Abstract
PurposeTo study the structural features of human post-LASIK corneas.MethodsA pair of post-mortem donor corneas, from a 55-year old patient who underwent uncomplicated LASIK surgery five years previously, were bisected and fixed in 4% paraformaldehyde. The right cornea and one half of the left cornea were processed for light microscopy and scanning electron microscopy. One half of the right cornea was also examined by transmission electron microscopy.ResultsThe flap-bed interface could be easily detected several years after LASIK and, although the flap appeared to be in close association with the stromal bed, there was a noticeable absence of reconnection between adjacent severed lamellae. Tissue gaps were evident at the flap margin, which once free of cellular components revealed the presence of a few bridging fibres.ConclusionExamination of corneas five years after LASIK revealed evidence of primitive reparative scar development at the wound interface, but no reconnection of severed collagen lamellae. Such findings may explain the occurrence of flap dislocation following trauma in some patients months or years after surgery.
Highlights
Laser in situ keratomileusis (LASIK) has been used to correct corneal refractive error for over 20 years [1]; the surgery involves the use of a mikrokeratome to create a hinged corneal flap and the in situ ablation of the exposed stromal bed with an excimer laser (Figure 1A)
This paper examines the corneal ultrastructure of two postmortem human corneas that underwent uncomplicated LASIK 5 years previously
Light microscopy images showed that the flap-bed interface was clearly visible five years after LASIK surgery (Figure 2) and, some epithelial cells were missing, Bowman’s layer and Descemet’s membrane appeared intact
Summary
Laser in situ keratomileusis (LASIK) has been used to correct corneal refractive error for over 20 years [1]; the surgery involves the use of a mikrokeratome to create a hinged corneal flap and the in situ ablation of the exposed stromal bed with an excimer laser (Figure 1A). A large number of publications have evaluated the results of LASIK surgery in terms of its clinical outcomes. Few have investigated the ultrastructural changes that occur within the cornea and result in the creation of a flap that can be dislocated many years after treatment [2,3]. Most studies that concentrate on ultrastructural changes are based on animal models [4,5,6] and one must realise that the architecture [7] and material properties [8] of animal corneas can be quite different from those of humans. This paper examines the corneal ultrastructure of two postmortem human corneas that underwent uncomplicated LASIK 5 years previously. The findings contribute to our understanding of the material behavior of post-LASIK corneas
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