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Garcia-Gonzalez M, Gros-Otero J, Rodriguez-Perez I, Rodero A, Teus MA. Effect of age on visual and refractive results after laser-assisted subepithelial keratomileusis (LASEK) with adjuvant use of mitomycin C. JOURNAL OF OPTOMETRY 2019; 12:92-98. [PMID: 30898533 PMCID: PMC6449780 DOI: 10.1016/j.optom.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the influence of age on visual and refractive results after laser-assisted subepithelial keratomileusis (LASEK) with the adjuvant use of mitomycin C (MMC) for the correction of myopia. METHODS Retrospective, nonrandomized, cohort study. A total of 1374 eyes treated with LASEK+MMC were included in the study (we compared 1163 eyes of patients aged 18 to 40 years versus 211 eyes of patients over 40 years). Visual and refractive results were evaluated at the 6-month postoperative visit. RESULTS Six months postoperatively, both the uncorrected distance visual acuity and the corrected distance visual acuity were significantly better in the group of young patients (P=0.0001). We found a slight tendency to overcorrection in the group of young patients compared to a slight tendency to undercorrection in the group of patients over 40 years (P=0.002). The efficacy index was significantly better in the group of younger patients (0.91±0.2) than in the older patients (0.86±0.2) (P=0.0001). No significant difference was found in the safety index between groups. 81.5% of eyes in the group of patients aged 18 to 40 years compared to 75.3% of eyes in the group of patients aged >40 years were within±0.5D of emmetropia (P=0.001). CONCLUSIONS A tendency toward undercorrection and less predictability was found with aging after myopic LASEK with MMC for the correction of myopia.
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Affiliation(s)
| | | | | | | | - Miguel A Teus
- Clínica Novovisión Madrid, Madrid, Spain; Hospital Universitario "Príncipe de Asturias", University of Alcalá, Alcalá de Henares, Madrid, Spain
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Abstract
Purpose Mitomycin C after photorefractive keratectomy (PRK) is used to reduce the development of haze and regression in higher intended corrections. The aim of this study was to investigate the safety, stability, and efficacy of EpiLASIK with mitomycin C. Methods Fifty eyes of 29 patients underwent EpiLASIK with the Gebauer EpiLift microkeratome. The mean preoperative spherical equivalent was −6.89 D (SD ±0.63, range −6.0 to −8.0 D). After the laser ablation, mitomycin C 0.02% was applied for 30 seconds on a sterile filter paper. Preoperatively and 1, 3, 6, and 12 months after surgery, a full ophthalmic examination was performed. Results In 42 of 50 eyes, the bandage contact lens was removed at day 3. Twelve months after surgery, 96% of all eyes were within ±1.0 D and 82% were within ±0.5 D of intended correction. Five percent of all patients lost 1 line of best-corrected Snellen visual acuity, 42% were stable, and 56% gained 1 or more lines. In most patients, the cornea was clear during the whole follow-up, and in 10% only trace haze was visible. The uncorrected visual acuity was at least 1.0 in 86% of all patients, and all patients reached 0.5. Conclusions EpiLASIK with mitomycin C with higher intended corrections seems to be an effective and safe procedure. With the application of mitomycin C, only minimal haze appears.
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Affiliation(s)
| | - Ramin Khoramnia
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Mathias Maier
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
| | - Chris P. Lohmann
- Augenklinik, Klinikum rechts der Isar, Technische Universität München, München - Germany
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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A Review of Mitomycin Use in Ophthalmic Surgery: Clarification of Safety Standards for Patients and Hospital Personnel. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Quinto GG, Camacho W, Combs JC, Vedula SS, Myrowitz EH, Chuck RS. Mitomycin C for prevention of postoperative haze following excimer laser surface ablation in moderate to high myopia. Hippokratia 2016. [DOI: 10.1002/14651858.cd007418.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Guilherme G Quinto
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Walter Camacho
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Juan-Castro Combs
- Johns Hopkins School of Medicine; The Wilmer Ophthalmological Institute; Baltimore MD USA
| | | | - Elliott H Myrowitz
- Johns Hopkins University School of Medicine; Wilmer Eye Institute; 600 N. Wolfe Street 255 Woods Building Baltimore Maryland USA 21287
| | - Roy S Chuck
- Albert Einstein College of Medicine, Montefiore Medical Center; Department of Ophthalmology and Visual Sciences; 3332 Rochambeau Avenue Centennial, Room 306 New York NY USA 10467
