PubMed · 8784638
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O Gris, J L Güell, A Muller. 1996. Keratomileusis update.. https://doi.org/10.1016/s0886-3350(96)80021-6
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The aim of this study was to examine the corneal surface structures with a new investigative method, the atomic force microscope following 193 nm excimer laser photoablation. Fresh human corneas were irradiated in vitro with an increasing number of impulses emitted by a 193 nm ArF laboratory excimer laser in order to produce either smooth flat surfaces or stair-like formations within the cornea. The corneas were investigated in a Topometrix(R) atomic force microscope in their native state. For comparison, three corneas were fixed with glutaraldehyde and processed for scanning electron microscopy. Atomic force microscopy and scanning electron microscopy revealed the same surface characteristics of photoablated corneas, though the preparation for scanning electron microscopy induced considerable shrinkage of the tissues. The layers of the cornea could be distinguished from each other and deeper ablations of the stroma produced a rougher surface. On the lateral walls of ablated stairs small droplets of ejected material could be seen with scanning electron microscope. Atomic force microscope produces three-dimensional images of the scanned native corneal surfaces and it could be a valuable tool to investigate the corneal smoothness. Our investigations have provided similar results as those obtained with scanning electron microscopy showing that the laser-ablated corneal surface remains relatively smooth. We suggest that the formation of condense droplets of ejected materials is based on hydrodynamic motions induced by boiling water solutions.
We report an unusual flap-related complication that occurred 11 months after uneventful laser in situ keratomileusis (LASIK) performed in the eye of a 50-year-old woman. She developed partial infolding of the LASIK flap in her left eye after blunt trauma. The initial diagnosis was partial flap loss and 4 weeks later, infolding of the flap was diagnosed after severe epithelial ingrowth. Surgical repositioning of the flap resulted in a best corrected visual acuity of 20/20. Clinical features that assist in the diagnosis of this unusual complication and guidelines for its management are described.