Constitui-se num potente inibidor de mitose, bloqueia a ativação e a profliferação dos fibroblastos e a diferenciação dos miofibroblastos. Embora existam muitos estudos apontando a segurança da mitomicina nas doses ultilizadas, ainda persistem dúvidas quanto à segurança, a longo prazo, do uso da mitomicina. Quando as córneas são examinadas com microscópios confocal, após depleção inicial dos ceratócitos, a densidade celular parece retornar ao normal seis a 12 meses após o uso de mitomicina C . A maioria dos estudos clínicos não encontrou diferença significativa entre a densidade endotelial celular pré-operatória e pós-operatória quando a mitomicina C 0.02% foi aplicada durante a cirurgia com um tempo de exposição de 2 minutos ou menos. Em aproximadamente 14 anos, a mitomicina C mostrou-se eficaz na prevenção e tratamento do haze corneano.

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Mitomycin C: Biological Effects and Use in Refractive Surgery

Abstract: After more than 10 years of use, MMC has been found to be effective when used for prevention and treatment of corneal haze. Questions remain regarding optimal treatment parameters and long-term safety.

Cited by 90 publications

References 171 publications

Very late-onset corneal scar triggered by trauma after photorefractive keratectomy

Very late-onset corneal scar triggered by trauma after photorefractive keratectomy

Platelet-Rich Plasma Prolongs Myofibroblast Accumulation in Corneal Stroma with Incisional Wound

Mitomycin C application in refractive surgery

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