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Majmudar PA, Schallhorn SC, Cason JB, Donaldson KE, Kymionis GD, Shtein RM, Verity SM, Farjo AA. Mitomycin-C in corneal surface excimer laser ablation techniques: a report by the American Academy of Ophthalmology. Ophthalmology 2015; 122:1085-95. [PMID: 25795477 DOI: 10.1016/j.ophtha.2015.01.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To review the published literature assessing the efficacy and safety of mitomycin-C (MMC) as an adjunctive treatment in corneal surface excimer laser ablation procedures. METHODS Literature searches of the PubMed and Cochrane Library databases were last conducted on August 19, 2014, without language or date limitations. The searches retrieved a total of 239 references. Of these, members of the Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel selected 26 articles that were considered to be of high or medium clinical relevance, and the panel methodologist rated each article according to the strength of evidence. Ten studies were rated as level I evidence, 5 studies were rated as level II evidence, and the remaining 11 studies were rated as level III evidence. RESULTS The majority of the articles surveyed in this report support the role of MMC as an adjunctive treatment in surface ablation procedures. When MMC is applied in the appropriate concentration and confined to the central cornea, the incidence of post-surface ablation haze is decreased. Although a minority of studies that evaluated endothelial cell density (ECD) reported an MMC-related decrease in ECD, no clinical adverse outcomes were reported. CONCLUSIONS Over the past 15 years, the use of MMC during surgery in surface ablation has become widespread. There is good evidence of the effectiveness of MMC when used intraoperatively as prophylaxis against haze in higher myopic ablations. Although there are reports of decreased endothelial counts after the administration of MMC during surgery, the clinical significance of this finding remains uncertain, because no adverse outcomes were reported with as much as 5 years of follow-up. Optimal dosage, effectiveness as prophylaxis in lower myopic and hyperopic ablations, and long-term safety, particularly in eyes with reduced corneal endothelial cell counts from prior intraocular surgery, have yet to be established.
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Affiliation(s)
- Parag A Majmudar
- Department of Ophthalmology, Rush University Medical Center; Chicago Cornea Consultants Ltd, Chicago, Illinois
| | - Steven C Schallhorn
- University of California, San Francisco, California; Global Medical Director, Optical Express; Gordon-Weiss-Schanzlin Vision Institute, San Diego, California
| | - John B Cason
- Ophthalmology Clinic, Naval Medical Center, San Diego, California. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, or Department of Defense, nor the U.S. Government
| | | | - George D Kymionis
- Institute of Vision and Optics (IVO), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Steven M Verity
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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Clinical Effectiveness of Topical Cyclosporine A 0.05% After Laser Epithelial Keratomileusis. Cornea 2013; 32:e150-5. [DOI: 10.1097/ico.0b013e31829100e5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stojanovic A, Chen S, Chen X, Stojanovic F, Zhang J, Zhang T, Utheim TP. One-step transepithelial topography-guided ablation in the treatment of myopic astigmatism. PLoS One 2013; 8:e66618. [PMID: 23799124 PMCID: PMC3684575 DOI: 10.1371/journal.pone.0066618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/08/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate one-step topography-guided transepithelial ablation in the treatment of low to moderate myopic astigmatism using a 1KHz excimer laser. METHODS Retrospective study of 117 consecutive eyes available for evaluation 12 months after surgery. Pre- and post-operative visual and refractive data as well as post-operative pain and haze were analyzed. A novel technique integrating custom refractive- and epithelial- ablation in a single uninterrupted procedure was used. RESULTS The mean pre-operative spherical equivalent (SE) and the mean cylinder were: -3.22 diopters (D) ±1.54 (SD) (range -0.63 to -7.25 D) and -0.77 D ±0.65 (range 0 to -4.50 D), respectively. At 12 months after surgery: no eyes lost ≥2 lines of corrected distant visual acuity (CDVA). Safety and efficacy indexes were 1.27 and 1.09, respectively. Uncorrected distant visual acuity (UDVA) was ≥20/20 in 96.6% of the eyes. Manifest refraction spherical equivalent was within ±0.5 D of the desired refraction in 93.2% of the eyes. Average root mean square (RMS) wavefront error measured at central 6 mm, increased from 0.38 pre-operatively to 0.47 µm post-operatively. Refractive stability was achieved and sustained 1 month after surgery. No visually significant haze was registered during the observation period. Post-operative pain was reported in 4.5% of patients. CONCLUSIONS One-step transepithelial topography-guided treatment for low to moderate myopia and astigmatism performed with a 1 KHz laser, provided safe, effective, predictable and stable results with low pain and no visually significant haze.
