Mitomycin-C for Post-PRK Corneal Haze

Drs. Rasheed and Rabinowitz have described an interesting technique for treating post-photorefractive keratectomy (PRK) corneal haze, using superficial lamellar keratectomy performed with the microkeratome.1 Post-PRK haze has been a challenging problem with very few satisfactory treatments—additional phototherapeutic keratectomy, lamellar, or penetrating keratoplasty techniques have met with variable success. We have been using mitomycin-C (MMC) debridement to effectively treat post-PRK haze for 2 years.2–4 The technique does not require an excimer laser and can be performed in a minor surgery suite. It effectively eliminates not only the haze, but also the myopic regression typically associated with it. The technique, in brief, is as follows: Prep with providone–iodine drops and drape the eyelashes. Manually remove the epithelium with a #64 blade. Then remove the subepithelial haze using the blade or a pterygium burr. Soak a methylcellulose sponge (Corneal Light Shield, Mentor Ophthalmics) with MMC 0.02% solution. Place the sponge on the exposed corneal stroma for 2 minutes. Irrigate the cornea and conjunctiva vigorously with a balanced salt solution. Treat with a pressure patch or bandage contact lens until re-epithelialized along with antibiotic/steroid drops 4 times daily for a week. The corticosteroid drops are then tapered over 1 to 3 months. With this technique, we have found it possible to eradicate reticular haze and prevent its recurrence. Myopic regression, which accompanies the haze, is also significantly reduced or eliminated. We have treated 30 eyes successfully, improving best corrected and uncorrected visual acuities in all cases. There have been no untoward effects from the MMC after a mean follow-up of 14 months. We encourage the authors to consider using this less invasive technique first when managing post-PRK corneal haze. Tal Raviv MD Parag A. Majmudar MD Richard F. Dennis Randy J.