Hello all....I've really enjoyed this forum.

I had PRK in April/2005. I had strong myopia (7.25 in both eyes as I recall). The PRK went really well and as soon as I went off the steroid drops about a month later, I had very close to 20/20 vision. My night vision wasn't perfect, but I anticipated that and planned to get some glasses in a few months for driving and the like. I could still drive safely, though.

About two months ago, I noticed that my vision suddenly wasn't as sharp as it used to be. I met with my doctor who told me I had developed some haze. I went on steroid drops again for about a month in the hope that it would clear up on it's own. No such luck....

I'm scheduled for PTK in about two weeks. This appears to be a realaively simple process (compared to the original PRK). The doctor will laser off the outer layer of the cornea with the hazing. He's confident that I'll return to the good vision I had before the hazing set in. We're doing the left eye first followed by the right eye in about 30 days.

The doctor plans to treat my eye with Mitomycin-C to prevent the hazing from reoccurring. This appears to be standard operating procedure, but it's still a bit controvercial. It appears the MMC is a very powerful drug that some doctors are nervous about (stories of melting eyeballs and such).

The MMC can be placed in your eye for as little as eight seconds to as long as two minutes. My doctor plans to go with two minutes.

I don't question his thinking. I want to make sure the hazing doesn't come back. I also don't want to make sure I don't wake up one morning with melting eye goo running down my cheeks (joking but still concerned). I'm just curious what others have heard about MMC and how long it should be in the eye.

Thanks all....

Steve

I give a lecture each year at our Annual meeting (ASCRS) on surface ablation in tough cases...and I have given the course with Parag Majmudar, one of the leaders in the safe use of Mitomycin C. His research has shown for prevention of scarring in high risk patients, 12 seconds of exposure is just as effective as 2 minutes (using the standard dose).
The real question that has not been answered is what is the optimal time when trying to prevent recurrence of haze. 2 minutes has been the standard treatment, and perhaps 30 seconds would be just as good....but there are no studies that have compared 30 seconds to 2 minutes for prevention of haze recurrence. So going with 2 minutes should be just fine. For many years, 2 minutes was the standard, and in general patients did very well.
The biggest concern is getting the wrong concentration. I am sure your doctor will triple check the dose, but that is a nice thing to discuss with your doctor if you are very concerned. Of course, there are risks with every surgery, so please discuss the risks of Mitomycin C, PTK for haze removal, etc with your doctor.

Best of luck

Bill Trattler, MD
Miami, FL

Thanks for your prompt reply, Doctor.

Just for coversations sake with my doctor, that concentration of the MMC should be .02% or something like that, correct?

I appreciate it.

Steve

The concentration should be no more than 0.02% for around 12 seconds, and some doctors are reporting good results with 0.002% for 10 seconds.

>Hello all....I've really enjoyed this forum.

>I had PRK in April/2005. I
>had strong myopia (7.25 in both
>eyes as I recall). The
>PRK went really well and as
>soon as I went off the
>steroid drops about a month later,
>I had very close to 20/20
>vision. My night vision wasn't
>perfect, but I anticipated that and
>planned to get some glasses in
>a few months for driving and
>the like. I could still
>drive safely, though.

>About two months ago, I noticed that
>my vision suddenly wasn't as sharp
>as it used to be.
>I met with my doctor who
>told me I had developed some
>haze. I went on steroid
>drops again for about a month
>in the hope that it would
>clear up on it's own.
>No such luck....

>I'm scheduled for PTK in about two
>weeks. This appears to be
>a realaively simple process (compared to
>the original PRK). The doctor
>will laser off the outer layer
>of the cornea with the hazing.
> He's confident that I'll return
>to the good vision I had
>before the hazing set in.
>We're doing the left eye first
>followed by the right eye in
>about 30 days.

>The doctor plans to treat my eye
>with Mitomycin-C to prevent the hazing
>from reoccurring. This appears to
>be standard operating procedure, but it's
>still a bit controvercial. It
>appears the MMC is a very
>powerful drug that some doctors are
>nervous about (stories of melting eyeballs
>and such).

>The MMC can be placed in your
>eye for as little as eight
>seconds to as long as two
>minutes. My doctor plans to
>go with two minutes.

>I don't question his thinking. I
>want to make sure the hazing
>doesn't come back. I also
>don't want to make sure I
>don't wake up one morning with
>melting eye goo running down my
>cheeks (joking but still concerned).
>I'm just curious what others have
>heard about MMC and how long
>it should be in the eye.
>

>Thanks all....

