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Reduced Keratocyte Loss after Laser Epithelial Keratomileusis (LASEK) in Comparison to Photorefractive Keratectomy (PRK) in Rabbits
1Wissing S., 1Laube T., 2Theiss C., 1Brockmann C., 3Steuhl K. P., 1Meller D.,
1Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde (Essen)
2Ruhr-Universität Bochum, Abteilung für Zytologie (Bochum)
3Universität-Gesamthochschule Essen, Zentrum für Augenheilkunde, Abt. für Erkrankungen des vorderen Augenabschnitts (Essen)
Purpose: To compare corneal wound healing with special regard to keratocyte loss in corneal stroma after LASEK and conventional PRK in rabbits.
Methods: LASEK and PRK were performed in rabbits and studied after 1, 3, 10 and 20 days (each group n=2-5). In all eyes the corneal epithelium was weakened with 30% ethanol for 3.5 min. Excimer photoablation was performed unilaterally with a 6.0mm ablation zone and 80 µm depth equivalent to -6.0 dpt using the SUMMIT APEX PLUS laser with photorefractive keratectomy (PRK) mode. Keratocyte loss was analyzed using a DNA fragmentation detecting TUNEL assay. TUNEL positive keratocytes were counted in 4 different high power fields.
Results: One day after LASEK, eyes showed minor epithelial defects, whereas PRK treated eyes developed a distinct wound. In general, corneal wound healing occurred faster after LASEK than PRK. After 10 days a smooth, stable and optically transparent cornea was documented in all eyes. Numerous TUNEL positive keratocytes predominantely located in the anterior corneal stroma were noted 1 day after PRK which diminished distinctively after 3 days. LASEK treated eyes revealed significant less TUNEL positive keratocytes at these time points and showed a delayed transient increase of TUNEL positive cells 3 days after laser photoablation. At 10 days, the number of TUNEL positive keratocytes decreased in both surgical groups but remained significantly higher after PRK than LASEK. At 20 days the number of TUNEL positive cells remained in both surgical groups in their mean below that of the first day counts, with identical numbers in LASEK and PRK.
Conclusions: LASEK does induce significantly less keratocyte loss than PRK and supports wound healing in the acute phase after laser photoablation. LASEK might offer the possibility to treat higher myopia with reduced risk of developing complications as known to occur in PRK.