Corneal Opacity Caused by LASEK with Improper High-concentrated Mitomycin-C

Su Jin Kim; Min Ho Lee; Eun Hee Kim; Jong Soo Lee

doi:10.3341/jkos.2008.49.9.1525

Journal List > J Korean Ophthalmol Soc > v.49(9) > 1008087

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lee, Kim, and Lee: Corneal Opacity Caused by LASEK with Improper High-concentrated Mitomycin-C

Original Article

J Korean Ophthalmol Soc 2008;49(9):1525-1531.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1525

Corneal Opacity Caused by LASEK with Improper High-concentrated Mitomycin-C

Su Jin Kim, M.D.¹, Min Ho Lee, M.D.¹, Eun Hee Kim, M.D.², Jong Soo Lee, M.D., Ph.D.¹

¹Department of ophthalmology, College of Medicine, Pusan National University, Pusan, Korea

²Pusan St. Mary’s Medical Center, Pusan, Korea

Address reprint requests to Jong Soo Lee, M.D., Ph.D. Department of Ophthalmology, Pusan National University Hospital #1-10 Ami-dong, Seo-gu, Pusan 602-739 Korea Tel: 82-51-240-7323, Fax: 82-51-242-7341, E-mail: Jongsool@pusan.ac.kr

Received 20 May 2008 Accepted 4 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of corneal opacity with postoperative changes of topographic features and visual acuity after laser subepithelial keratomileusis (LASEK) treated with an improper concentration of mitomycin-C.

Case summary

A 25-year-old female patient who experienced corneal opacity after LASEK treated with mitomycin-C was evaluated for changes in corneal opacity by photography, central corneal power by Orb scan Ⅱ z, and best corrected visual acuity (BCVA) over the period of 1 year. The corneal epithelial defect was completely healed 2 weeks after the LASEK operation. Subepithelial and stromal opacity decreased over time, but her cornea did not return to normal. BCVA was 20/25 in the right eye and 20/20 in the left eye at postoperative 1 year, but stromal opacity remained.

Conclusions

An improper concentration of mitomycin-C during LASEK could result in corneal opacity. Long time is needed to recover visual acuity and a normal corneal structure.

Keywords: Corneal opacity, LASEK, Mitomycin-C

References

1. Xu H, Liu S, Xia X. . Mitomycin C reduces haze formation in rabbits after excimer laser photorefractive keratectomy. J Refract Surg. 2001; 17:342–9.

2. Majmudar PA, Forstot SL, Dennis RF. . Topical mitomycin-C for subepithelial fibrosis after refractive corneal surgery. Ophthalmology. 2000; 107:89–94.

3. Carones F, Vigo L, Scandola E. . Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy. J Cataract Refract Surg. 2002; 28:2088–95.

4. Chang SW. Early corneal edema folllowing topical application of mitomycin-C. J Cataract Refract Surg. 2004; 30:1742–50.

5. Quazi MA, Johnson TW, Pepose JS. Development of late-onset subepithelial corneal haze after laser-assisted subepithelial keratectomy with prophylactic intraoperative mitomycin-C. J Cataract Refract Surg. 2006; 32:1573–8.

6. Wilson SE, Mohan RR, Hong JW. . The wound healing response after laser in situ keratomileusis and photorefractive keratectomy; elusive control of biological variability an effect of custom laser vision correction. Arch Ophthalmol. 2001; 119:889–896.

7. Kaji Y, Soya K, Amano S. . Relation between corneal haze and transforming growth factor- β1 after photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg. 2001; 27:1840–6.

8. Cobett MC, Prydal JI, Verma S. . An in vivo investigation of the structures responsible for corneal haze after photorefractive keratectomy and their effect on visual function. Ophthalmology. 1996; 103:1366–80.

9. Carones F, Fiore T, Brancato R. Mechanical vs alcohol epithelial removal during photorefractive keratectomy. J Refract Surg. 1999; 15:556–62.

10. Lin N, Yee SB, Mitra S. . Prediction of corneal haze using an ablation depth/corneal thickness ratio after alser epithelial keratomileusis. J Refract Surg. 2004; 20:797–802.

11. Autrata R, Rehurek J. Laser-assisted subepithelial keratectomy and photorefractive keratectomy for the correction of hyperopia: results of a 2-year follow-up. J Cataract Refract Surg. 2003; 29:2105–14.

12. Sonmez B, Maloney AR. Central toxic keratopathy:Description of a syndrome in laser refractive surgery. Am J Ophthalmol. 2007; 143:420–7.

13. Linebarger EJ, Hardten DR, Lindstrom RL. Diffuse lamellar keratitis:diagnosis and management. J Cataract Refract Surg. 2000; 26:1072–7.

14. Alio JL, Perez-Santonja JJ, Tervo T. . Postoperative inflammation, microbial complication, and wound healing following laser in situ keratomileusis. J Refract Surg. 2000; 16:523–38.

15. Pushker N, Dada T, Sony P. . Microbial keratitis after laser in situ keratomuleusis. J Refract Surg. 2002; 18:280–6.

16. Laplace O, Bourcier T, Chaumeil C. . Early bacterial keratitis after laser-assisted subepithelial keratectomy. J Cataract Refract Surg. 2004; 30:2638–40.

17. Kim TI, Tchah H, Cho EH, Kook MS. Evaluation for Safety of cultured Corneal Fibroblasts with Cotreatment of Alcohol and Mitomycin C. Invest Ophthalmol Vis Sci. 2004; 45:86–92.

18. Talamo JH, Gollamudi S, Green WR. . Modulation of corneal wound healing after excimer laser keratomileusis using topical mitomycin C and steroids. Arch Ophthalmol. 1991; 109:1141–6.

19. Kim KS, Baek SH. Endothelial cell change after photorefractive keratectomy and laser in situ keratomileusis. J Korean Ophthalmol Soc. 1999; 40:2728–34.

20. Lee JH, An JH, Yu HM, Lee DH. Effect of mitomycin C on rabbit corneal wound healing after excimer laser photorefractive keratectomy. J Korean Ophthalmol Soc. 2003; 44:2876–84.

21. Moller-Pederson TM, Cavanagh HD, Petroll WM, Jester JV. Stromal wound healing explains refractive instability and haze development after photorefractive keratectomy: a 1-year confocal microscopic study. Ophthalmology. 2000; 107:1235–45.

22. Gambato C, Ghirlando A, Moretto E. . Mitomycin Cmodulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes. Ophthalmology. 2005; 12:208–18.

Figure 1.

Photographs showing corneal epithelial defect and corneal opacity at 10 days (A), 16 days (B), and 8 months (C) after LASEK. Epithelial defect was healed 2 weeks after LASEK and subepithelial stromal opacity faded and almost disappeared 6 months after surgery (OD=right eye; OS=left eye).

Figure 2.

Orbscan showing corneal astigmatism before (upper) and 1 year after (lower) LASEK. At 1 year after LASEK, irregular astigmatism produced by surgery reduced considerably.

TOOLS

Similar articles