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Fares U, Sarhan ARS, Dua HS. Management of post-keratoplasty astigmatism. J Cataract Refract Surg 2013; 38:2029-39. [PMID: 23079317 DOI: 10.1016/j.jcrs.2012.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 03/02/2012] [Accepted: 04/28/2012] [Indexed: 11/24/2022]
Abstract
UNLABELLED Post-keratoplasty astigmatism remains a challenge for corneorefractive surgeons. While maintaining a healthy graft is the most crucial issue in keratoplasty procedures, astigmatism is a limiting factor in the visual rehabilitation of otherwise successful corneal grafts. The management of post-keratoplasty astigmatism takes place at 2 stages: when sutures are still present at the graft-host junction and when all sutures have been removed. Excessive suture-in post-keratoplasty astigmatism is usually managed by selective suture manipulation, ie, suture adjustment and/or suture removal along the steep meridian of astigmatism. A small amount of suture-out post-keratoplasty astigmatism can be managed by spectacles. Higher magnitudes of astigmatism can be addressed by contact lenses or surgical intervention, such as relaxing and compressing procedures. Laser lamellar refractive surgery can also be used to manage post-keratoplasty astigmatism, and toric phakic intraocular lenses have recently been recommended. In this review, we discuss the etiology and management of post-keratoplasty astigmatism and provide recommendations and tips to minimize it. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Usama Fares
- Division of Ophthalmology and Visual Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
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Yoon KC, Oh HJ, Park JW, Choi J. Application of umbilical cord serum eyedrops after laser epithelial keratomileusis. Acta Ophthalmol 2013; 91:e22-8. [PMID: 22994307 DOI: 10.1111/j.1755-3768.2012.02538.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). METHODS Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. RESULTS No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). CONCLUSION Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.
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Affiliation(s)
- Kyung-Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea.
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Abstract
PURPOSE To provide an overview of the safety and efficacy of mitomycin C (MMC) as adjuvant therapy after refractive surgery procedures. METHODS Literature review. RESULTS Over the past 10 years, MMC has been used by refractive surgeons to prophylactically decrease haze after surface ablation procedures and therapeutically in the treatment of preexisting haze. Development of MMC treatments has had a significant role in the revival of surface ablation techniques. We reviewed the literature regarding mechanism of action of MMC, its role in modulating wound healing after refractive surgery, and its safety and efficacy as adjuvant therapy applied after primary photorefractive keratectomy surgery or after photorefractive keratectomy re-treatment after laser in situ keratomileusis and other corneal surgeries and disorders. The drug is a potent mitotic inhibitor that effectively blocks keratocyte activation, proliferation, and myofibroblast differentiation. Many studies have suggested that MMC is safe and effective in doses used by anterior surface surgeons, although there continue to be concerns regarding long-term safety. After initial depletion of anterior keratocytes, keratocyte density seems to return to normal 6 to 12 months after the use of MMC when corneas are examined with the confocal microscope. Most clinical studies found no difference between preoperative and postoperative corneal endothelial cell densities when MMC 0.02% was applied during refractive surgery, with exposure time of 2 minutes or less. CONCLUSIONS After more than 10 years of use, MMC has been found to be effective when used for prevention and treatment of corneal haze. Questions remain regarding optimal treatment parameters and long-term safety.
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de Benito-Llopis L, Cañadas P, Drake P, Hernández-Verdejo JL, Teus MA. Keratocyte density 3 months, 15 months, and 3 years after corneal surface ablation with mitomycin C. Am J Ophthalmol 2012; 153:17-23.e1. [PMID: 21864828 DOI: 10.1016/j.ajo.2011.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 05/13/2011] [Accepted: 05/21/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To study the effects of surface ablation with mitomycin C (MMC) on keratocyte population. DESIGN Prospective, nonrandomized, interventional, comparative case series. METHODS Thirty two eyes treated with surface ablation with 0.02% MMC were compared with nontreated eyes at Vissum Santa Hortensia, Madrid, Spain. Keratocyte density was measured with the Heidelberg Retina Tomograph II (Rostock Cornea Module) 3, 15, and 36 to 42 months after the surgery in the anterior, mid, and posterior stroma, and compared with control eyes. RESULTS Three months postoperatively, we found a lower stromal bed density compared to controls (16 993 ± 8001 vs 29 660 ± 5904 cells/mm(3), P = .0001), while there was a significantly higher cell density in the mid (30 783 ± 9300 vs 18 505 ± 1996 cells/mm(3), P = .0001) and deep stroma (30 268 ± 8321 vs 18 438 ± 2139 cells/mm(3), P = .0001). Three years after the surgery, the cellularity in the stromal bed had not significantly changed from the 3-month follow-up, but the density in the mid (18 889 ± 3474 cells/mm(3)) and posterior stroma (18 992 ± 3402 cells/mm(3)) had decreased to show no difference from controls. The mean cell density between the anterior, mid, and posterior stroma was not significantly different from controls 15 months and 3 years after the surgery. CONCLUSION Our study suggests that there is a reorganization of the stromal cell population soon after surface ablation with MMC, with a decrease in the stromal bed compensated initially with an increase in the mid and posterior stroma. Corneal cellularity tends to normalize over time, and 3 years postoperatively the mean cell density throughout the cornea seems to maintain normal values.
