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Hyperopic PRK and LASIK in Rabbits - an Electron Microscopic Study

Hammer T.,
Martin-Luther-Universität, Klinik und Poliklinik für Augenheilkunde (Halle/Saale)

Background: Purpose of this study was to investigate different postoperative medical regimens after refractive surgery in comparison to the scarring reaction in the anteror corneal stroma of PRK -eyes and the interface reactions of LASIK -eyes.
Method: 72 corneal buttons treated either by PRK or by LASIK were investigated with morphological and immunohistochemical methods using transmission electron microscopy. After the hyperopic PRK and LASIK different postoperative eye drop therapies were applied.
Results: Interdigitations between the epithelial cell layer and the anterior corneal stroma , basal membrane defects and duplications were visible in PRK eyes under a considerably thick epithelial cell layer. Only minor changes in the region between the epithelial cell layer and the corneal stroma could be seen in eyes treated by hyperopic LASIK. However, deposits of fibrillar extracellular matrix components were detectable in the interface of the lamellar cut.
Conclusions: The clinically important problem of corneal scars and haze after PRK treatment is caused by the interdigitations between the epithelial cell layers and the anterior corneal stroma. Not all degrees of corneal opacities that can be seen at the slit lamp are clearly detectable by means of electron microscopy. Corneal opacities may also be the consequence of a slightly irregular collagen fibre arrangement. Eyes that were treated with corticosteroids postoperatively showed minor reactions between the epithelial cell layer and the anterior stroma. The delicate wound healing reactions within the interface produced by LASIK procedures corresponded nicely to the clinically visible minor reactions in these corneas.

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