Stroma remodelling during healing of corneal surface irregularities induced by PTK

Predictability of the Achieved Lenticule Thickness in Keratorefractive Lenticule Extraction for Myopia Correction

PURPOSE

To assess the predictability between the SCHWIND ATOS femtosecond laser (SCHWIND eye-tech-solutions) read-out and achieved lenticule thickness measured using MS-39 anterior segment optical coherence tomography (ASOCT; CSO) at the corneal vertex at postoperative 1 day and 1 and 3 months of follow-up.

METHODS

This retrospective case series included 130 eyes of 65 consecutive patients who were treated with SmartSight (SCHWIND eye-tech-solutions) lenticule extraction. Sixty-four percent of patients were women with a mean spherical refraction of -4.98 ± 1.19 diopters (D) and mean astigmatism of 0.53 ± 0.64 D. The measurements were performed using AS-OCT with the Phoenix Software v 4.1.1.5. Lenticule thickness was obtained by the subtraction method between preoperative and postoperative total corneal thickness.

RESULTS

A lower reduction in central corneal thickness (CCT) compared to the laser read-out for all three follow-up visits can be observed. Essentially, the reduction in CCT was identical at 3 months versus 1 month. The reduction in CCT was lowest at postoperative 1 day. Examining the 1- and 3-month data (essentially equivalent), one can see a best fit of y = 0.94 x -7 µm.

CONCLUSIONS

The reduction in CCT was stable from 1 month of follow-up. The stable reduction in CCT was -6% (-1.5% after accounting for design decisions) and -7 µm lower than the respective laser read-out. The findings are predictable, showing a certain level of the lenticules becoming slightly thinner than their respective laser read-outs. [J Refract Surg. 2023;39(11):728-735.].

Spectral OCT with speckle contrast reduction for evaluation of the healing process after PRK and transepithelial PRK

We evaluate Spectral OCT (SOCT) with a speckle contrast reduction technique using resonant scanner for assessment of corneal surface changes after excimer laser photorefractive keratectomy (PRK) and we compare healing process between conventional PRK and transepithelial PRK. The measurements were performed before and after the surgery. Obtained results show that SOCT with a resonant scanner speckle contrast reduction is capable of providing information regarding the healing process after PRK. The main difference between the healing processes of PRK and TransPRK, assessed by SOCT, was the time to cover the stroma with epithelium, which was shorter in the TransPRK group.

Comparison of laser in situ keratomileusis reoperation outcomes with the Moria M2 head 90 and 130 following previous photorefractive keratectomy or laser in situ keratomileusis

PURPOSE

To compare the Moria Model Two (M2) automated microkeratome with the head 90 (intended to create a 120-microm flap) to the head 130 (intended to create a 160-microm flap) in reoperations following previous photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in terms of accuracy, predictability, safety and complications of the procedure.

METHODS

Eighty-five eyes of 70 consecutive patients received LASIK with the Moria M2 microkeratome. Nine previously PRK-operated eyes were reoperated with the head 90 and 37 eyes were reoperated with the head 130. Repeated LASIK was performed on 16 eyes with the head 90 and on 23 eyes with head the 130. Flap dimensions were measured and correlated to preoperative parameters.

RESULTS

The average flap thickness in the previously PRK-operated eyes was 115.1 microm [range 82-137 microm, standard deviation (SD) 17.9] with the head 90 and 131.2 microm (range 105-171 microm, SD 19.8) with the head 130. In the previously LASIK-operated eyes, the mean flap thickness was 139.2 microm (range 92-182 microm, SD 23.8) with the head 90 and 141.9 microm (range 109-179 microm, SD 15.2) with the head 130. There were no free or incomplete flaps or flaps with buttonholes in the study. There was no statistically significant difference in postoperative uncorrected visual acuity (UCVA) between the groups.

CONCLUSION

In eyes with previous PRK or LASIK, LASIK reoperation offers a safe alternative for improving refractive outcomes. The Moria M2 head 90, especially in LASIK-operated eyes, does not cut thinner flaps compared to the head 130.

Role of epidermal growth factor receptor (EGFR) in corneal remodelling in diabetes

PURPOSE

This study examined the role of epidermal growth factor receptor (EGFR) signalling on the organization and remodelling of collagen fibrils (CFs) and proteoglycans (PGs) in the stroma of diabetic rat cornea.

METHODS

Diabetes was induced in female Wistar rats (n = 5) by streptozotocin (STZ) injection (55 mg/kg). Treatment with a selective inhibitor of EGFR tyrosine kinase, AG1478, was started on the same day as the induction of diabetes and administered every other day for 4 weeks. Corneas were fixed in 4% paraformaldehyde at 4 degrees to allow for analysis of CF diameters and in 2.5% glutaraldehyde in sodium acetate buffer containing cuprolinic blue to enable the study of PG distribution. AnalySIS soft imaging software was used to analyse CFs and PGs.

RESULTS

Epithelial thickness, and median diameter and area fraction of CF in corneal stroma were decreased in diabetic rat cornea compared with normal cornea (p < 0.001), whereas the median PG area and area fractions were significantly increased (p < 0.001). Treatment with AG1478, although it had no action on normal cornea, prevented these diameter and area fraction changes in CFs and PGs. The cornea of AG1478-treated diabetic rats showed a slight increase in CF diameter and area fraction and a decreased number density.

CONCLUSIONS

These data show that the distribution of corneal stroma CFs and PGs was altered after 4 weeks of diabetes and that, furthermore, treatment with an EGFR signalling inhibitor normalized these abnormalities. The data suggest that EGFR plays an important role in the development of diabetes-induced corneal remodelling.