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Evaluation of the Long-Term Effects of Photorefractive Keratectomy Correction for Myopia in China. Eur J Ophthalmol 2011; 21:355-62. [PMID: 21240858 DOI: 10.5301/ejo.2011.6226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2010] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate the long-term effects of photorefractive keratectomy (PRK) correction for myopia in China. Methods A comprehensive literature research was conducted in 2 Chinese databases and PubMed. Statistical analysis was performed using the RevMan 4.2 software. Results Seven prospective studies involving 2,796 eyes were included. The follow-up period was 5 to 11 years. Meta-analysis showed efficacies in low to moderate myopia that surpassed those in high myopia, and pooled odds ratios were 9.14 (95% confidence interval [CI] 4.37–19.11) in the proportion of eyes with uncorrected visual acuity (UCVA) ≥20/20 and 5.61 (95% CI 3.97–7.93) in the proportion of eyes with UCVA ≥20/40. More than 10 years post operation, 82.0% had 20/20 or better UCVA and 96.1% had 20/40 or better in the ≤-6.00 D myopia group. Among patients with >-6.00 D myopia, 31.7% had 20/20 or better UCVA and 80.4% had 20/40 or better. Moreover, 82.1% and 46.4% of the treated eyes were within ±1.0 D of target refraction in the low to moderate myopia and high myopia group, respectively. About 1.4%-3.5% of eyes lost ≥2 lines of best spectacle-corrected visual acuity, and 0.6%-4.1% of eyes had grade 1 corneal haze. Conclusions Photorefractive keratectomy for myopia is an effective and safe procedure for the long term in China. The efficacy and predictability of PRK in low to moderate myopia are better than in high myopia.
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Long-term outcome of epi-LASIK for high myopia. Eur J Ophthalmol 2011; 22 Suppl 7:S98-105. [PMID: 21928261 DOI: 10.5301/ejo.5000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of epipolis laser-assisted in situ keratomileusis (epi-LASIK) for high myopia. METHODS High myopic patients who underwent epi-LASIK during 2004 and 2005 were included in this study. Epi-LASIK was performed with an automatically rotational epikeratome (KM-5000D). Postoperative visual acuity, manifest refraction, and haze formation were assessed 3 mo, 6 mo, 1 y, and 3 y after surgery. Results were compared by dividing patients into 2 groups according to preoperative mean refractive spherical equivalent (MRSE): group A (≥-6 D to -10 D; group B ≥-10 D). The differences within groups were analyzed using mixed model for continuous variables. The differences between groups were analyzed using t test or rank sum test for continuous variables, and Pearson χ² or Fisher exact probabilities for categorical variables. RESULTS A total of 20 patients (33 eyes) were followed up for more than 3 years with 17 eyes in group A (MRSE -8.15 ± 1.41 D) and 16 eyes in group B (MRSE -12.95 ± 2.91 D). While postoperative refraction regression occurred in both groups, it was more prominent in group B (p<0.05). The long-term predictability is good in group A with 14 eyes (82.35%) within ±1 D of attempted correction at 3 years while the percentage in group B was 18.75%. The efficacy index was significantly different between the 2 groups (p<0.05): 0.84 ± 0.29 for group A and 0.61 ± 0.47 for group B at 3 years. The safety index was above 1.0 at each timepoint in both groups. Haze was at low level and faded with time after epi-LASIK. CONCLUSIONS Epi-LASIK had a satisfactory long-term effect for high myopia of less than -10 D. Myopic regression limited the satisfaction of epi-LASIK in eyes with myopia of more than -10.0 D.
