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Mitomycin not as effective in treating existing corneal haze as in prophylaxis
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CLEVELAND — Mitomycin-C is effective as a prophylactic agent to prevent corneal haze formation after corneal ablation, but it is less effective in treating existing corneal haze, said Marcelo V. Netto, MD, of the Cole Eye Institute.
Dr. Netto and colleagues conducted a study evaluating the effects of mitomycin in the prevention of haze and in treating existing haze associated with PRK. He described the study results here at the Cole Eye Institute’s Cornea and Refractive Surgery Summit.
Mitomycin’s mechanisms of action in the cornea included keratocyte apoptosis and myofibroblast apoptosis when the drug is used to treat previous haze, Dr. Netto said. Mitomycin also blocks the replication of keratocytes and corneal fibroblasts that are thought to differentiate into myofibroblasts, he added.
Although clinicians disagree about optimal concentration for mitomycin, a low dose such as 0.002% “should be used to minimize the possible toxic side effects and maintain its clinical efficacy,” Dr. Netto said.
Dr. Netto and colleagues have proposed usage guidelines for mitomycin as a prophylactic primary treatment for corneal haze prevention and as a secondary treatment for existing haze.
For haze prophylaxis with primary corrections, the authors suggest using mitomycin only for corrections of more than –6 D. As a secondary treatment for existing corneal haze, the authors suggest mitomycin application only after epithelial removal. Dr. Netto further suggested inclusion of vigorous mechanical or automated stromal scraping for re-treatments.