Mitomycin C

Mitomycin C is unlicensed for laser eye surgery in the USA.

Even the surgeons themselves are now questioning the use of MMC.

Randy J. Epstein, MD said, “It has potential to do serious injury to the eye, if you’re not careful. It is radiomimetic. And nobody knows how long it hangs around after it’s administered.”
www.aao.org/publications/eyenet/200503/feature.cfm

Scary stuff!

Of course few will come out & admit it's bad as they've already done the damage to so many.

A third procedure is possible and can be very successful - but much depends on the overall levels of correction provided. This will determine what type of procedure will be required. It is possible to be overcorrected again (become shortsighted) but that is a better place to be than farsighted (Hyperopic).

You need to be evaluated thoroughly and a copy of your medical records is vital to understand what treatments have been performed etc.

My surgeon cocked up my surgery and now I have been over corrected. I am told that too much laser was used for a person of my age and because the MMC was used there will be no regression to a suitable prescription??

I have been told by an expert that I have hypermytropia which I believe is longsightedness and that this is why my medium vision is totally all over the place and this is why I feel disorientated (as if my eyes are not working together) and get Lots of headaches/migraines.I am finding it very difficult to cope with this situation, but because I have already Lasik and Lasek on both eyes I don't like. T he idea of more surgery, and certainly not with Optical Express. If I've been through 2 procedures which went wrong it seemslogical that the same can happen again!

Can you please tell me what the real risks of more surgery are (with a reputable provider). Would you recommend a third procedure?....and what other options are there?

THANK YOU

Yes agree on all fronts.

Essentially MMC is a dangerous drug that has not been fully evaluated scientifically for use in this context. There are some animal studies that have shown MMC entering the eye. Other studies show endothelial cell counts (cells on the back layer of the cornea) are not significantly harmed, however as these cells are not really multiplying, they are unlikely to be harmed. Chemotherapeutic agents like MMC work on rapidly multiplying cells!

Yes MMC really clobbers wound healing reactions and in doing so could cause a number of side effects and affect laser ablation outcomes (overcorrections etc.) Based on the paucity of scientific data in my view it really has no place in highly elective surgery like PRK/LASEK. Do I use MMC ? Yes - I use MMC only in repeat pterygium surgery, glaucoma surgery and therapeutic laser eye surgery (fixing up problem cases where surface treatment is needed).

I do not know about routine practice at OE and cannot comment.

InthebusinessnotOE:
I have read a number of articles suggesting MMC is unnecessary for low order corrections and yet routinely used prophyllactically by OE.

If there is an element of over correction during the Lasek procedure does the use of MMC during that procedure mean normal regression towards the desired result is impeded making the over correction permanent?

"The use of the topical eye drop Mitomycin C during surgery dramatically reduces the probability of haze, and can be used to treat haze when it occurs, but this is rather strong medicine. Mitomycin C is appropriate when required, but probably needs to be avoided if possible. Also, Mitomycin C changes how much tissue the laser ablates with each pulse, so the doctor needs to manually change the treatment plan. This requires additional expertise."
www.usaeyes.org/lasik/faq/corneal-haze.htm

Would you agree?

Complaints concerning the use of this unlicensed drug should be reported to Medicines and Healthcare products Regulatory Agency (MHRA).

www.mhra.gov.uk/

SEND COMPLAINTS VIA THIS PAGE:

www.mhra.gov.uk/Contactus/Howtomakeacomplaint/index.htm

www.northerneye.co.uk

"I also use it prophylactically in very high primary LASEK's over -8 . However, this use of mitomycin-C is totally "off label" and really done at the patient's risk"

If it's at the patients risk surely it's imperative that
a) the patient should be aware of its use in the first place
b) the patient should be informed of any potential list
c) the patient should be given the opportunity to decline the risk.

Possible long term problems discussed here`````
www.northerneye.co.uk
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But the question of whether there will be delayed toxicity remains unanswered.
"Mitomycin-C affects DNA in the same way as beta-irradiation does, and looking back at the radiation literature we see that problems with corneal and scleral flap melts did not develop for 15 to 20 years after treatment.
"So, only time will reveal the long-term safety of mitomycin-C in refractive surgery," Dr Palmon said.
Dr Palmon's concerns about potential late complications were echoed by panel members Eric Donnenfeld MD, Jonathan Rubinstein MD and Dimitri Azar MD.
Dr Rubinstein noted that he has begun to see superior stem cell problems in eyes that are 10 to 12 years after a glaucoma filtering surgery procedure with adjunctive mitomycin-C.
"These patients are just beginning to show up with significant conjunctivalisation of the superior cornea and I think we will have to wait to see if there are going to be long-term complications secondary to stem cell effects," he said.
Dr Azar, Associate Professor of Ophthalmology, Harvard Medical School, Boston, US remarked that treatment of haze with mitomycin-C is entirely justifiable.
"But because it is so efficacious in that indication, it makes more sense to use mitomycin-C therapeutically rather than prophylactically," he added.
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Scary...why are Optical Express getting away with this?

This is absolutely scandalous. I had Lasek and I'd be mortified to think that I had been given this. Will ask for my records and have a look

Does anyone know which companies use this stuff and which ones don't . How do the companies using it justify their actions and what reasons do the companies not using it give for not doing so?