>Steve
Dr. Trattler explained it well. it should be 0.02%. I would probably go with 1 minute but 2 should be fine and we all did many cases at 2 minutes without problems
J. Salz

Thanks for the replies. Lot's of good information....

The PTK with MMC on my left eye is scheduled for November 7th with the right following 30 days behind if all goes well. I'll let everybody know how it works out.

One unfortunate thing is that since the doctor wants to do one eye at a time, I can only take about three days off from work for each surgery. For my original PRK we did both eyes at the same time and I took a full week. I just don't have the sick leave to burn for two full weeks. Oh well...so it goes.

Keep your fingers crossed for me.

Steve

Very good question, Steve. Although it is gaining wide acceptance in the ophthalmic community for the prevention and treatment of haze in surface laser ablations, MMC is not without some controversy. MMC is a very powerful antimetabolite, and its effectiveness is well documented. However, that there may be some risk associated with its use is also well documented. MMC has been used in pterygium eye surgery for a number of years, and during that time a few cases of serious corneal "melt" have occurred. For instance, in this research article (http://bjo.bmjjournals.com/cgi/content/full/86/3/357), a 1% (3 in 300) incidence of corneal melt occurred with a 0.02% application of MMC for 3 minutes. To me, that is cause for some concern. Now, it is certainly true that refractive surgery is not pterygium surgery, and the use of MMC is somewhat different in the two procedures, but, still, the potential for corneal melt may be there. I also know of several refractive surgeons who include a notification in their informed consent forms that states that the long-term effects, if any, of MMC in refractive surgery are unknown but may include corneal melt. So, in short, MMC is an effective drug and any additional risk, if it exists, is likely small, but it is one more thing to factor into your personal risk/benefit analysis.

Bryce Carlson

The link, above, is correct but when you click on it it picks up the trailing ")" and won't work; so, here it is without the parentheses:

http://bjo.bmjjournals.com/cgi/content/full/86/3/357

This way should work.

Bryce Carlson

I just met with my doctor for my pre-op appointment before my PTK on Monday. My doctor did some additional research and has decided to only use the MMC for only twenty seconds (instead of the planned two minutes).

He was also changed his mind about the use of Vitamin C. Originally, he had no opinion and expressed his doubts. Now he wants me to start taking 500 mg twice a day.

He also wants me to be on the steroid drops for six months. I'm not excited about that because those drops screw up my vision while I'm on them.

So my new question is this....

After my original PRK, my solid 20/20 vision didn't kick in until I stopped taking the steroid drops 30 days after the surgery. Within a week of going off the drops my vision was excellent.

Is it common for the steroid drops to effect vision this way? Are there different steroid drops which effect vision less then others. Unfortunately, I don't recall the name of the steroid drops I previously used.

Going under the laser Monday morning! Everyone keep their fingers crossed for me!

Thanks....

Steve

If you are representing your doctor's words accurately, Steve, I, personally, would not be particularly comfortable with what he is saying for several reasons. (1) Apparently, before you pointed it out to him, he did not know about the prophylactic use of ascorbic acid to avert or minimize haze. (2) Apparently, before you pointed it out to him, he also did not know that to reduce risk there is a strong trend among doctors who use it to limit the intra-op use of MMC to a single dose of 15 sec to 20 sec. I, personally, would not feel comfortable having to educate my doctor to that degree about a procedure he was about to perform on ME. And, (3), I also don't like his plan to keep you on topical steroids for 6 months. That is a very long time to be on topical steroids. Based on many articles in the literature, it is long enough to induce glaucoma, and long enough to cause sub-capsular posterior cataracts in susceptible patients. Based on standard-of-care as I understand it, it is just too long to safely be on steroids (a 3 month taper is usual, though some docs opt for less unless haze develops). Personally, I prefer to benefit from a doctor's learning curve, not participate in it. But, then, that's me.

BC

>Hello all....I've really enjoyed this forum.

>I had PRK in April/2005. I
>had strong myopia (7.25 in both
>eyes as I recall). The
>PRK went really well and as
>soon as I went off the
>steroid drops about a month later,
>I had very close to 20/20
>vision. My night vision wasn't
>perfect, but I anticipated that and
>planned to get some glasses in
>a few months for driving and
>the like. I could still
>drive safely, though.

>About two months ago, I noticed that
>my vision suddenly wasn't as sharp
>as it used to be.
>I met with my doctor who
>told me I had developed some
>haze. I went on steroid
>drops again for about a month
>in the hope that it would
>clear up on it's own.
>No such luck....

