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I. Schmack, W. Gao, D. G. Dawson, H. E. Grossniklaus, H. F. Edelhauser; Histopathology and Immunohistology of Corneal Wound Healing in Humans following Laser in situ Keratomileusis (LASIK). Invest. Ophthalmol. Vis. Sci. 2007;48(13):3485.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate long term changes in corneal wound healing following laser in situ keratomileusis (LASIK) using routine light and confocal scanning laser microscopy.
Thirteen human eye bank corneas from 13 donors (mean±SD: 53.0±9.2 yrs; range 30-70 yrs) with previous LASIK (mean±SD: 4.1±1.9 yrs; range 0.75-7.0 yrs post-op) were studied. Tissue samples were bisected, formalin-fixed and embedded in paraffin according to standard protocols. Six microns thick sections were cut, stained for hematoxylin and eosin (H&E), and periodic acid Schiff (PAS), or were incubated with monoclonal anti-human cellular fibronectin (FN) IgG1 antibody or biotinylated hyaluronic acid binding protein (HABP). Immunoreactivity was detected using FITC conjugated goat anti-mouse IgG (FN) or avidin-horseradish-peroxidase method (HABP). Sections were evaluated for histopathologic and immunohistologic findings at the peripheral (flap margin) and central/paracentral LASIK interface wound by light and confocal scanning laser microscopy.
LASIK corneas showed 3 histopathologic types of corneal wound healing: epithelial cell modifications (basal cell hypertrophy, hyperplasia), production of a hypercellular fibrotic (flap margin) and a hypocellular primitive stromal scar (central/paracentral interface). LASIK flap thickness measured on average 133.8±15.0µm (range 120 to 160µm). Immunohistochemistry revealed FN in the hypercellular peripheral scar (n=10; flap margin) up to 7 years post-LASIK. A faint signal (FN) was also detected in the central/paracentral interface wound (n=4) in LASIK corneas with thin flaps (≤120µm). Immunostaining for HA was positive at the corneal endothelium and occasionally in subepithelial areas at the flap margin, but negative in the LASIK interface wound and corneal stroma.
Corneal injury following LASIK results in formation of a hypercellular, fibrotic (flap margin) and a hypocellular, primitive scar(central/paracentral interface). Long-lasting expression of extracellular matrix proteins usually involved in corneal wound healing (i.e. fibronectin) appears to reflect a highly coordinated, bi-directional communication between corneal epithelial cells and stromal keratocytes and may contribute to a more pronounced wound healing response at the LASIK flap margin.
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