36 | EYEWORLD DAILY NEWS | MAY 7, 2019
ASCRS SYMPOSIA
ASCRS ASOA ANNUAL MEETING
by Rich Daly
EyeWorld Contributing Writer
EW Onsite
36
Dr. Pineda re-
moved a few microns
with PTK to smooth the bed and
remove more of the scarring. He
also applied MMC for 1 minute.
Dr. Pineda acknowledged, "I
don't like MMC, so this says a lot."
Also important to note is that
the patient clearly did not have an
adequate course of steroids after
the PRK treatment.
After Dr. Pineda's treatment,
the opacity cleared and vision im-
proved dramatically by 2 months
postop. Several months postop he
achieved uncorrected vision of
A
n unusual case under-
scored the importance
of using mitomycin-C
(MMC) in certain types
of cases.
Roberto Pineda,
MD, Cambridge, Mas-
sachusetts, was referred the case
of a 27-year-old male patient with
decreased post-refractive vision.
He reported cloudy vision and
glare for 4 months following PRK
enhancement of a femtosecond
LASIK treatment 4 years earlier.
That had followed an initial 3
months of good vision.
MMC was never applied,
according to the medical records,
and topical steroids were used only
3 weeks after the PRK treatment.
(PTK)
with MMC,
or LASIK flap
amputation.
However, OCT
showed the dense opacities
remained superior to the LASIK
flap.
"This raises the question of
what kind of opacity he had," Dr.
Pineda said.
The leading candidates were
hypertrophic scars following
LASIK or corneal keloid, which
differ in important ways.
"We felt this represented
more of a hypertrophic scar," Dr.
Pineda said.
In response, he performed a
superficial keratectomy. The sur-
face was still smooth and regular.
MMC essential after PRK
enhancement for LASIK
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The preop LASIK evaluation
showed he was a moderately high
myope with a low amount of astig-
matism, with somewhat thinner
corneas, and normal slit lamp
corneas.
The patient had sought
retreatment several years after his
myopia continued to progress.
By the time he presented to
Dr. Pineda, the patient's uncorrect-
ed vision has declined to 20/125
in the right eye and 20/300 in the
left eye.
"He did have central opacifi-
cation over his LASIK flaps and
was obviously struggling with his
vision," Dr. Pineda said.
Dr. Pineda weighed whether
to perform superficial keratecto-
my, phototherapeutic keratectomy
Dr. Majmudar discusses
topography-guided treatment.