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Chen SH, Feng YF, Stojanovic A, Wang QM. Meta-analysis of Clinical Outcomes Comparing Surface Ablation for Correction of Myopia With and Without 0.02% Mitomycin C. J Refract Surg 2011; 27:530-41. [DOI: 10.3928/1081597x-20110112-02] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 11/24/2010] [Indexed: 11/20/2022]
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De Benito-Llopis L, Teus MA, Drake-Casanova P. [Effect of mitomycin C on corneal regrowth after laser-assisted sub-epithelial keratectomy (LASEK)]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2011; 86:213-217. [PMID: 21798407 DOI: 10.1016/j.oftal.2011.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 01/23/2011] [Accepted: 02/22/2011] [Indexed: 05/31/2023]
Abstract
PURPOSE To study the effect of mitomycin C (MMC) on the corneal regrowth after laser-assisted sub-epithelial keratectomy (LASEK). METHODS We performed a prospective, controlled, observer-masked study of 64 consecutive eyes scheduled to undergo LASEK to correct their myopia. The patients were divided into two age-matched groups, with group 1 including 32 eyes in which the ablation depth was ≤ 50 μm and received no MMC. Group 2 consisted of 32 eyes in which the ablation depth exceeded 50 μm and were treated with intra-operative 0.02% MMC for 30 seconds over the ablated zone. A masked observer measured the central corneal thickness (CCT) 1 and 3 months after surgery. We compared the change in CCT between both groups up to 3 months after surgery. RESULTS The mean patient age was 31.5 years (SD 4.6) and 31.6 (SD 8.7) years in groups 1 and 2, respectively (P=.9). Group 1 showed a mean CCT of 444.0 (SD 41.3) μm one month after surgery and 450.3 (SD 43.5) μm three months after surgery (P=.04). CCT in group 2 was 399.7 (SD 31.2) μm and 407.9 (SD 32.6) μm one and three months after surgery, respectively (P=.006). The difference in the CCT increases between both groups was not statistically significant (P=.6). CONCLUSIONS A single intraoperative application of 0.02% MMC for 30 seconds did not seem to cause a substantial change in the post-surgical corneal thickening expected after LASEK.
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Taneri S, Weisberg M, Azar DT. Surface ablation techniques. J Cataract Refract Surg 2011; 37:392-408. [PMID: 21241926 DOI: 10.1016/j.jcrs.2010.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 11/25/2022]
Abstract
The ongoing quest for a safe, simple, effective, minimally invasive, and stable refractive surgical procedure to correct refractive errors has stimulated the development of surface ablation techniques and laser in situ keratomileusis. In this review, we describe the history, patient assessment, techniques, outcomes, and complications of surface ablation (photorefractive keratectomy, laser-assisted sub-epithelial keratectomy, epithelial laser-assisted in situ keratomileusis) and compare the results of various surface techniques. Surface ablation procedures will continue to evolve, with potential improvements in outcomes accompanying future sophisticated ablation profiles and laser technology.
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Affiliation(s)
- Suphi Taneri
- Center for Refractive Surgery, St Franziskus Hospital, Münster, Germany
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McAlinden C, Moore J. Laser-assisted subepithelial keratectomy retreatment surgery. J Cataract Refract Surg 2011; 37:358-63. [DOI: 10.1016/j.jcrs.2010.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/13/2010] [Accepted: 08/18/2010] [Indexed: 11/26/2022]
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Shin JH, Kim SJ, Lee JE, Lee JS. Effect of Mitomycin C, Dexamethasone, and Cyclosporine A 0.05% on the Proliferation of Human Corneal Keratocytes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Hoon Shin
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Soo Jin Kim
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
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de Benito Llopis L, Drake P, Cañadas P, Hernández-Verdejo JL, Teus MA. Keratocyte density after laser-assisted subepithelial keratectomy with mitomycin C. Am J Ophthalmol 2010; 150:642-649.e1. [PMID: 20691417 DOI: 10.1016/j.ajo.2010.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/20/2010] [Accepted: 05/20/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the effects of laser-assisted subepithelial keratectomy (LASEK) with mitomycin C (MMC) on the keratocyte population. DESIGN Prospective, nonrandomized, interventional, comparative case series. METHODS Fifty-six eyes treated at Vissum Santa Hortensia, Madrid, Spain, were included in the study. We compared 28 eyes treated with LASEK with intraoperative 0.02% MMC versus 28 non-treated eyes. Keratocyte density was measured 3 months after the surgery in the anterior, mid, and posterior stroma and was compared with the corresponding layers in the control eyes. The anterior layer in the LASEK group was compared with 2 layers in the control group: the most anterior stromal layer and the 80 μm-deep layer, because that was the mean ablation depth performed in eyes that underwent LASEK. RESULTS We found a statistically significantly lower keratocyte population in the most anterior stromal layer after LASEK with MMC compared with both the most anterior stromal layer and the 80 μm-deep layer in controls. On the contrary, the treated group showed a significantly higher keratocyte density in both the mid stroma and the deep stroma. The comparison between the average densities through the entire cornea showed a significantly higher keratocyte population in the LASEK with MMC group. CONCLUSIONS LASEK with MMC seems to cause a decrease in the anterior stromal cells 3 months after the surgery compared with nonoperated corneas. There seems to be a compensating proliferation of keratocytes in the deeper corneal layers, suggesting that the ability of keratocytes to repopulate the cornea is maintained after the surgical procedure.
