Abstract
BackgroundTo evaluate, using a rabbit model, the influence of the wound healing process at the flap edge on corneal biomechanics after sutured, glued, and non-augmented microkeratome flaps.MethodsUnilateral 160 μm thick laser in situ keratomileusis (LASIK) flaps using a mechanical microkeratome were performed on the corneas of the left eyes of 36 rabbits. Animals were then divided into 3 groups of 12 rabbits each: A: the flaps were glued with human fibrin tissue adhesive (Tisseel); B: the flaps were sutured; and C: the flaps were allowed to heal without the use of sutures or glue (non-augmented). The contralateral eyes served as controls. Reichert ocular response analyzer (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and cornea-compensated IOP (IOPcc) at 6 weeks and 3 months postoperatively. In vivo confocal microscopy (IVCM) was also used to study the corneal wound healing process in all groups.ResultsBoth mean CH and mean CRF were significantly higher in sutured and glued groups compared with the non-augmented group at 6 weeks and 3 months postoperatively (P < 0.0001). No statistically significant difference in corneal biomechanics was found between controls and groups A and B at any time points. Activated keratocytes were detected at the wound edge and peripheral flap interface in sutured and glued groups.ConclusionThe healing process at the wound edge is critical for optimal corneal integrity. Fibrin glue may serve as a safe and effective substitute to sutures in enhancing the corneal flap edge healing response and in increasing its mechanical strength.
Highlights
To evaluate, using a rabbit model, the influence of the wound healing process at the flap edge on corneal biomechanics after sutured, glued, and non-augmented microkeratome flaps
In post-laser in situ keratomileusis (LASIK) ectasia, the lamellar cut and excimer laser ablation lead to a state of biomechanical failure with an inability to support the continuous stresses caused by intraocular pressure (IOP), extraocular muscle action, blinking, eye rubbing, and other forces [1]
The corneal flap created with a mechanical microkeratome is a meniscus-shaped flap, meaning it is thinner in the center with a beveled flap edge that produces almost no healing response
Summary
To evaluate, using a rabbit model, the influence of the wound healing process at the flap edge on corneal biomechanics after sutured, glued, and non-augmented microkeratome flaps. The introduction of the Intralase femtosecond laser to create the LASIK flap has been an important milestone in Abdelkader Eye and Vision (2016) 3:15 dispelling the myth of the never-healing flap. Traditional mechanical microkeratome for LASIK flap creation has been shown to produce unpredictable cut depths and variable flap thickness [4, 5]. The corneal flap created with a mechanical microkeratome is a meniscus-shaped flap, meaning it is thinner in the center with a beveled flap edge that produces almost no healing response. The femtosecond laser produces a planar flap with uniform thickness from edge to edge thereby inducing a stronger stromal healing response [6]
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