If you are thinking about having Lasik, IntraLasik, PRK, LASEK, Epi-Lasik, RLE, or P-IOL eye surgery, this is the forum to research your concerns or ask your questions.


Postby GeneralPatientInquiry » Mon Jun 05, 2006 4:53 am

my concern is that i was ready for the surgery and at the last minute while in the room they decided not to do lasik due to my cornea being too thin and prk was the alternative but my prescription is 7.00 left and 7.25 right and that i needed midol miacin(mitomyacin?)to prevent a haze due to the risk so everything was called off right in the surgery room so my question is that if this midol miacin is safe and recommended due to my prescription. my doctor did not seem to sure that this procedure would be the best for me.please provide me with as much information as you can in regards to this pkr with mitomyacin. thank you
This post is a reprint of a previously requested inquiry received by via email.
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Postby LasikExpert » Mon Jun 05, 2006 5:00 am

Photorefractive Keratectomy (PRK) is a surgical procedure using an excimer laser to reshape the cornea by applying laser energy to the surface of the cornea. The primary difference between PRK and LASIK is where the laser energy is applied. PRK applies the energy and removes tissue from the outer surface of the eye. LASIK applies the energy underneath a flap of corneal tissue.

LASIK attempts to "fool" the eye into not thinking it has not had surgery. This reduces the keratocyte activity. Keratocytes are cells that work to repair the cornea. The concentration and high activity of keratocytes within the cornea after surgery is a contributing factor to late-onset haze.

Surface ablation techniques like PRK, and its cousins LASEK and Epi-LASIK, do not use a flap of corneal tissue, but have a higher rate of corneal haze than LASIK. At least, a higher rate of late-onset haze when more than about 6.00 diopters of correction is attempted.

Mitomycin C is a medication that changes keratocyte activity and also reduces the probability of late-onset corneal haze in higher myopes and surface ablation correction. Mitomycin C can also eliminate haze after it exists.

Instead of a LASIK flap, the doctor can elect to use a medication like Mitomycin C intraoperatively with a surface ablation technique and get the same relative net effect as using a LASIK flap (in relation to haze). The difference is that Mitomycin C is a strong medicine that may be appropriate when needed, but should be avoided when possible. The LASIK flap virtually eliminates the need for application of Mitomycin C to reduce the probability of corneal haze.

The process of ablation under a flap is, in a general way, the same as anesthesia. One could have eye surgery without any numbing drops and the body would know without a doubt that it has had surgery, but what is the value of a patient experiencing pain unnecessarily? Equally, the flap reduces the probability of late-onset corneal haze by using a process that limits or reduces the cornea's healing response in a positive and constructive way. This can also be accomplished with Mitomycin C, but in some cases a LASIK flap may be a more appropriate choice.

It may be better for you to consider IntraLASIK than either conventional LASIK or PRK. IntraLASIK is LASIK except that the flap is created with a laser, rather than a steel blade. The laser that creates the flap is much more accurate than a blade and can reliably create a thinner flap.

There is no easy answer for you. If you have PRK alone, there is a relatively high probability of having corneal haze. If you have PRK with Mitomycin C, the probability of haze is reduced, but that is rather strong medicine for an elective procedure. If you have LASIK, the untouched cornea may be too thin to remain stable. It may be that you are able to have IntraLASIK with a thin flap, but you may need to be evaluated by a different surgeon.

If you decide to have any refractive surgery, I highly recommend that you take 500mg of vitamin C (yes, plain old vitamin C) twice a day for at least a week before surgery and for at least two weeks after surgery, plus wear 100% UV protection sunglasses if you even think of going into the sun. This will help reduce the probability of corneal haze with all procedures. It may be unnecessary, but it normally can't hurt.
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