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de Benito-Llopis L, Teus MA. Efficacy of surface ablation retreatments using mitomycin C. Am J Ophthalmol 2010; 150:376-380.e2. [PMID: 20570239 DOI: 10.1016/j.ajo.2010.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 03/20/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the visual and refractive results and the incidence of complications after laser subepithelial keratectomy (LASEK) enhancement using mitomycin C (MMC) after a previous LASEK procedure with MMC. DESIGN Retrospective, noncomparative, interventional case series. METHODS Setting was Vissum Santa Hortensia, Madrid, Spain. We performed a retrospective study of LASEK-treated eyes that received intraoperative MMC for 30 seconds and that needed an enhancement procedure. LASEK retreatment with MMC 0.02%, applied for 60 seconds, was performed 3 to 6 months after the initial surgery. We measured the visual and refractive results 3 months after the enhancement and the incidence of complications. RESULTS Eighty-two eyes were included in the study. The preoperative data were best spectacle-corrected visual acuity (BSCVA) 1.08 +/- 0.19, sphere -4.68 +/- 2.8 diopters (D), and cylinder -1.30 +/- 1.20 D. Three to 6 months postoperatively, before enhancement, the uncorrected VA (UCVA) was 0.59 +/- 0.2; the BSCVA, 0.976 +/- 0.2; the residual sphere, +0.17 +/- 0.7 D, and the cylinder, -0.39 +/- 0.5 D. Three months after retreatment, the UCVA was 0.93 +/- 0.1; the BSCVA, 0.977 +/- 0.1; the residual sphere, 0.09 +/- 0.3 D; and the residual cylinder, -0.2 +/- 0.3 D. The safety index after retreatment was 1.01 +/- 0.1, and the efficacy index was 0.96 +/- 0.1. No haze, no delay in epithelial healing, and no case of endothelial decompensation were detected. CONCLUSION Surface ablation retreatment using MMC seems to be effective to correct residual refractive errors after an initial surgery with MMC.
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de Benito-Llopis L, Teus MA, Gil-Cazorla R, Drake P. Comparison between femtosecond laser-assisted sub-Bowman keratomileusis vs laser subepithelial keratectomy to correct myopia. Am J Ophthalmol 2009; 148:830-6.e1. [PMID: 19781686 DOI: 10.1016/j.ajo.2009.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/06/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare femtosecond laser sub-Bowman keratomileusis (FSBK) vs laser subepithelial keratectomy (LASEK) to correct myopia. DESIGN Retrospective, nonrandomized, interventional, comparative case series. METHODS Two thousand one hundred and eight eyes were included in the study. We compared 1,072 eyes treated with FSBK vs 1,036 eyes treated with LASEK with or without mitomycin C (MMC). Visual and refractive results were evaluated 1 day, 1 week, and 1 and 3 months postoperatively. RESULTS Preoperative mean sphere and best spectacle-corrected visual acuity (BSCVA) were -3.93 diopters (D) vs -3.87 D (P = .5) and 1.12 vs 1.12 (P = .8) in FSBK and LASEK, respectively. Uncorrected visual acuity (UCVA) was 0.92 vs 0.62, 0.98 vs 0.78, 0.96 vs 0.91, and 1.06 vs 1.03 in FSBK and LASEK, respectively, at 1 day, 1 week, and 1 and 3 months after surgery (P < .01 for all comparisons). Three months postoperatively, BSCVA was 1.13 and 1.10, respectively (P = .001). At that moment, 20 eyes (1.93%) in the LASEK group vs 9 eyes (0.84%) in the FSBK group had lost 2 or more lines of BSCVA. Ten eyes (0.96%) in the LASEK group gained 2 or more lines of BSCVA, whereas 3 eyes (0.28%) in the FSBK group gained 2 lines. Six months postoperatively, only 2 LASEK eyes (0.19%) showed loss of 2 or more lines of BSCVA, compared to 3 FSBK-treated eyes (0.28%). CONCLUSION Both FSBK and LASEK are safe and effective procedures to correct myopia. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 3-month follow-up.
