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P. Fournie, G. M. Gordon, H. F. Edelhauser, D. G. Dawson, M. E. Fini; Matrix Metalloproteinase Expression in Post-LASIK Corneas. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1957.
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Laser-assisted in situ keratomileusis (LASIK) represents a particular model of healing with a possible enzymatic role played by the matrix metalloproteinases (MMPs) in the physiopathology of the post-LASIK corneal ectasia. In general, MMP expression follows the time course of corneal healing. We investigated the hypothesis that MMPs are expressed long-term in post-LASIK corneas implying a long-term remodeling.
Eighteen postmortem corneas from 10 patients with postoperative intervals of 2 to 8 years after LASIK surgery were collected from various eye banks in the United States. The specimens were processed for conventional histologic analysis and immunofluorescence with antibodies to MMPs (MMP-1, -2, -3, -7, -8, -9, -10, and -14), laminin, α-smooth muscle actin (α-SMA), tryptase, and CD11b. The pathologic changes were evaluated in 4 regions: the LASIK flap wound margin, the stroma in the LASIK flap, the paracentral and central lamellar wound regions, and the residual stromal bed.
Some corneas expressed MMPs at the wound margin, although the degree and type of staining varied greatly. No MMP expression was observed at the paracentral and central lamellar wound regions. α-SMA was present in the wound margin scar in 4- and 6-year-old LASIK wounds. There was no observable correlation between postoperative interval and the severity or type of MMP activity. The severity and type of MMP expression were correlated with some histopathologic findings at the wound margin: focal area of epithelial hyperplasia, variable amounts of epithelial ingrowth into the lamellar wound, and variability in the alignment of the cut end of Bowman’s layer.
Long-term MMP expression in post-LASIK corneas is a surprising finding. MMP expression at the wound margin of uneventful LASIK reflects an ongoing wound healing process and can affect post-LASIK cornea stability. This long-term remodeling in successful LASIK may move us toward a better understanding of progressive post-LASIK keratectasia.
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