International Ophthalmology

, Volume 38, Issue 3, pp 1211–1217 | Cite as

Endothelial cell changes after photorefractive keratectomy with graded usage of mitomycin C

  • Hamid Gharaee
  • Siamak Zarei-Ghanavati
  • Reza Alizadeh
  • Mojtaba Abrishami
Original Paper



To compare differences in the endothelial cells before and after photorefractive keratectomy (PRK) for myopia with refractive error graded mitomycin C (MMC) application.


In a prospective randomized clinical trial, forty-eight myopic patients referred to Khatam-al-Anbia Eye Hospital, Mashhad, Iran, for PRK. Patients were treated with PRK by a Bausch and Lomb Technolas 217z excimer laser (Bausch and Lomb, Rochester, NY). MMC was applied after PRK 5 s for each diopter of spherical equivalent myopic refractive error corrected. The manifest refraction, visual acuity, MMC treatment length, corneal pachymetry and specular microscopy were evaluated preoperatively and at 1 and 6 months postoperatively.


A total of 48 cases (96 eyes, 68.75% female) were treated, with a mean age of 26.70 ± 4.89 years (range, 18–34 years). Postoperative cell density, cell size and polymegathism did not significantly change. On the other hand, standard deviation (SD) of cell size (P = 0.008), pleomorphism (P = 0.003) and coefficient of variation (CV) (P = 0.016) were significantly increased. None of these parameters was related to the length of MMC application. Corneal thickness decreased significantly after the operation but it increased 6 months postoperatively compared with the first month (P < 0.001).


MMC application for PRK in myopia can affect the endothelial cells, but in early follow-ups, it does not affect the cell density or size. Cell size was changed but it was obvious not in mean cell size, but in SD and CV. MMC time below the 30 s was not significant on endothelial cell changes.


Endothelial cell Mitomycin Photorefractive keratectomy 



The authors would like to thank Sophie Deng, MD, Ph.D., Associate Professor of Ophthalmology at Jules Stein Eye Institute, for her kind help in revising the manuscript. We also would like to thank Pardis Eghbali, BSc, for her help in PRK procedures, Maryam Kadkhoda, BSc, and Jalil Rahimi, BSc, for their help in optometric tests, Parisa Eghbali, MSc, for her assistance in statistical analysis. It is a pleasure for us to appreciate kindness of Capt. Hossein Goli. This work was part of ophthalmology residency thesis of Dr. Mojtaba Abrishami and was supported by research Grant Number 88708 from office of Vice-Chancellor for Research Affairs of Mashhad University of Medical Sciences.


No funding was received for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

The research followed the tenets of the Declaration of Helsinki and was approved by the Mashhad University of Medical Sciences Research Ethics Committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Hamid Gharaee
    • 1
  • Siamak Zarei-Ghanavati
    • 1
  • Reza Alizadeh
    • 2
  • Mojtaba Abrishami
    • 3
  1. 1.Eye Research Center Mashhad University of Medical SciencesMashhadIran
  2. 2.Stein Eye Institute, Glaucoma DivisionUniversity of California, Los Angeles (UCLA)Los AngelesUSA
  3. 3.Eye Research Center, Khatam Eye Hospital Mashhad University of Medical SciencesMashhadIran

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