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Abstract
Mitomycin C has played a deciding role in the current revival of excimer laser surface ablation techniques. We review the literature regarding mechanism of action of mitomycin C, histological effects on the cornea, and indications, dose, exposure time, and toxicity of mitomycin C in corneal refractive surgery. Mitomycin C is an alkylating agent with cytotoxic and antiproliferative effects that reduces the myofibroblast repopulation after laser surface ablation and, therefore, reduces the risk of postoperative corneal haze. It is used prophylactically to avoid haze after primary surface ablation and therapeutically to treat pre-existing haze. There is no definite evidence that establishes an exact diopter limit or ablation depth at which to apply prophylactic mitomycin C. It is usually applied at a concentration of 0.2mg/ml (0.02%) for 12 to 120 seconds over the ablated stroma, although some studies suggest that lower concentrations (0.01%, 0.002%) could also be effective in preventing haze when treating low to moderate myopia. This dose of mitomycin C has not been associated with any clinically relevant epithelial corneal toxicity. Its effect on the endothelium is more controversial: two studies report a decrease in endothelial cell density, but the majority of reports suggest that the endothelium is not altered. Regarding mitomycin C's effect on keratocyte population, although animal studies report keratocyte depletion after its use, longer follow-up suggested that the initial keratocyte depletion does not persist over time.
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Abstract
PURPOSE OF REVIEW Since their introduction in the mid-1990s, surface ablation techniques have continued to evolve, enabling surgeons to give patients better quality of vision with less postoperative pain. The purpose of this chapter is to discuss that evolution, the common techniques used today, and how to address potential complications. RECENT FINDINGS Advanced surface ablation techniques offer advantages over laser in situ keratomileusis, including expanded potential patient profiles, reduced haze and pain postoperatively, and increased quality of vision. Haze reduction via preserved epithelial flaps, smoother stromal beds, and introduction of mitomycin-C intraoperatively have all improved safety outcomes of advanced surface ablation. SUMMARY Experience has shown us that virtually all patients who are candidates for laser in situ keratomileusis can be candidates for surface ablation, but patients with specific ocular conditions, such as epithelial basement membrane dystrophy, superficial corneal scars, and previous radial keratotomy will have the best outcomes with surface ablation. Surface ablation and laser in situ keratomileusis are comparable in terms of safety and quality of vision. Wavefront-guided photorefractive keratectomy offers better acuity and less induction of higher order aberrations than wavefront-guided laser in situ keratomileusis.
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Thornton I, Xu M, Krueger RR. Comparison of standard (0.02%) and low dose (0.002%) mitomycin C in the prevention of corneal haze following surface ablation for myopia. J Refract Surg 2008; 24:S68-76. [PMID: 18269154 DOI: 10.3928/1081597x-20080101-13] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To retrospectively compare the safety and efficacy of lower dose mitomycin C (MMC) (0.002%) to that of the standard dose (0.02%) in eyes treated with photorefractive keratectomy (PRK) for myopia. METHODS The clinical efficacy of 95 eyes receiving myopic PRK with a standard concentration of MMC (0.02%) is sequentially compared to 126 eyes receiving low dose MMC (0.002%). The topical exposure times for MMC varied between 30 seconds and 2 minutes in both groups, and direct contralateral eye comparison of these two exposure times was analyzed in a prospective subset of 39 patients from among the low dose group. Patients were examined preoperatively and postoperatively at 1, 3, 6-9, and 9-12 months. Haze, visual acuity, and efficacy ratio outcomes were analyzed. RESULTS The preoperative findings were overall statistically similar, except for higher spherical equivalent refractive error (P = .007) and best spectacle-corrected visual acuity (P = .007) in the standard MMC group. Postoperatively, haze levels ranged from 0 to 4+. With multivariable analysis, significantly less haze was noted among the standard dose MMC eyes for high myopia and higher ablation depth at all postoperative time points. In contrast, the haze levels were statistically similar for moderate myopia and lower ablation depths at the latter postoperative time points. The subset of contralateral eyes randomly receiving low dose MMC (0.002%) at either 30 seconds or 2 minutes exposure showed no significant difference in haze between these exposure times. CONCLUSIONS The standard concentration of topical MMC (0.02%) is more effective than low dose MMC (0.002%) in preventing postoperative haze following surface ablation for myopia > or = -6.00 D and deeper ablation depth > or = 75 microm. However, for moderate myopia and shallow depth, low dosing appears to be equally effective. The duration of MMC exposure appears to be less important than its concentration.
