Department of Ophthalmology, Rush University Medical Center; Chicago Cornea Consultants Ltd, Chicago, Illinois.
University of California, San Francisco, California; Global Medical Director, Optical Express; Gordon-Weiss-Schanzlin Vision Institute, San Diego, California.
Ophthalmology. 2015 Jun;122(6):1085-95. doi: 10.1016/j.ophtha.2015.01.019. Epub 2015 Mar 18.
To review the published literature assessing the efficacy and safety of mitomycin-C (MMC) as an adjunctive treatment in corneal surface excimer laser ablation procedures.
Literature searches of the PubMed and Cochrane Library databases were last conducted on August 19, 2014, without language or date limitations. The searches retrieved a total of 239 references. Of these, members of the Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel selected 26 articles that were considered to be of high or medium clinical relevance, and the panel methodologist rated each article according to the strength of evidence. Ten studies were rated as level I evidence, 5 studies were rated as level II evidence, and the remaining 11 studies were rated as level III evidence.
The majority of the articles surveyed in this report support the role of MMC as an adjunctive treatment in surface ablation procedures. When MMC is applied in the appropriate concentration and confined to the central cornea, the incidence of post-surface ablation haze is decreased. Although a minority of studies that evaluated endothelial cell density (ECD) reported an MMC-related decrease in ECD, no clinical adverse outcomes were reported.
Over the past 15 years, the use of MMC during surgery in surface ablation has become widespread. There is good evidence of the effectiveness of MMC when used intraoperatively as prophylaxis against haze in higher myopic ablations. Although there are reports of decreased endothelial counts after the administration of MMC during surgery, the clinical significance of this finding remains uncertain, because no adverse outcomes were reported with as much as 5 years of follow-up. Optimal dosage, effectiveness as prophylaxis in lower myopic and hyperopic ablations, and long-term safety, particularly in eyes with reduced corneal endothelial cell counts from prior intraocular surgery, have yet to be established.
综述米诺环素（MMC）作为角膜表面准分子激光消融术辅助治疗的有效性和安全性的已发表文献。
文献检索最后于 2014 年 8 月 19 日在 PubMed 和 Cochrane Library 数据库进行，不限制语言和日期。检索共获得 239 篇参考文献。其中，眼科技术评估委员会屈光管理/干预小组的成员选择了 26 篇被认为具有较高或中等临床相关性的文章，并且小组方法学家根据证据强度对每篇文章进行了评分。10 项研究被评为一级证据，5 项研究被评为二级证据，其余 11 项研究被评为三级证据。
本报告调查的大多数文章支持 MMC 在表面消融术中作为辅助治疗的作用。当 MMC 以适当的浓度应用并局限于中央角膜时，表面消融后混浊的发生率降低。尽管少数评估内皮细胞密度（ECD）的研究报告 MMC 相关的 ECD 下降，但没有报告临床不良结局。
在过去的 15 年中，在表面消融术中使用 MMC 已变得广泛。在较高近视消融术中，MMC 作为预防混浊的术中预防性使用有良好的有效性证据。尽管有报道称在手术中给予 MMC 后内皮细胞计数减少，但由于长达 5 年的随访未报告不良结局，因此该发现的临床意义仍不确定。最佳剂量、在较低近视和远视消融术中的预防有效性以及长期安全性，特别是在因先前眼内手术而导致角膜内皮细胞计数减少的眼中，仍有待确定。
