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Optical Coherence Tomography (OCT) for the Detection of Laser in Situ Keratomileusis (LASIK) in Organ Cultured Donor Corneas
1Neubauer A. S., 1Priglinger S., 2May C.-A., 3Ludwig K., 1Welge-Lüßen U.,
1Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Augenklinik (München)
2Friedrich-Alexander-Universität Erlangen-Nürnberg, Anatomisches Institut LS II (Erlangen)
3Augenklinik der Ludwig-Maximilians-Universität München (München)
Purpose: In the year 2000, more than one million laser in situ keratomileusis (LASIK) procedures have been performed worldwide. Considering the long term collective accumulation of individuals who will have undergone refractive procedures, eye banks will be increasingly confronted with the problem of how to identify those donors with prior refractive surgery. Until now, efficient screening methods to identify excimer laser vision correction surgery in donor eyes have not been established. Thus the purpose of the present study is to determine if Optical Coherence Tomography (OCT) can be utilized to detect the presence of LASIK - induced changes in human corneas.
Methods: LASIK was performed on 20 organ cultured human cornea discs. The excimer laser ablation performed ranged from 0 - 12 diopters. The corneas were maintained in culture, and structural changes were measured with OCT on day 1, 2, 7, 14 and 1, 2, 4, and 6 months after the LASIK procedure. Detectibility of the flap-stroma interface was quantified. The treated corneas were investigated with light and transmission electron microscopy plus immunohistochemical staining for collagen type III, laminin and fibronectin.
Results: OCT scans resolved the interface between the corneal flap and the residual stromal tissue in all corneas and at all time intervals. Ultrastructural investigations in the peripheral area of the cornea revealed a disarrangement of collagen fibers indicating scar formation. Such findings were not observed in the central area. Immunohistochemical investigations showed staining for fibronectin and collagen type III over the entire stromal incision interface, whereas laminin staining was related to the ingrowth of epithelial cells.
Conclusions: In this organ culture model, morphological changes following LASIK seem to simulate the in vivo situation. Thus OCT examination of corneoscleral disc may be an applicable technique for eye banks to screen potential keratoplasty donors in order to detect prior LASIK surgery.