Laser in situ keratomileusis flap margin: wound healing and complications imaged by in vivo confocal microscopy - 05/09/11
, W.Matthew Petroll, PhD b, Juan J Pérez-Santonja, MD, PhD c, Tuuli U Valle, MD, PhD a, Jorge L Alió, MD, PhD c, Timo M.T Tervo, MD, PhD aAbstract |
PURPOSE: To examine the healing response of laser in situ keratomileusis flap margin in vivo.
METHODS: Forty-three eyes of 43 patients who had undergone myopic (n = 39) or hyperopic (n = 4) laser in situ keratomileusis were examined once after surgery. The flap margin was imaged by in vivo confocal microscopy at various depths, and the wound healing response, flap alignment, and complications were evaluated. Ten eyes were examined on day 3 postoperatively, 13 eyes at 1 to 2 weeks, 10 eyes at 1 to 2 months, five eyes at 3 months, and five eyes at 6 months or later.
RESULTS: At 3 days after laser in situ keratomileusis, the surface epithelium and basal epithelium appeared normal. Keratocyte activation was strongest at 1 to 2 weeks and 1 to 2 months, and an increased amount of haze was observed correspondingly. Intrastromal epithelial cells forming a plug could occasionally be perceived in the wound gape. Wound constriction was completed in most cases by 3 to 6 months or later. Good alignment was observed in 12 of 43 flaps (27.9%) and moderate and poor alignment in 17 of 43 flaps (39.5%) and 13 of 43 flaps (30.2%), respectively. Poor alignment was not associated with lamellar epithelial ingrowth. Epithelial ingrowth was associated with dense haze at the interface. Diffuse lamellar keratitis was imaged in two corneas after hyperopic laser in situ keratomileusis.
CONCLUSIONS: The laser in situ keratomileusis incision wound at the flap margin appears to heal after the sequence observed in incisional wounds in nonhuman primates. Complications, such as lamellar epithelial in growth and diffuse lamellar keratitis, were often observed, particularly after hyperopic laser in situ keratomileusis.
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 | This work was supported by the Instrumentarium Scientific Foundation, Helsinki, Finland; (Drs Vesaluoma, Valle, and Tervo), Alicante Institute of Ophthalmology, Alicante, Spain (Drs Vesaluoma, Valle, and Petroll), Finnish Medical Council, Helsinki, Finland, (Drs Tervo and Petroll), Helsinki University Central Hospital, Helsinki, Finland, (Drs Tervo and Vesaluoma), Finnish Eye and Tissue Bank Foundation, Helsinki, Finland, (Dr Vesaluoma), Finnish Eye Foundation, Helsinki, Finland, (Drs Vesaluoma and Tervo), Mary and Georg C. Ehrnrooth Foundation, Helsinki, Finland, (Dr Vesaluoma), Ella and Georg Ehrnrooth Foundation, Helsinki, Finland, (Dr Vesaluoma), The Friends of the Blind, Helsinki, Finland (Dr Tervo). |
Vol 130 - N° 5
P. 564-573 - novembre 2000 Retour au numéro
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