Official ESCRS | European Society of Cataract & Refractive Surgeons


Corneal haze after cross-linking for keratoconic eyes with and without mitomycin C application: a prospective evaluation

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Session Details

Session Title: Corneal Cross-Linking

Session Date/Time: Monday 16/09/2019 | 16:00-18:00

Paper Time: 16:36

Venue: South 5

First Author: : S.Awwad LEBANON

Co Author(s): :    L. Chacra   A. Dhaini   C. Helwe   J. Torbey   E. Torres   F. Hafezi              

Abstract Details


To evaluate corneal haze as determined by OCT after cross-linking as compared to cross-linking with Mitomycin C application, for the treatment of mild to moderate Keratoconus.


American University of Beirut Medical Center, Lebanon


A prospective analysis of 87 myopic eyes of 72 patients with mild to moderate keratoconus. Eyes were divided into 2 randomized groups. The first group (n=43 eyes) underwent cross-linking with mitomycin C and the second group (n=44 eyes) underwent cross-linking without mitomycin C, both following the Dresden Protocol. Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Main outcome measures were haze intensity, size and location as measured by a dedicated OCT image analysis software. Secondary outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest spherical equivalent and cylinder, simK and Kmax.


The anterior stromal haze area at 1 month postoperatively was 53.34±23.4 and 28.98±20.67 for the MMC and conventional group, respectively (p<0.0001), and 47.3±18.06 and 38.89±17.02 (p<0.0281) at 3 months postoperatively. The anterior stromal brightness at 1 month postoperatively was 70.67±9.31 and 50.09±7.70 (p<0.0001) for the MMC and conventional respectively, and 58.89±12.89 and 52.48 ±6.11 (p<0.0046) at 3 months postoperatively. For the MMC group, the UDVA and CDVA LogMar were 0.40±0.35 and 0.35±0.34 at 1 month postoperatively and 0.21±0.19 and 0.21±0.21 at 1 year postoperatively (p>0.05). For the conventional group they were 0.35±0.31 and 0.26±0.19, and 0.17± 0.20 and 0.14±0.16 (p>0.05).


Mitomycin C application following cross-linking increases corneal haze. Similar studies need to be performed on simultaneous cross-linking and PRK procedures to evaluate MMC role in haze formation.

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