Photorefractive keratectomy with mitomycin C versus LASIK in custom surgeries for myopia: a bilateral prospective randomized clinical trial.
To compare photorefractive keratectomy (PRK) with prophylactic use of mitomycin C (MMC) and LASIK in custom surgeries for myopic astigmatism.



Eighty-eight eyes of 44 patients with a minimum estimated ablation depth of 50 microm were randomized to receive PRK with MMC 0.002% for 1 minute in one eye and LASIK in the fellow eye. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, slit-lamp microscopy, contrast sensitivity, specular microscopy, aberrometry, and a subjective questionnaire were evaluated. Forty-two patients completed 6-month follow-up.



Mean spherical equivalent refraction error before surgery and mean ablation depth were -3.99+/-1.20 diopters (D) and 73.09+/-14.55 microm in LASIK eyes, and -3.85+/-1.12 D and 70.7+/-14.07 microm in PRK with MMC eyes, respectively. Uncorrected visual acuity was significantly better in PRK with MMC eyes 3 months (P=.04) and 6 months (P=.01) after surgery. Best spectacle-corrected visual acuity and spherical equivalent refraction did not differ significantly in the groups during follow-up (P>.05). Significant haze was not observed in any PRK with MMC eye. Mean higher order aberration was lower in PRK with MMC eyes postoperatively compared with LASIK eyes (P=.01). Better contrast sensitivity was observed in PRK with MMC eyes than LASIK eyes (P<.05). The endothelial cell count did not differ significantly between groups (P=.65). In terms of visual satisfaction, PRK with MMC eyes were better rated.



Photorefractive keratectomy with MMC appears to be more effective than LASIK in custom surgery for moderate myopia. During 6-month follow-up, no toxic effects of MMC were evident. Long-term follow-up is necessary to attest its safety.
Wallau
Anelise Dutra
AD
Vision Institute, Federal University of São Paulo, Department of Ophthalmology, São Paulo, Brazil.
Campos
Mauro
M
D000328:Adult; D000477:Alkylating Agents / Q000008:administration & dosage*; D001251:Astigmatism / Q000601:surgery; D003131:Combined Modality Therapy; D015350:Contrast Sensitivity / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009216:Myopia / Q000601:surgery*; D017060:Patient Satisfaction; D018903:Photorefractive Keratectomy / Q000379:methods*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D000477:Alkylating Agents; D016685:Mitomycin