>I'm scheduled for PTK in about two
>weeks. This appears to be
>a realaively simple process (compared to
>the original PRK). The doctor
>will laser off the outer layer
>of the cornea with the hazing.
> He's confident that I'll return
>to the good vision I had
>before the hazing set in.
>We're doing the left eye first
>followed by the right eye in
>about 30 days.

>The doctor plans to treat my eye
>with Mitomycin-C to prevent the hazing
>from reoccurring. This appears to
>be standard operating procedure, but it's
>still a bit controvercial. It
>appears the MMC is a very
>powerful drug that some doctors are
>nervous about (stories of melting eyeballs
>and such).

>The MMC can be placed in your
>eye for as little as eight
>seconds to as long as two
>minutes. My doctor plans to
>go with two minutes.

>I don't question his thinking. I
>want to make sure the hazing
>doesn't come back. I also
>don't want to make sure I
>don't wake up one morning with
>melting eye goo running down my
>cheeks (joking but still concerned).
>I'm just curious what others have
>heard about MMC and how long
>it should be in the eye.
>

>Thanks all....

>Steve

As Dr. Trattler pointed out, the trend is for less time for the mitomycin so 20 seconds should be fine. If your cornea remains clear, you can probably start a slow taper of the cortisone at 4 weeks and be off by 3 months unless it appears the haze is returning. You should do well and the steroid does not decrease your vision while you are using it. Your visual recover after PRK with a high correction takes a little longer than LASIK and the improvement in your vision was most likely related to your recovery from the PRK and not stopping the drops.
Dr Salz

Well, it's been eight days since my PTK with MMC to clear the haze in my right eye and my vision is excellent. I'm very, very pleased.

I'm scheduled to get my left eye done in early January.

We did the MMC for twenty seconds as we discussed and there haven't been any problems as of yet.

The only bummer is the dramatic contrast between the poor vision in my left eye and the great vision in my right. It's a bit awkward, but it's a hell of an improvement from before.

Thanks again for all the good advice....

Steve

I am glad you are doing well

Best of luck

Bill Trattler, MD
Miami, FL

Congratulations!

BC

>Hello all....I've really enjoyed this forum.

>I had PRK in April/2005. I
>had strong myopia (7.25 in both
>eyes as I recall). The
>PRK went really well and as
>soon as I went off the
>steroid drops about a month later,
>I had very close to 20/20
>vision. My night vision wasn't
>perfect, but I anticipated that and
>planned to get some glasses in
>a few months for driving and
>the like. I could still
>drive safely, though.

>About two months ago, I noticed that
>my vision suddenly wasn't as sharp
>as it used to be.
>I met with my doctor who
>told me I had developed some
>haze. I went on steroid
>drops again for about a month
>in the hope that it would
>clear up on it's own.
>No such luck....

>I'm scheduled for PTK in about two
>weeks. This appears to be
>a realaively simple process (compared to
>the original PRK). The doctor
>will laser off the outer layer
>of the cornea with the hazing.
> He's confident that I'll return
>to the good vision I had
>before the hazing set in.
>We're doing the left eye first
>followed by the right eye in
>about 30 days.

>The doctor plans to treat my eye
>with Mitomycin-C to prevent the hazing
>from reoccurring. This appears to
>be standard operating procedure, but it's
>still a bit controvercial. It
>appears the MMC is a very
>powerful drug that some doctors are
>nervous about (stories of melting eyeballs
>and such).

>The MMC can be placed in your
>eye for as little as eight
>seconds to as long as two
>minutes. My doctor plans to
>go with two minutes.

>I don't question his thinking. I
>want to make sure the hazing
>doesn't come back. I also
>don't want to make sure I
>don't wake up one morning with
>melting eye goo running down my
>cheeks (joking but still concerned).
>I'm just curious what others have
>heard about MMC and how long
>it should be in the eye.
>

>Thanks all....

>Steve

thanks for the follow-up and I am pleased to see you did so well.
Dr. Salz

Well....we waited two months before eliminating the haze in my 2nd eye. I'm now eight days post-op on the second eye.

Ten weeks post-op, my first eye is doing very well. It's still a bit jumpy, but I could read the 20/15 line and I can now drive safely at night without any glasses. I've now discontinued steroid drops in the first eye. I'm very pleased.

The second eye is doing very well. It doesn't have the accuity yet of the first eye, but there is improvement every day. I've now discontinued using the Vigomox and Acular drops and am now just using steroid drops four times a day until I finish the bottle.

And I'm still taking Vitamin-C like a fiend!

Still enjoying this forum. I'll keep in touch.