Corneal Healing after Uncomplicated LASIK and Its Relationship to Refractive Changes: A Six-Month Prospective Confocal Study

PURPOSE. To investigate corneal healing and the factor(s) possibly responsible for refractive changes after laser in situ keratomileusis (LASIK). METHODS. Twenty eyes of 10 patients who underwent LASIK for myopia were examined clinically and by real-time confocal microscopy for 6 months. Epithelial and posterior stromal thicknesses and the thickness of the keratocyte activation zone were measured, and refractive changes were compared with these values. Keratocyte morphology, flap thickness, and subbasal nerve fiber bundle morphology after LASIK were also investigated. RESULTS. No significant change was detected over time in epithelial thickness after LASIK treatment; however, the posterior stromal thickness was found to be significantly higher 1 month after surgery. A slight but statistically significant negative correlation was detected between the thickness of the keratocyte activation zone and the spheroequivalent refraction after LASIK. The subbasal nerve fiber bundle's morphology returned to its preoperative appearance 6 months after LASIK, but in the flap stroma the nerve fiber bundle morphology remained abnormal at 6 months after LASIK surgery. CONCLUSIONS. A weak but significant negative correlation between the thickness of the keratocyte activation zone and spheroequivalent refraction was found after LASIK. The different refractive properties of activated keratocytes may be responsible for the myopic shift after LASIK. Further studies are needed to clarify this hypothesis. (Invest Ophthalmol Vis Sci. 2004;45:1334 -1339) DOI:10.1167/iovs.03-1025 L aser in situ keratomileusis (LASIK) is a relatively new technique for correction of myopia. A hinged flap (consisting of epithelium, Bowman's layer, and anterior stroma) is created first, and the exposed stroma is photoablated after the flap is folded back. Although many studies have been published on the clinical outcome after LASIK, 1-4 relatively few reports address the biological changes associated with the procedure. 10,11 Keratocyte activation was strongest at 1 to 2 weeks and persisted until 3 months after LASIK surgery. 10,13 Neither LASIK nor PRK has been shown superior in efficacy outcomes 14 -16 A recent confocal microscopic study revealed that keratocyte-mediated regrowth of the photoablated stroma was a key biological factor responsible for post-PRK refractive instability in humans treated with PRK. The purpose of this study was to investigate the factor(s) responsible for the refractive changes after LASIK. For this purpose, epithelial thickness, posterior stromal thickness, and the thickness of the keratocyte activation zone were measured by confocal microscopy, and we sought to establish a correlation between refractive changes and these measurements. We also investigated keratocyte morphology, flap thickness, and subbasal nerve fiber bundle morphology after LASIK. METHODS Design This prospective, interventional cohort study was begun after approval was obtained from the LSU Health Sciences Center institutional review board. Each patient gave written informed consent, and the research followed the tenets of the Declaration of Helsinki. Patients Twenty eyes of 10 patients who underwent LASIK for myopia were included in the study. All eyes had normal anterior ocular segments, intraocular pressure (Ͻ20 mm Hg), and fundi. Contact lens wear was discontinued 2 weeks (soft lenses) or 3 weeks (hard lenses) before the LASIK operation. There were six women and four men (mean age, 35.4 Ϯ 8.7 years). All patients were 21years of age or older and had stable refractive errors at least 1 year before the laser procedure. Patients who had undergone reoperation, those with diabetes mellitus or glaucoma, or those using any topical ophthalmic medication were excluded. Patients with corneas thinner than 500 m centrally and/or with a severe systemic disorder that could cause them to miss examinations were also excluded. The average preoperative spheroequivalent refraction was Ϫ5.87 Ϯ 3.45 D (range, Ϫ1.75-11.00 D) and the planned ablation depth was 59.8 Ϯ 27.1 m (range, 16 -110 m). Each patient was examined in the pre-and postoperative period. Preoperative examinaFrom th

In Vitro Synergism of Trifluorothymidine and Ganciclovir against HSV-1

Ganciclovir and trifluorothymidine are clinically approved topical antiherpetic agents for ophthalmic use. Combination therapy against an acyclovir-resistant HSV isolate was able to produce significant synergistic antiviral activity in vitro with half the concentration required if each drug were used separately