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M.D. Hirsch, M.B. Raizman MD, R.F. Steinert; Topical Mitomycin-C Application Prevents Stromal Haze Formation After Photorefractive Keratectomy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2650.
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Purpose: Photorefractive keratectomy can induce the formation of stromal haze. The development of haze appears to increase with the amount of ablation depth. As a result LASIK is often the preferred procedure in patients when large ablation is necessary. However, due to corneal thickness, some patients cannot safely undergo larger ablation treatments because of a lack of adequate residual stromal bed. Our study analyzes the results of patients who underwent PRK because of an inadequate corneal thickness. Topical mitomycin-C was applied intraoperatively to prevent stromal haze formation. The outcomes of these patients are presented. Methods: A retrospective review of all patients who underwent PRK with a one time application of mitomycin-C was undertaken. Patients were included if they had not undergone any other ocular surgical procedure and were not deemed safe candidates for LASIK. Uncorrected and best-spectacle corrected visual acuity was reported preoperatively, at 1month, 3 month, and 6 month's post PRK when available. Accuracy of the procedure was determined by recording the manifest refraction spherical equivalent at 1 month, 3 month, and 6 month post-PRK. Regression to refractive effect was also measured by these results. Post-operative haze observable at the slit-lamp was recorded at 1,3, and 6 months post-PRK. Any complications during the post-operative course were noted and presented Results: 13 patients were identified who met the study critieria. No patient developed haze that decreased best-spectacle corrected visual acuity. No patient developed worse than grade 1 haze based on a scale of 1-4. No patient received an increased topical steroid regimen to treat excessive haze at any point in the follow-up. There was no delay in epithelial healing compared to standard PRK. Most patients were slightly overcorrected at all follow up visits. Conclusions: Photorefractve keratectomy with topical application of mitomycin-C is a safe procedure. No significant haze was noted in any of the patients in the study. Adjustment of a personal nomagram will be needed to improve the refractive results. At a follow up of up to six months topical mitomycin did not cause any adverse outcomes. Longer follow-up will be needed to assure the prevention of late haze development and the long-term refractive results.
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