Original articleLaser in situ keratomileusis flap margin: wound healing and complications imaged by in vivo confocal microscopy☆
Section snippets
Methods
The flap margin of 43 eyes of 43 patients (26 women and 17 men, age 33.6 ± 8.6 years; mean ± SD) who had undergone myopic (n = 39) or hyperopic (n = 4) laser in situ keratomileusis was examined once at different time points after surgery using in vivo confocal microscopy. The preoperative spherical equivalent of refraction of the myopic eyes was −6.74 ± 3.04 diopters (D) (range, −1.75 D to −12.25 D) and that of the hyperopic eyes was +4.12 ± 0.60 D (range, +3.75 to +5.0 D). The Ethical Review
Results
The predictability of the surgery at the time of follow-up was within 0.25 D of the desired result in 20 of 43 eyes (46.5%), within 0.5 D in 28 of 43 eyes (65.1%), within 1.0 D in 35 of 43 eyes (81.4%), within 2.0 D in 42 of 43 eyes (97.7%), and within 3.0 D in 43 of 43 eyes (100%).
Fifteen eyes (34.9%) presented flap striae, and three eyes presented larger folds (7.0%) on slit-lamp examination. In addition, the following complications were registered in seven of 43 eyes (16.3%): lamellar
Discussion
After laser in situ keratomileusis the healing patterns of the incisional wound at the flap margin and the central lamellar intrastromal wound are different. The wound-healing mechanisms of incisional wounds were recently reviewed by Jester and associates.14 In a nonhuman primate eye, the healing is initiated by an early sliding of the corneal epithelium over the wound margin followed by the formation of an epithelial plug in the wound cleft (observed at 7 days after partial thickness
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Cited by (63)
Enhanced wound healing of tissue-engineered human corneas through altered phosphorylation of the CREB and AKT signal transduction pathways
2018, Acta BiomaterialiaCitation Excerpt :According to the US Food and Drug Administration (FDA), epithelial defects reach 0.5% in patients treated with LASIK but a more realistic non-FDA estimate reported defects ranging between 5 and 22.6% depending on the study [74]. The cellular and molecular regulatory phenomena associated with postoperative wound healing are likely to be involved in the adverse effects observed after these surgeries [75] but their underlying mechanisms yet remain to be elucidated. Our demonstration that wound closure could be considerably accelerated by simultaneously suppressing CREB activation with C646 whereas that of Akt is increased with SC79 is particularly interesting as it may provide a new therapeutic tool in the treatment of many of these wound-healing related corneal pathologies.
Clinical in vivo confocal microscopy of the human cornea in health and disease
2010, Progress in Retinal and Eye ResearchCitation Excerpt :Whilst the origin of these lesions is unclear, the morphology is similar to that observed in adenoviral keratoconjunctivitis (Knappe et al., 2005) and the lesions resolve completely following treatment with topical corticosteroids. IVCM in diffuse lamellar keratitis demonstrated inflammatory cells at the LASIK flap interface (Vesaluoma et al., 2000b; Buhren et al., 2001) with keratocyte activation in the corneal stroma immediately anterior and posterior to the flap interface (Moilanen et al., 2004). Laser-assisted sub-epithelial keratectomy (LASEK) has been studied with IVCM to examine sub-basal nerve fibre regeneration (Darwish et al., 2007a,c).
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2009, Journal of Cataract and Refractive SurgeryCollagen ultrastructural changes during stromal wound healing in organ cultured bovine corneas
2009, Experimental Eye ResearchWound instability and management after cataract surgery in a patient with prior laser in situ keratomileusis
2007, Journal of Cataract and Refractive SurgeryContact lens-induced changes in the anterior eye as observed in vivo with the confocal microscope
2007, Progress in Retinal and Eye Research
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This work was supported by the Instrumentarium Scientific Foundation, Helsinki, Finland; (Drs Vesaluoma, Valle, and Tervo), Alicante Institute of Ophthalmology, Alicante, Spain (Drs Vesaluoma, Valle, and Petroll), Finnish Medical Council, Helsinki, Finland, (Drs Tervo and Petroll), Helsinki University Central Hospital, Helsinki, Finland, (Drs Tervo and Vesaluoma), Finnish Eye and Tissue Bank Foundation, Helsinki, Finland, (Dr Vesaluoma), Finnish Eye Foundation, Helsinki, Finland, (Drs Vesaluoma and Tervo), Mary and Georg C. Ehrnrooth Foundation, Helsinki, Finland, (Dr Vesaluoma), Ella and Georg Ehrnrooth Foundation, Helsinki, Finland, (Dr Vesaluoma), The Friends of the Blind, Helsinki, Finland (Dr Tervo).