Use of mitomycin-C for phototherapeutic keratectomy and photorefractive keratectomy surgery

Purpose of review Experience with mitomycin C (MMC) application during corneal surface ablation procedures such as phototherapeutic keratectomy and photorefractive keratectomy has grown over the last decade. This review will highlight our understanding of the utility, mechanism of action, and safety profile of MMC. Recent findings MMC, although still off-label treatment for ophthalmic surgical uses, is now widely employed for photorefractive keratectomy corrections of greater than four to six diopters. The last few years have seen the refractive surgery community embrace its use for virtually any corneal surgical procedure that carries an increased risk for haze formation. Experience has shown that MMC is highly effective at preventing haze and is well tolerated, with few reported complications. However, several recent reports have raised new questions about the long-term safety profile of MMC, especially with regard to decreased keratocyte and corneal endothelial cell populations noted months to years after surgery. New findings regarding the penetration of MMC to the endothelium and into the aqueous humor may lead surgeons to reassess appropriate dosing and patient selection when the drug is used for surgery. Summary The use of MMC has revitalized the application of surface ablation procedures such as photorefractive keratectomy or phototherapeutic keratectomy for refractive and therapeutic treatments. Questions remain, however, regarding the long-term safety profile of MMC. A cautious approach to its continued use is advisable.