Second, in patients with haze recalcitrant to medical therapy, or recurrent haze, I suggest laser re-treatment. When re-treating such patients, I prefer a transepithelial approach to avoid any mechanical trauma to the corneal surface. The patient is examined after the laser treatment and if a substantial haze remains, then additional pulses using a PTK technique are cautiously applied to reduce residual haze. In such a case, the transepithelial approach is similarly used. It is positioned directly over the area of haze and applied for 2 minutes.
Care is taken to avoid excess mitomycin leaking over the remainder of the cornea.
After removal of the pledget, the surface of the cornea is vigorously irrigated with balanced salt solution. Using this technique, I have not yet seen haze recur. However, overcorrection can be a problem and can be avoided by being conservative in laser application. Indeed, some investigators have advocated mechanical stripping of any plaque-like haze with the subsequent use of mitomycin, without laser ablation. They suggest that simply removing the fibrous plaque mechanically will reduce the refractive error and mitomycin will prevent recurrence.