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Affiliation(s)
- Ivey Thornton
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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De Benito-Llopis L, Teus MA, Sánchez-Pina JM, Fuentes I. Stability of laser epithelial keratomileusis with and without mitomycin C performed to correct myopia in thin corneas: a 15-month follow-up. Am J Ophthalmol 2008; 145:807-12. [PMID: 18342832 DOI: 10.1016/j.ajo.2008.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Revised: 01/02/2008] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To study the stability of the refraction 15 months after myopic laser epithelial keratomileusis (LASEK) performed in thin corneas with and without adjuvant mitomycin C (MMC). DESIGN Retrospective review. METHODS One hundred and thirty-six consecutive eyes that had undergone LASEK to correct their myopia and that had a preoperative central corneal thickness (CCT) of <500 microm at Vissum Madrid, Spain, were included. Intraoperative MMC was applied when the ablation depth exceeded 50 microm (49 eyes). We compared the residual refraction between the three- and 15-month examinations to detect a possible myopic change that would suggest secondary corneal ectasia. RESULTS Mean preoperative CCT +/- standard deviation (SD) was 484.4 +/- 11.8 microm (range, 440 to 499 microm). Mean CCT +/- SD three months after surgery was 417.9 +/- 32.1 microm (range, 339 to 473 microm). Mean preoperative spherical refraction +/- SD was -3.49 +/- 2.10 diopters (D). Mean preoperative cylinder +/- SD was -0.87 +/- 1.20 D. The mean residual sphere +/- SD was 0.15 +/- 0.40 D three months after surgery and 0.11 +/- 0.60 D 15 months after surgery (P = .45). The mean cylinder +/- SD was -0.13 +/- 0.30 D and -0.25 +/- 0.50 D, respectively (P = .06). Both the uncorrected visual acuity (UCVA) and the best-spectacle corrected visual acuity (BSCVA) showed statistically significant improvement on the 15-month examination (P = .01 and P = .0001, respectively). When analyzed separately, the subgroup treated with intraoperative MMC also showed stability of the refraction and a statistically significant improvement both in UCVA and in BSCVA. Topography showed no signs of ectasia in any case. CONCLUSIONS Myopic LASEK performed on thin corneas, regardless of the use of intraoperative MMC, seems to obtain stable refractive results, with no sign of ectasia during a 15-month follow-up.
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Photorefractive Keratectomy With Mitomycin C After Deep Anterior Lamellar Keratoplasty for Keratoconus. Cornea 2008; 27:417-20. [DOI: 10.1097/ico.0b013e318164e4b8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison Between LASEK With Mitomycin C and LASIK for the Correction of Myopia of –7.00 to –13.75 D. J Refract Surg 2008; 24:516-23. [DOI: 10.3928/1081597x-20080501-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thornton I, Puri A, Xu M, Krueger RR. Low-dose mitomycin C as a prophylaxis for corneal haze in myopic surface ablation. Am J Ophthalmol 2007; 144:673-681. [PMID: 17889818 DOI: 10.1016/j.ajo.2007.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 07/17/2007] [Accepted: 07/18/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the efficacy of low-dose (0.002%) mitomycin C (MMC) vs no prophylactic MMC (control) in reducing corneal haze after surface laser ablation. DESIGN Two-year retrospective follow-up study performed in Jaipur, India. METHODS Ninety-two eyes with no MMC application and 83 eyes with 0.002% MMC application during laser epithelial keratomileusis (LASEK) were analyzed in a retrospective chart review with one month, two months, three months, six months, one year, and two years of postoperative follow-up. Postoperative haze, visual acuity, and efficacy ratio (EFFR) then were analyzed statistically. RESULTS The no-dose MMC and low-dose MMC groups were statistically similar except for a thinner corneal pachymetry (P < .001), higher spherical equivalent error (P = .006), and smaller ablation zone (P = .009) in eyes not treated with MMC when subjected to univariate analysis. Multivariate analysis was used to overcome the preoperative statistical differences among the two groups. Eyes treated with low-dose MMC (0.002%) demonstrated statistically less haze at all postoperative time points and in each myopic subgroup (P < .001). The postoperative uncorrected visual acuity (UCVA) and EFFR, however, showed no difference between the groups, except for better EFFR with MMC at one month (P < .001) and two months (P = .034). CONCLUSIONS Low-dose MMC (0.002%) in eyes after LASEK results in less corneal haze than in eyes not receiving this agent. Concerns regarding the potential toxicity of MMC make a 10-fold less concentration more desirable in refractive surgery. Further comparative study of low- vs higher-dose MMC is recommended to characterize its clinical benefit fully.
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Affiliation(s)
- Ivey Thornton
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Midena E, Gambato C, Miotto S, Cortese M, Salvi R, Ghirlando A. Long-term Effects on Corneal Keratocytes of Mitomycin C During Photorefractive Keratectomy: A Randomized Contralateral Eye Confocal Microscopy Study. J Refract Surg 2007; 23:S1011-4. [DOI: 10.3928/1081-597x-20071102-06] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nakano EM, Bains HS, Hirai FE, Portellinha W, Oliveira M, Nakano K. Comparison of Laser Epithelial Keratomileusis With and Without Mitomycin C for Wavefront Customized Surface Ablations. J Refract Surg 2007; 23:S1021-8. [DOI: 10.3928/1081-597x-20071102-08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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