Photorefractive Keratectomy With Mitomycin-C for High Myopia: Three Year Follow-Up Results

  • Hassan Hashemi Mail Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
  • Yahya Salimi Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. AND Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • Poopak Pir Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.
  • Soheila Asgari Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Photorefractive keratectomy, Mitomycin C, Visual acuity, Visual quality, Aberration, High myopia


Photorefractive keratectomy (PRK) is a safe and effective surgical keratorefractive technique which is done with the application of mitomycin-C (MMC) in cases of high myopia to prevent the formation of corneal haze This study was conducted to evaluate 3-year visual acuity and quality outcomes of PRK-MMC in high myopia. This before-after study was conducted on 20 individuals (40 eyes) with myopia more than 6.0 diopter (D). Visual acuity and quality indices were evaluated before and three years after the procedure and their stability was examined between the 1st and 3rd years. At 3 years after surgery, mean uncorrected visual acuity was 0.03±0.06 in the logarithm of minimum angle of resolution (logMAR) unit which showed a significant improvement when compared to baseline (P<0.001) and means best corrected visual acuity was 0.03±0.06 logMAR, which showed no significant difference (P=0.730). Manifest refraction spherical equivalent (MRSE) at 3 years (-0.12±0.2D) was significantly decreased when compared to baseline (P<0.001), but it did not change significantly after the 1st year and was stable (P=0.368). Mean coma and spherical aberration 3 years postoperatively were -0.54±0.26 µm and 0.46±0.19 µm, respectively, and neither parameter showed significant differences when compared to baseline (P<0.001). No significant change was found in mesopic contrast sensitivity. The long-term results of this study showed that PRK-MMC could be regarded an effective, safe, and stable procedure in patients with myopia more than 6.0 D.


Guerin MB, Darcy F, O'Connor J, O'Keeffe M. Excimer laser photorefractive keratectomy for low to moderate myopia using a 5.0 mm treatment zone and no transitional zone: 16-year follow-up. J Cataract Refract Surg 2012;38:1246-50.

Shortt AJ, Allan B, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev 2013;1:CD005135.

Koshimizu J, Dhanuka R, Yamaguchi T. Ten-year follow- up of photorefractive keratectomy for myopia. Graefes Arch Clin Exp Ophthalmol 2010;248:1817-25.

Shortt AJ, Bunce C, Allan BD. Evidence for superior efficacy and safety of LASIK over photorefractive keratectomy for correction of myopia. Ophthalmology 2006;113:1897-908.

Barsam A, Allan BD. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev 2010;5:CD007679.

Hersh PS, Schwartz-Goldstein BH. Corneal topography of phase III excimer laser photorefractive keratectomy: characterization and clinical effects. Ophthalmology 1995;102:963-78.

Alio JL, Ortiz D, Muftuoglu O, Garcia MJ. Ten years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for moderate to high myopia (control-matched study). Br J Ophthalmol 2009;93:1313-8.

Chen S, Feng Y, Stojanovic A, Wang Q. 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.

Wallau AD, Campos M. Photorefractive keratectomy with mitomycin C versus LASIK in custom surgeries for myopia: a bilateral prospective randomized clinical trial. J Refract Surg 2008;24:326-36.

Chayet AS, Assil KK, Montes M, Espinosa-Lagana M, Castellanos A, Tsioulias G. Regression and its mechanisms after laser in situ keratomileusis in moderate and high myopia. Ophthalmology 1998;105:1194-9.

Netto MV, Mohan RR, Sinha S, Sharma A, Dupps W, Wilson SE. Stromal haze, myofibroblasts, and surface irregularity after PRK. Exp Eye Res 2006;82:788-97.

Shalaby A, Kaye GB, Gimbel HV. Mitomycin C in photorefractive keratectomy. J Refract Surg 2009;25:S93-7.

Corbett MC, O'Brart DPS, Warburton FG, Marshall J.Biologic and Environmental Risk Factors for Regression after Photorefractive Keratectomy. Ophthalmology 1996;103:1381-91.

Hashemi H, Fatehi F. Results of photorefractive Keratometry (PRK) for high myopia in Noor Clinic of

Tehran. J School Med 2000;58:24-8.

Corbett MC, O’Brart DP, Patmore AL, Marshall J. Effect of collagenase inhibitors on corneal haze after PRK. Exp Eye Res 2001;72:253-9.

O'Brart D, Lohmann CP, Klonos G, Corbett MC, Pollock WS, Kerr-Muir MG, et al. The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study. Ophthalmology 1994;101:1565-74.

Rosman M, Alió JL, Ortiz D, Perez-Santonja JJ.Comparison of LASIK and photorefractive keratectomy for myopia from-10.00 to-18.00 diopters 10 years after surgery. J Reract Surg 2010;26:168-76.

Kang SG, Chung H, Yoo YD, Lee JG, Choi YI, Yu YS.Mechanism of growth inhibitory effect of Mitomycin-C on cultured human retinal pigment epithelial cells: apoptosis and cell cycle arrest. Curr Eye Res 2001;22:174-81.

Wu KY, Hong SJ, Huang HT, Lin CP, Chen CW. Toxic effects of mitomycin-C on cultured corneal keratocytes and endothelial cells. J Ocul Pharmacol Ther 1999;15:401-11.

