Delayed epithelial healing following photorefractive keratectomy with mitomycin C treatment

Acta Ophthalmol. 2012 May;90(3):271-6. doi: 10.1111/j.1755-3768.2010.01894.x. Epub 2010 Apr 23.


Purpose: To evaluate the epithelial healing following photorefractive keratectomy (PRK) with mitomycin C (MMC) 0.02%.

Methods: A total of 1520 eyes of 760 patients with myopia with spherical equivalent between -1.5 and -8.0 dioptres underwent PRK during 2004-2008. The epithelium was removed mechanically, and laser ablation was followed by topical application of MMC (0.02%) for 20 seconds. A therapeutic contact lens (TCL), kept in 4°C, was fitted and worn until complete epithelialization. Antibiotic, steroid and diclofenac drops were instilled during the healing phase. Steroid drops were used for 6-8 weeks and gradually reduced. The results were compared with a retrospective analysis of 500 myopic eyes which underwent PRK without MMC therapy during 2002-2004.

Results: In 30 MMC treated eyes (2%), epithelial healing was delayed with a stellate defect which healed after 12-14 days. Another fifteen eyes (1%) revealed loose midperipheral epithelium and complete epithelialization took 10-14 days after scraping. Two of these eyes developed recurrent erosion treated by scraping and TCL. Seven eyes (0.5%) revealed delayed healing with paracentral epithelial plaques which were scraped and complete healing took 12-14 days. No final haze was found in the MMC-treated eyes. In comparison, only 0.8% of the eyes which had undergone PRK without MMC revealed epithelial problems. Haze was found in 8% of these eyes. A statistically significant difference was found between the rate of epithelial problems of the two groups (p ≤ 0.002).

Conclusions: MMC (0.02%) applied for 20 seconds post-PRK was found to delay epithelial wound healing up to 14 days in 3.5% of patients with myopia compared to 0.8% of PRK eyes without MMC application. Final haze was not found despite delayed epithelialization because of MMC treatment.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Alkylating Agents / administration & dosage*
  • Anti-Bacterial Agents / administration & dosage
  • Combined Modality Therapy
  • Debridement
  • Epithelium, Corneal / physiology*
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage*
  • Myopia / physiopathology
  • Myopia / surgery*
  • Ophthalmic Solutions / administration & dosage
  • Photorefractive Keratectomy*
  • Retrospective Studies
  • Time Factors
  • Wound Healing / drug effects*
  • Young Adult


  • Alkylating Agents
  • Anti-Bacterial Agents
  • Glucocorticoids
  • Ophthalmic Solutions
  • Mitomycin