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Corneal Breakthrough Haze After Photorefractive Keratectomy With Mitomycin C: Incidence and Risk Factors

Kaiserman, Igor MD, MSc, MHA*,†,‡; Sadi, Na'ava MD*; Mimouni, Michael MD§; Sela, Tzahi BSc; Munzer, Gur BSc; Levartovsky, Shmuel MD*,†

doi: 10.1097/ICO.0000000000001231
Clinical Science

Purpose: To identify preoperative and intraoperative factors affecting breakthrough corneal haze incidence after photorefractive keratectomy (PRK) with mitomycin C (MMC).

Methods: In this retrospective study of PRK performed at the Care Vision Refractive Laser Center, Tel Aviv, Israel, a total of 7535 eyes (n = 3854 patients; mean age ± SD, 26 ± 6 years; 55% men) underwent PRK with intraoperative MMC application. Patients with histories of corneal pathology or surgery were excluded. Incidence, time of onset, and corneal haze severity were documented on follow-up of 118 ± 110 days. Eyes were grouped by preoperative refraction [low (≤−3D), moderate (−3D to −6D), or high (>−6D) myopia; low (≤3D) or high (>3D) astigmatism; low or high hyperopia]; by intraoperative time (above or below 40 seconds); and by MMC application time (above or below 40 seconds). The main outcome measures were incidence, onset time, and severity of corneal haze.

Results: The haze incidence was 2.1% in eyes with high myopia versus 1.1% in those with low to moderate myopia (P = 0.002), and 3.5 times higher in eyes with high than with low astigmatism (P < 0.05). The overall incidence was higher in eyes treated for hyperopia (10.8%) than for myopia (1.3%) (P = 0.0001). In eyes with moderate myopia, the haze incidence was lower in MMC application time ≥40 seconds (0%) than in <40 seconds (1.3%) (P = 0.03). After surgery, a mild early haze incidence peaked at 68.8 ± 6 days and severe late haze at 115 ± 17 days (P = 0.02).

Conclusions: Hyperopic and large myopic or astigmatic corrections carry higher risk of haze. Longer MMC application might have beneficial haze prevention.

*Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel;

Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel;

Care Vision Laser Centers, Tel Aviv, Israel; and

§Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.

Reprints: Igor Kaiserman, MD, MSc, MHA, Department of Ophthalmology, Barzilai University Medical Center, Hahistadrout St 2, Ashkelon 7830604, Israel (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received February 05, 2017

Received in revised form March 19, 2017

Accepted March 22, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.