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Impressum
The effect of the keratome cut on the human cornea
Bühren J., Baumeister M., Wellermann G., Mirshahi A., Kohnen T.
Dept. of Ophthalmology, University of Frankfurt am Main, Theodor-Stern- Kai 7, 60590 Frankfurt am Main
Background: Data on the effect of a single keratome cut on micromorphology
and biomechanics of the human cornea are rare, because in most cases the
preparation of the flap is followed by excimer laser ablation. After the
microkeratome cut in bioptics procedure (microkeratome cut- phakic IOL
implantation- excimer ablation), the effects of the lamellar dissection
can be studied.
Patients and Methods: Four eyes of three patients were examined
with confocal microscopy (Confoscan P4, Tomey) 1 hour, 1 day, 1 week and
1 month after microkeratome cut. Orbscan II-examinations (Bausch&Lomb)
were performed 1 day, 1 week and 1 month postoperatively.
Results: All eyes had normal appearance the first postoperative day. One
hour postoperatively, confocal microscopy showed diffuse epithelial desquamation
and discrete folds in the posterior stroma. The first postoperative day,
the epithelium was normal, but all eyes showed microfolds in the flap
stroma. At the interface, highly reflective debris particles were visible.
One week and one month after the keratome cut the appearance was similar.
Orbscan examinations revealed only discrete changes of elevation of the
anterior surface, whereas the first day postoperatively in all eyes a
mean forward shift of the posterior surface of 87 µm (± 45µm)
could be detected.
Discussion: Confocal microscopic examination showed that microfolds,
which may occur after LASIK, could be detected following a singular microkeratome
cut. The keratome cut has only little effects on the anterior corneal
surface. In contrast, a biomechanic effect resulting in bulging of the
posterior corneal surface is detectable.