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Mitomycin-C helps alleviate corneal haze after PRK
Study shows an intraoperative topical application of 0.02% mitomycin-C enhances visual acuity and prevents corneal haze.
LISBON – A topical application of 0.02% mitomycin-C can help prevent corneal haze associated with PRK and improve visual acuity without side effects, according to one ophthalmologist.
A study conducted by Ewa Mrukwa-Kominek, MD, PhD, and colleagues at the Silesian School of Medicine in Poland showed how treatment with 0.02% mitomycin-C acts on corneal structures to prevent postop haze.
“After treatment, the epithelium becomes more regular, nerve fibers regenerate, and in the site of Bowman’s layer, small illumination was noticed,” Dr. Mrukwa-Kominek said at the meeting of the European Society of Cataract and Refractive Surgeons.
Dr. Mrukwa-Kominek and colleagues evaluated the changes in corneal structures before and after application of mitomycin-C.
“Local mitomycin-C application inhibits keratocyte activity and collagen synthesis, thus decreasing the frequency of haze,” she said.
Thirteen eyes of 12 patients were included in the study. The eyes experienced corneal haze and regression of the achieved refractive effect after previous PRK. In the study, they were treated with 0.02% mitomycin-C during a second PRK procedure.
All patients had haze ranging from grade 3 to 4, with a mean preoperative uncorrected visual acuity of 0.17 and a mean preoperative best corrected visual acuity of 0.51. Follow-up ranged from 9 to 15 months, and the course of the healing process was observed through confocal microscopy.
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Images: Mrukwa-Kominek E |
Rapid corneal healing
Within 5 days of the treatment, the corneas showed signs of healing, according to Dr. Mrukwa-Kominek.
“After 5 days, all the corneas were epithelialized without any signs of haze, and the visual acuity was satisfactory,” she told Ocular Surgery News in an e-mail interview.
She said that after 1 month, two eyes showed haze of grade 1. After 6 months, 10 eyes had haze of grade 0 to 0.5, two eyes had grade 1 haze, and one eye had grade 2 haze.
By 9 months postop, 10 eyes had haze of grade 0 to 0.5, and three eyes had haze of grade 1.
Visual acuity showed equally rapid correction, with mean UCVA increasing from 0.17 to 0.51 at 1 month and then to 0.6 at 6 months, Dr. Mrukwa-Kominek said. This remained stable throughout the follow-up period. Mean BCVA increased in all eyes to 0.8 compared with the preop measurement of 0.51.
The mean preop spherical equivalent was –4.33 D, and at the 9-month follow-up it was –0.54 D. Dr. Mrukwa-Kominek said that the spherical equivalent had stabilized as early as the 3-month follow-up, and that the final mean spherical equivalent was –0.75 D.
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Confocal images
The improvement in visual acuity was illustrated in confocal images of the corneal structures.
According to Dr. Mrukwa-Kominek, the irregularities seen in the tissue in the preop confocal images disappeared after the 0.02% mitomycin-C treatment.
“The scar-like tissue observed in confocal microscopy before surgery in the site of previous photoablation was not observed during the follow-up time,” she said.
She also described changes the researchers observed in the epithelial cells of the cornea as well as in Bowman’s membrane.
“Strong desquamation and disturbance of superficial and basal epithelial cell layers, increased illumination of Bowman’s layer and atrophic nerve fibers were also observed,” Dr. Mrukwa-Kominek said. She explained that all of this was part of the corneal healing process.
For Your Information:
- Ewa Mrukwa-Kominek, MD, PhD, can be reached at Silesian School of Medicine, Ceglana 35, Katowice 40-582, Poland; +48-60-15-28-850; fax: +48-32-25-18-437; e-mail: emrowka@poczta.onet.pl.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.