Benítez MMC, González SY, Capote CA, Cárdenas DT, Noriega MJ

Language: Spanish
References: 9
Page:
PDF size: 283.77 Kb.

ABSTRACT

Objective: To describe the morphological alterations in the stromal scaring and re-inervation by using confocal microscopy in patients operated on with LASIK after radial postkeratotomy of 15 years old evolution.
Methods: A prospective, longitudinal, observational and descriptive study was conducted in 25 patients (50 corneas) operated on by radial keratotomy, with no further complications and re-operated on with Laser in Situ keratomileusis (SHWIND Esiris). The characteristics of the corneal structures and the regeneration of corneal nervous fibers were studied by means of confocal microscopy with Confoscan S4. Summary measures were used.
Results: The stromal scaring was limited on the edge of the flap; there was an increase of the keratocyte activity in the stromal channel during the first weeks of the postoperative period and a decrease of the keratocyte density caused by apoptosis observed up to one year of evolution. Before Lasik, the number of nervous plexuses was normal in more than 80% of the corneas with incisional corneal surgery. In the first 3 postoperative months there was no nervous regeneration; but this process began between 6th and 8th months, with evident alteration of the morphology and quantity of nervous plexuses per field of confocal microscopy a year after surgery.
Conclusion: The evolution of the microscopic characteristics of the cornea, which were studied with microscopy confocal in patients operated on by Lasik after radial keratotomy, was similar to that described in patients who had not undergone this type of surgery. The nervous regeneration began after 6 months when nervous nodes and progressive increase of corneal sensitivity occurred.

REFERENCES

1. Javaloy J, Vidal MT, Ruiz Moreno JM, Alió JL. Microscopía Confocal de la córnea en la cirugía fotorrefractiva. Arch Soc Esp Oftalmol. 2005;80(9):87-99.

2. Azar DT. Cirugía refractiva. 2da ed. España: Elservier; 2008.

3. Erie JC, Patel SV, McLaren JW, Ramirez M, Hodge DO, Maquire LJ, et al. Effect of myopic laser in situ keratomileusis on epithelial and stromal thickness: a confocal microscopy study. Ophthalmology. 2002;109(8):1447-52.

4. Moilanen JA, Holopainen JM, Vesaluoma MH, Tervo TM. Corneal recovery after LASIK for high myopia: a 2-year prospective confocal microscopic study. Br J Ophthalmol. 2008;92(10):1397402.

5. Ivarsen A, Fledelius W, Hjortdal J. Three-Year Changes in Epithelial and Stromal Thickness after PRK or LASIK for High Myopia. Invest Ophthalmol Vis Sci. 2009;50(5):2061-6.

6. Mastropasqua L, Nubile M. Normal Corneal Morphology. En: Mastropasqua L. Confocal Microscopy of the cornea. Italy: University G.D Annungio Slack Incorporating; 2002.

7. Netto AL, Fioravanti GA, Fioravanti TA, Andrade MR. Ceratectomia fotorrefrativa (PRK) com mitomicina C a 0,02% para correção de grau acentuado de astigmatismo hipermetrópico composto secundário a cirurgia de ceratotomia radial. Rev Bras Oftalmol. 2009;62(3):700-5.

8. Moilanen JAO, Holopainen JM, Vesaluoma MH, Tervo TM. Corneal recovery after LASIK for high myopia: a 2-year prospective confocal microscopic study. Br J Ophthalmol. 2008;92:1397402.

9. Pacheco Del Valle C, Baca-Lozano O, Velasco-Ramos R. Reinervación corneal y dinámica de queratocitos posterior a queratoplastía penetrante. Reporte de casos. Rev Mex Oftalmol. 2008;82(4):263-6.