A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel: Parag A. Majmudar, MD,1 Steven C. Schallhorn, MD,2 John B. Cason, MD,3 Kendall E. Donaldson, MD, MS,4 George D. Kymionis, MD, PhD,5 Roni M. Shtein, MD,6 Steven M. Verity, MD,7 Ayad A. Farjo, MD8
Ophthalmology, June 2015, Vol 122, 1085-1095 © 2015 by the American Academy of Ophthalmology. Click here for free access to the OTA.
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 following 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.
1Department of Ophthalmology, Rush University Medical Center; Chicago Cornea Consultants Ltd., Chicago, Illinois
2University of California, San Francisco, California; Global Medical Director Optical Express; Gordon-Weiss-Schanzlin Vision Institute, San Diego, California
3Ophthalmology 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.
4Bascom Palmer Eye Institute of Plantation, Plantation, Florida
5Institute of Vision and Optics (IVO), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
6Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
7Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
8Brighton Vision Center, Brighton, Michigan