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V. Casamenti, S. Benedetti; In Vivo Confocal Microscopy After Lasik: 1-year Follow-up . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2663.
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Purpose: To determine corneal flap thickness and to evaluate flap interface 4 to 12 months after lasik using in vivo confocal microscopy. Methods: 40 eyes of 20 patients were examined before and after lasik with a planned 160 µm flap and 9.5 mm flap diameter (Chiron Hansatome microkeratome) to correct refractive errors between –6D and –11D. Confocal microscopy (Confoscan 2.0, Nidek Technologies) was performed under topical anaesthesia before, 4 and 12 months after lasik: measurements of corneal thickness (CT), stromal thickness (ST) and flap thickness (FP) were effected. Results: The z-axis distance between intensity peaks emanating from superficial epithelium and flap interface was used to calculate flap thickness. The mean flap thickness was 130 15 microns (range 96 - 159) at 4 months; average corneal flap thickness using the Hansatome microkeratome was thinner than expected. Abnormal microfolds under the basal epithelial cell layer and highly reflective particles of variable size and shape in the flap interface were evidenced in all patients. Posterior stroma and endothelium of corneas appeared unchanged; only one eye showed abnormal reflective rod-like bodies, with bright punctate inclusions, in the stroma posterior to the flap interface. At 1 year postoperatively, microfolds and reflective particles in the interface were reduced and the z-scan showed lower intensity peaks corresponding to anterior stroma and flap interface. No significant change in stromal thickness and flap thickness between 4 and 12 months was observed. Conclusion: Confocal microscopy is a useful and non-invasive method to measure corneal flap thickness and to evaluate flap interface; although changes in total stroma thickness were not significant between 4 and 12 months, stromal remodeling was demonstrated by reduction of microfolds and flap interface debris.
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