Delayed epithelial healing following photorefractive keratectomy with mitomycin C treatment.
OBJECTIVE
To evaluate the epithelial healing following photorefractive keratectomy (PRK) with mitomycin C (MMC) 0.02%.


METHODS
A total of 1520 eyes of 760 patients with myopia with spherical equivalent between -1.5 and -8.0 dioptres underwent PRK during 2004-2008. The epithelium was removed mechanically, and laser ablation was followed by topical application of MMC (0.02%) for 20 seconds. A therapeutic contact lens (TCL), kept in 4°C, was fitted and worn until complete epithelialization. Antibiotic, steroid and diclofenac drops were instilled during the healing phase. Steroid drops were used for 6-8 weeks and gradually reduced. The results were compared with a retrospective analysis of 500 myopic eyes which underwent PRK without MMC therapy during 2002-2004.


RESULTS
In 30 MMC treated eyes (2%), epithelial healing was delayed with a stellate defect which healed after 12-14 days. Another fifteen eyes (1%) revealed loose midperipheral epithelium and complete epithelialization took 10-14 days after scraping. Two of these eyes developed recurrent erosion treated by scraping and TCL. Seven eyes (0.5%) revealed delayed healing with paracentral epithelial plaques which were scraped and complete healing took 12-14 days. No final haze was found in the MMC-treated eyes. In comparison, only 0.8% of the eyes which had undergone PRK without MMC revealed epithelial problems. Haze was found in 8% of these eyes. A statistically significant difference was found between the rate of epithelial problems of the two groups (p ≤ 0.002).


CONCLUSIONS
MMC (0.02%) applied for 20 seconds post-PRK was found to delay epithelial wound healing up to 14 days in 3.5% of patients with myopia compared to 0.8% of PRK eyes without MMC application. Final haze was not found despite delayed epithelialization because of MMC treatment.
Kremer
Israel
I
Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Ehrenberg
Miriam
M
Levinger
Shmuel
S
D000293:Adolescent; D000328:Adult; D000477:Alkylating Agents / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003646:Debridement; D019573:Epithelium, Corneal / Q000502:physiology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D009883:Ophthalmic Solutions / Q000008:administration & dosage; D018903:Photorefractive Keratectomy; D012189:Retrospective Studies; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
D000477:Alkylating Agents; D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D016685:Mitomycin