Assessment of Corneal Wound Healing by Interactive Topography

Response of the Cornea for up to Four Years After Photorefractive Keratectomy for Myopia

PURPOSE

To analyze the long-term corneal topographic changes 4 years after myopic photorefractive keratectomy (PRK).

METHODS

This study comprised 15 patients (30 eyes) who had PRK surgery with a scanning-spot excimer laser (Chiron Technolas 217C; Bausch & Lomb, Dornach, Germany) and were followed up to 4 years after surgery. The eyes were subdivided into three groups according to the preoperative spherical equivalent refraction. Corneal topographic maps were obtained for all eyes with a Placido disc topographer. Preoperative and follow-up topographical data were imported into a custom software program, which computed the average composite corneal maps and difference maps for each study group to quantify the anterior corneal changes following laser ablation. The software delineated three concentric zones of the corneal surface to characterize the regional corneal remodeling following the surgery.

RESULTS

A significant central corneal steepening (approximately 0.25 D, P < .001) was calculated between the 1- and 4-year postoperative maps in all study groups. A significant steepening (P < .001) of the corneal periphery was also noted for the lower myopic ablations whereas a peripheral flattening (P < .001) was observed for the deeper ablations between 1 and 4 years after surgery.

CONCLUSIONS

The anterior corneal surface was observed to remodel for up to 4 years after surface ablation, steepening a mean of approximately 0.25 D.

Theoretical Elastic Response of the Cornea to Refractive Surgery: Risk Factors for Keratectasia

PURPOSE

To explore the role that mechanical elastic factors may have in post-refractive surgery corneal phenomena, from mild curvature changes to keratectasia.

METHODS

The central cornea near the apex was modeled as an elastic spherical thin shell loaded by the intraocular pressure (IOP). Equations for myopic laser in situ keratomileusis (LASIK) were obtained to estimate shifts and curvature changes of the posterior corneal surface at the apex. The effect of every parameter was studied, identifying potential risk factors for ectasia.

RESULTS

Theoretically, corneal thinning by ablation will produce an elastic deformation of the posterior surface that depends on the corneal parameters (curvature, Young's modulus, Poisson ratio, and thickness), the IOP, and the ablation profile. In particular, a forward shift and an increase in power of the posterior surface was predicted for myopic LASIK, in agreement with previous experimental findings. These changes rise non-linearly with the attempted correction, and are greater for thinner preoperative corneas, higher IOP smaller Young's modulus, and thicker flaps. Corneas with Young's modulus half the average or less, or thickness <500 microm, may present high risk of ectasia, especially for high IOP and thick flaps.

CONCLUSIONS

Some postoperative effects may be explained in part by elasticity. Research efforts are needed to explain other biomechanical behaviors. The accepted criterion of 250 microm residual bed is insufficient for fine patient screening--depending on the individual ocular parameters, it could be more restrictive. Advances in technology are needed to create a preoperative examination including two-dimensional maps of topography, pachymetry, and Young's modulus.