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Minna Vesaluoma, Juan Pérez–Santonja, W. Matthew Petroll, Tuuli Linna, Jorge Alió, Timo Tervo; Corneal Stromal Changes Induced by Myopic LASIK. Invest. Ophthalmol. Vis. Sci. 2000;41(2):369-376.
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purpose. Despite the rapidly growing popularity of laser in situ keratomileusis
(LASIK) in correction of myopia, the tissue responses have not been
thoroughly investigated. The aim was to characterize
morphologic changes induced by myopic LASIK in human corneal stroma.
methods. Sixty-two myopic eyes were examined once at 3 days to 2 years after
LASIK using in vivo confocal microscopy for measurement of flap
thickness, keratocyte response zones, and objective grading of haze.
results. Confocal microscopy revealed corneal flap interface particles in 100%
of eyes and microfolds at the Bowman’s layer in 96.8%. The flaps were
thinner (112 ± 25 μm) than intended (160 μm). The keratocyte
activation in the stromal bed was greatest on the third postoperative
day. Patients with increased interface reflectivity due to abnormal
extracellular matrix or activated keratocytes at ≥1 month
(n = 9) had significantly thinner flaps than patients
with normal interface reflectivity (n = 18;
114 ± 12 versus 132 ± 22 μm, P =
0.027). After 6 months the mean density of the most anterior layer of
flap keratocytes was decreased.
conclusions. Keratocyte activation induced by LASIK was of short duration compared
with that reported after photorefractive keratectomy. The flaps were
thinner than expected, and microfolds and interface particles were
common complications. The new findings such as increased interface
reflectivity associated with thin flaps and the apparent loss of
keratocytes in the most anterior flap 6 months to 2 years after surgery
may have important clinical relevance.
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