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Mitomycin C: Biological Effects and Use in Refractive Surgery

Santhiago, Marcony R MD; Netto, Marcelo V MD; Wilson, Steven E MD

doi: 10.1097/ICO.0b013e31821e429d

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.

From *The Cole Eye Institute, The Cleveland Clinic, Cleveland, OH; and †Department of Ophthalmology, University of São Paulo, São Paulo, Brazil.

Received for publication December 18, 2010; revision received March 25, 2011; accepted April 5, 2011.

Supported in part by the US Public Health Service Grants EY10056 and EY15638 from the National Eye Institute, the National Institutes of Health, Bethesda, MD, and the Research to Prevent Blindness, New York, NY.

The authors state that they have no proprietary interest in the products named in this article.

Reprints: Steven E. Wilson, The Cole Eye Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 (e-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.