Safety and complications after three different surface ablation techniques with mitomycin C: a retrospective analysis of 2757 eyes

  • Juliane Mehlan
  • Stephan Johannes Linke
  • Christos Skevas
  • Johannes Steinberg
  • Konstantinos Giannakakis
  • Toam Katz
Refractive Surgery



To evaluate the safety and spectrum of complications of three excimer laser surface ablation techniques (SATs) with an intraoperative application of mitomycin C (MMC) 0.02%. A retrospective, non-comparative large case series.


SATs were performed on 2757 eyes with a preoperative spherical equivalent (SE) of − 4.41 ± 2.44 and a Wavelight Allegretto 200 platform. Ablation zone diameters between 6.0 and 7.0 mm were used according to mesopic pupil size. All patients were treated with an intraoperative application of MMC for 30 to 90 s depending on refractive error. The mean follow-up time was > 3 months (107 ± 24 days). Complication range and incidence were analyzed retrospectively and safety index was calculated.


Two thousand seven hundred and fifty-seven eyes met the inclusion criteria for surface ablation. Two thousand five hundred and seventy-three eyes were assigned to alcohol-assisted photorefractive keratectomy (APRK), 135 eyes to transepithelial photorefractive keratectomy (TPRK), and 49 eyes to off-flap epithelial laser in situ keratomileusis (EpiLASIK/EpiK). Overall, the safety index was 1.06 ± 0.28. Haze was graded according to the Fantes scale. Haze incidence rates were highest in the TPRK group (14.81%) and comparably low in APRK (2.95%) and EpiK (4.08%) groups.


Intraoperative topical application of MMC (0.02%) results in good safety and no severe side effects. However, highest incidence of haze was observed after TPRK. The more frequent peripheral localization of haze might be attributed to large ablation zones and the wavefront optimized ablation profile especially in the PTK modus of the laser platform.


Laser Mitomycin C Safety Surface ablation technique Haze 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Juliane Mehlan
    • 1
  • Stephan Johannes Linke
    • 1
    • 2
    • 3
  • Christos Skevas
    • 1
  • Johannes Steinberg
    • 2
    • 3
  • Konstantinos Giannakakis
    • 4
  • Toam Katz
    • 1
    • 2
  1. 1.Department of OphthalmologyUKE - University Clinic Hamburg-EppendorfHamburgGermany
  2. 2.Care-Vision GermanyHamburgGermany
  3. 3.zentrumsehstärkeHamburgGermany
  4. 4.Augenarztpraxis Dr. med. Wilhelm Kröncke & Albrecht ZwickBremerhavenGermany

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