Abstract
PurposeTo determine whether topical Substance-P (SP) plus insulin-like growth factor-1 (IGF-1) can improve corneal healing after photorefractive surface ablation in a rabbit.MethodsAfter a 9.0-mm corneal de-epithelialization using a combination of chemical (18% alcohol) and mechanical debridement, excimer photorefractive surface ablation was performed bilaterally in eight rabbits (16 eyes) with an 8.0-mm ablation zone and 70-μm depth. The right eye was treated with SP (250 μg/mL) and IGF-1 (25 ng/mL) in hyaluronic acid, one drop twice a day, and the other eye treated with only hyaluronic acid. The epithelial healing process was documented photographically twice a day until healing was complete. Six rabbits were sacrificed 6 weeks after photorefractive keratectomy (PRK) and corneas examined histologically.ResultsSeven of eight rabbit eyes treated with SP/IGF-1 healed in a shorter time than the untreated eye. For rabbit #6, both eyes healed at the same time. The average healing time (total time until wound closure) for the treated eyes was 99 hours, while the average healing time for the untreated eyes was 170 hours (P = 0.0490). A persistent epithelial defect was found in two of the nontreated eyes but none in the treated eyes. Corneal pathology showed some degree of epithelial separation in the central corneal wound in three out of six nontreated eyes and in just the treated eye of rabbit #6.ConclusionTopical SP plus IGF-1 increases the epithelial healing rate after PRK. There may have been beneficial effects upon cell adhesion as well.Translational RelevanceBetter and faster healing.
Highlights
Removal of the corneal epithelium is necessary before photorefractive keratectomy (PRK)
The timing of all these findings suggests an interaction between the epithelium and keratocytes and between epithelium and PMN leukocytes.[2,4]
Epithelial defects created by the chemical and mechanical technique healed uneventfully in all eyes treated with SP/insulin-like growth factor-1 (IGF-1), with an average healing time of 99 hours
Summary
Removal of the corneal epithelium is necessary before photorefractive keratectomy (PRK). Corneal wound healing after PRK and its consequences, epithelial defect and haze, has been studied extensively. Results on how the absence of corneal epithelium affects the stromal keratocytes are contradictory. Some studies showed that an early decrease in the density of keratocytes is followed by an increased number of these cells in the underlying stroma and polymorphonuclear (PMN) inflammatory reaction.[1,2] These stromal changes are related to stromal haze and stability of the refractive result. Other studies indicate that an atraumatic removal of the epithelium would prevent changes in the stromal healing.[3,4]
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