Photorefractive Keratectomy with Adjunctive Mitomycin C for Residual Error after Laser-Assisted In Situ Keratomileusis Using the Pulzar 213？nm Solid-State Laser: Early Results
Purpose. To evaluate the accuracy, efficacy, stability, and safety of photorefractive keratectomy (PRK) enhancement using the Pulzar 213？nm solid-state laser (SSL) with adjunctive Mitomycin C in eyes previously treated with laser assisted in situ keratomileusis (LASIK) with residual error of refraction. Methods. This is a prospective noncomparative case series of 16 eyes of 12 patients who underwent PRK for residual refractive error after primary LASIK. Mitomycin C 0.02% was used after the PRK to prevent haze formation. Outcomes measured were pre- and postoperative manifest refraction spherical equivalent (MRSE), uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), and slit lamp evidence of corneal complications. Results. The mean UDVA improved from 20/70 preoperatively to 20/30 postoperatively. The average gain in lines for the UDVA was 2.38. After six months of followup, the postoperative MRSE within 0.50？D in 56% (9) of eyes and 94% (15) eyes were within 1.0 diopters of the intended correction. No eyes developed haze all throughout the study. Conclusion. PRK enhancement with adjunctive use of Mitomycin C for the correction of residual error of refraction after LASIK using the Pulzar 213？nm solid-state laser is an accurate, effective, and safe procedure. 1. Introduction Laser eye surgery has been accepted worldwide as a procedure to modify the shape of the cornea and correct myopia, hyperopia, astigmatism, and presbyopia. However, the cornea is not a plastic material that if shaped a certain way would retain that shape forever. The cornea is a living tissue wherein its biomechanical and wound healing properties can restrict the predictability and stability of refractive surgery [1]. These factors contribute to the discrepancies between intended and achieved visual outcomes after laser-assisted in situ keratomileusis (LASIK), surface ablation, and other keratorefractive procedures leading to residual errors. To correct the remaining refractive error, a second refractive laser surgery can be done. In this study, we chose to do photorefractive keratectomy (PRK) with adjunctive Mitomycin C using the 213？nm solid-state laser for the correction of residual error after LASIK. Photorefractive keratectomy (PRK) with adjunctive Mitomycin C has been shown to be safe and effective with the use of the 193？nm excimer lasers. These lasers have been widely used in the past two decades and up to the present [2–4]. With the recent development and introduction of the 213？nm solid-state laser, use of this machine for refractive surgery has been increasing
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