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M. Woodward, P. Larson, J. Randleman; Confocal Microscopy Findings in Keratoectasia after Laser In Situ Keratomileusis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5351.
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To compare the corneal confocal microscopy findings in eyes with and without corneal ectasia after laser in situ keratomileusis (LASIK).
Five eyes with corneal ectasia after LASIK (ectasia cases) and five eyes with LASIK without complication (controls) were imaged with the Nidek Technologies Confoscan 3.0. Confocal images were generated using "multiscanning" technique and digital imaging. Using confocal images, corneal thickness, flap thickness, and residual stromal bed thickness (RSB) was measured. Keratocyte density was examined at three distinct corneal layers: anterior stroma (anterior to the LASIK flap), mid-stroma (posterior to the LASIK flap), and posterior stroma (immediately anterior to the endothelium).
There were no significant differences between ectasia cases and controls in corneal thickness (406 vs.448, p = 0.3), flap thickness (118 vs. 106, p = 0.3), or RSB (288 vs. 339, p = 0.2). Compared to controls, ectasia cases had 16% less anterior stromal keratocyte density (p = 0.3), 40% less mid-stromal keratocyte density (p = 0.05), and 49% less posterior stromal keratocyte density (p = 0.0003).
Keratocyte density was significantly less posterior to the corneal flap in eyes with corneal ectasia after LASIK. Premature or accelerated loss of posterior keratocytes may contribute to the development of postoperative corneal ectasia.
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