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K. I. Cubukcu, G. Richard, P. Haberland, T. Katz, S. Linke; Phototherapeutic Keratectomy With Intraoperative Mitomycin C: Selected Cases and Review of Literature. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2931. doi: https://doi.org/.
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To report the results of excimer laser phototherapeutic keratectomies (PTK) performed for different corneal pathologies (n=10)with a single intraoperative application of adjunctive topical 0.02% mitomycin C (MMC).
Interventional case reports and review of the literature. The excimer laser (Allegretto; Wavelight, Erlangen) was set for a 7-mm circular optical zone, which correlates to 8,9 mm treatment zone. The ablation depth varied between 20 µm and 130µm. In Salzmann Nodular Degeneration the treatment was preceded by a superficial keratectomy with a blade. Best corrected visual acuity (BCVA) was determined pre- and up to 12 months post laser treatment. Additionaly in vivo confocal microscopy (HRT II Rostock Cornea Modul) and corneal topography (Orbscan II; Bausch & Lomb) were performed.
Best corrected visual acuity and subjective satisfaction improved in all of the cases. 12 months post surgery no recurrence of disease was observed and the corneae remained clear. Healing time of epithelial defects in MMC treated corneas were within normal range (< 4 days post treatment) and toxic MMC related side effects (corneal or scleral melting, limbal stem cell insufficiency) did not appear in the 12 month follow-up.
The use of topical MMC in conjunction with PTK may be a safe and effective treatment of recurrent corneal pathologies (Granular corneal dystrophy, Salzmann nodular Degeneration, recurrent corneal scar after pterygium surgery). Confocal microscopy is a useful tool for planning surgical strategy and to reveal subtle changes of recurrent disease after Excimer laser treatment. Although the results show some promise it is important to keep in mind that they base on a limited number of patients.
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