Chabner B, Ryan D, Paz-Ares L, Garcia-Carbonero RP, eds. Calabresi in the Pharmacological Basis of Therapeutics. New York, NY: McGraw Hill, 2001.

Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology 1991;98:317-21.

Susanna Jr R, Oltrogge EW, Carani JCE, Nicolela MT.Mitomycin as adjunct chemotherapy with trabeculectomy in congenital and developmental glaucomas. J glaucoma 1995;4:151-7.

Helal M, Messiha N, Amayem A, El-Maghraby A, Elsherif Z, Dabees M. Intraoperative mitomycin-C versus postoperative topical mitomycin-C drops for the treatment of pterygium. Ophthalmic Surg Lasers 1996;27:674-8.

Frucht-Pery J, Siganos CS, Ilsar M. Intraoperative application of topical mitomycin C for pterygium surgery. Ophthalmology 1996;103:674-7.

Gambato C, Ghirlando A, Moretto E, Busato F, Midena E. Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes. Ophthalmology 2005;112:208-18.

Hashemi H, Taheri SM, Fotouhi A, Kheiltash A.Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy in high myopia: a prospective clinical study. BMC Ophthalmol 2004;4:12.

Diakonis VF, Pallikaris A, Kymionis GD,Markomanolakis MM. Alterations in endothelial cell density after photorefractive keratectomy with adjuvant mitomycin. Am J Ophthalmol 2007;144:99-103.

Rajan MS, O'Brart DP, Patmore A, Marshall J. Cellular effects of mitomycin-C on human corneas after photorefractive keratectomy. J Cataract Refract Surg 2006;32:1741-7.

Nassiri N, Farahangiz S, Rahnavardi M, Rahmani L, Nassiri N. Corneal endothelial cell injury induced by mitomycin-C in photorefractive keratectomy: nonrandomized controlled trial. J Cataract Refract Surg 2008;34:902-8.

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

Netto MV, Mohan RR, Sinha S, Sharma A, Gupta PC, Wilson SE. Effect of prophylactic and therapeutic mitomycin C on corneal apoptosis, cellular proliferation, haze, and long-term keratocyte density in rabbits. J Refract Surg 2006;22:562-74.

Zhao LQ, Wei RL, Ma X-Y, Zhu H. Effect of intraoperative mitomycin-C on healthy corneal endothelium after laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2008;34:1715-9.

Hashemi H, Miraftab M, Asgari S. Comparison of the visual outcomes between PRK-MMC and phakic IOL implantation in high myopic patients. Eye 2014;28:1113-8.

Diakonis VF, Kankariya VP, Kymionis GD, Kounis G, Kontadakis G, Gkenos E, et al. Long Term Followup of Photorefractive Keratectomy with Adjuvant Use of Mitomycin C. J Ophthalmol 2014;2014:821920.

Verdon W, Bullimore M, Maloney RK. Visual performance after photorefractive keratectomy: a prospective study. Arch Ophthalmol 1996;114:1465-72.

Seiler T, Holschbach A, Derse M, Jean B, Genth U.Complications of myopic photorefractive keratectomy with the excimer laser. Ophthalmology 1994;101:153-60.

Leccisotti A. Mitomycin C in photorefractive keratectomy: effect on epithelialization and predictability. Cornea 2008;27:288-91.

Bedei A, Marabotti A, Giannecchini I, Ferretti C, Montagnani M, Martinucci C, et al. Photorefractive keratectomy in high myopic defects with or without intraoperative mitomycin C: 1-year results. Eur J Ophthalmol 2005;16:229-34.

Hashemi H, Taheri M-R, Fotouhi A. Prophylactic effects of mitomycin-C on regression and haze formation in photorefractive keratectomy. J Ophthalmic Vis Res 2008;1:31-5

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.

Morales AJ, Zadok D, Mora-Retana R, Martínez-Gama E, Robledo NE, Chayet AS. Intraoperative mitomycin and corneal endothelium after photorefractive keratectomy. Am J Ophthalmol;142:400-4.

Lee DH, Chung HS, Jeon YC, Boo SD, Yoon YD, Kim JG. Photorefractive keratectomy with intraoperative mitomycin-C application. J Cataract Refract Surg 2005;31:2293-8.

Moshirfar M, Schliesser JA, Chang JC, Oberg TJ, Mifflin MD, Townley R, et al. Visual outcomes after wavefront- guided photorefractive keratectomy and wavefront-guided laser in situ keratomileusis: prospective comparison. J Cataract Refract Surg 2010;36:1336-43.

Yamane N, Miyata K, Samejima T, Hiraoka T, Kiuchi T, Okamoto F, et al. Ocular higher-order aberrations and contrast sensitivity after conventional laser in situ keratomileusis. Invest Ophthalmol Vis Sci 2004;45:3986-90.

Chalita MR, Xu M, Krueger RR. Correlation of aberrations with visual symptoms using wavefront analysis in eyes after laser in situ keratomileusis. J Refract Surg 2003;19:S682-S6.

How to Cite
Hashemi H, Salimi Y, Pir P, Asgari S. Photorefractive Keratectomy With Mitomycin-C for High Myopia: Three Year Follow-Up Results. Acta Med Iran. 55(1):42-48.