Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C

Abstract

We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite^® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.

Keywords:

• polypharmacy
• corneal toxicity
• surface ablation
• hypersensitivity
• medication toxicity
• mitomycin corneal toxicity
• photorefractive keratectomy

Ethics Approval

This case report has been approved by the Hoopes Vision Ethics Board. The study conforms with the Helsinki Declaration of 1964, as revised in 2013, concerning human and animal rights.

Consent for Publication

The patient signed an informed consent for publication and use of data in research. No information was included in the report that could result in the identification of the patient.

Disclosure

The authors report no conflicts of interest in this work.