Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Corneal Wound Healing after Laser in situ keratomileusis Flap Lift and Epithelial Abrasion

Bühren J., Kohnen T.
Department of Ophthalmology, Johann-Wolfgang-Goethe-University Frankfurt/Main

Purpose: Epithelial débridement for the treatment of folds and striae after LASIK is discussed controversely because of the potential risk of diffuse lamellar (DLK) or infectious keratitis. The aim of the present case report is to demonstrate the clinical and confocal microscopic findings of wound healing reactions after epithelium débridement and flap lift for the treatment of folds in a thin LASIK flap.
Method: Case report: A 30-year-old female underwent flap lift with deepithelisation because of persistent striae after LASIK. The patient developed stage 2 DLK and dense haze. Three weeks postoperatively, a myopic shift of -2 D was observed. The central cornea showed grade 1-2 haze with a maximum two months after the intervention. Under treatment with topical steroids haze resolved and spherical equivalent returned to baseline within twelve months.
Results: Confocal microscopy showed a loss of the most anterior keratocytes six days after flap relifting and deepithelisation. Subsequently, consecutive stromal repopulation with the appearance of spindle shaped fibroblasts and activated keratocytes was detectable. Two months postoperatively, a maximum of haze tissue was found at the interface level. Twelve months after the flap lift, keratocyte nuclei appeared reflective and somewhat irregular, but cells were quiescent and no haze tissue was detectable.<

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