Laser Epithelial Keratomileusis With Mitomycin C: Indications and Limits

PURPOSE: To assess the advantages and safety of using mitomycin C (MMC) with laser epithelial keratomileusis (LASEK) by measuring high order aberrations of the cornea. METHODS: We analyzed the results of 86 eyes that had LASEK plus a brushstroke of MMC 0.01%. Another group of 100 eyes had LASEK only (control group). Mean follow-up was 312 days for the MMC group and 774 days for the control group. A Nidek EC-5000 laser was used in all eyes. We measured mean refractive error, best spectacle-corrected visual acuity (BSCVA), haze, and high order aberrations before and at 1 month and nearly 1 year after LASEK. RESULTS: Mean baseline spherical equivalent refraction was -6.80 +/- 3.00 D for the MMC group and -6.00 +/- 3.10 D for the control group (P=.34). In eyes with low myopia (-1.20 to -10.80 D), a single ablation zone of 6 mm with a transition zone of 8 mm was used, and in the higher myopia group (-5.60 to -15.50 D), smoothing and a cross sphere procedure (+0.75 D) were used. Mean spherical equivalent refraction after LASEK for low myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 0.93, and 0 +/- 0.34 D for the control group. Mean spherical equivalent refraction after LASEK for high myopia in the MMC group at last examination (mean follow-up 312 days) was +0.50 +/- 1.03 D, and +0.40 +/- 0.78 D for the control group. Mean haze in the low myopia MMC group was 0.06 and in the control group, 0.11; in the high myopia MMC group it was 0.1, and in the control group, 0.27 (all differences P<.05). No differences between baseline and postoperative BSCVA were noted. Early and late overcorrection were noted in the MMC group. Increased high order aberrations were evident at 1 month and 1 year in the MMC groups. CONCLUSIONS: The use of mitomycin C 0.01% with LASEK significantly decreased subepithelial haze. However, refractive outcome was less predictable. High order aberrations increased after LASEK with MMC. Additional studies with longer follow-up are necessary to evaluate long-term effects, and ideal MMC concentration and exposure time.