Meta-analysis of clinical outcomes comparing surface ablation for correction of myopia with and without 0.02% Mitomycin-C

1. Shi-hao Chen¹
2. Yi-fan Feng¹
3. Aleksandar Stojanovic²
4. Qin-mei Wang¹

¹The Affiliated Eye Hospital at Wenzhou Medical College, Zhejiang, China
²Synslaser Kirurgi, Tromsø and Oslo, Norway

Purpose: To evaluate the current clinical evidence of safety and efficacy of intraoperative topical application of 0.02% mitomycin-C (MMC) used for up to 2 minutes after surface ablation for correction of myopia.

Design: Meta-analysis/systematic review.
Participants: Patient data from previously reported comparative, prospective, randomized and nonrandomized clinical trials.

Methods: A comprehensive literature search of Cochrane Library, MEDLINE and EMBASE to identify relevant trials comparing surface ablation for correction of myopia with and without MMC. A meta-analysis was performed on the results of the reports and the statistical analysis was performed using RevMan 4.2 software.

Results: Eleven clinical trials were identified with MMC use in 534 eyes and no MMC in 726 eyes. Surface ablations with MMC led to significantly less corneal haze in photorefractive keratectomy (PRK), while the results were comparable in laser epithelial keratomiieusis (LASEK) and epithelial laser in situ keratomileusis (Epi-LASIK). Although proportionately more eyes in the MMC group achieved uncorrected distance visual acuity (UDVA) ≥ 20/25 and less frequently loss ≥ 2 lines of corrected distance visual acuity (CDVA), the difference was not statistically significant. While there were no reports of immediate toxic effects, endothelial cell loss may be a relevant complication of MMC use.

Conclusions: Our meta-analysis suggest that the topical intraoperative application of 0.02% MMC may reduce haze, and improve visual acuity after surface ablation for correction of myopia without major safety issues. However, the advantage of using MMC in LASEK and Epi-LASIK may be controversial. Further trials are needed.