[Immunohistochemical and clinical studies on sub-corneal flap epithelial implantation accompanied by flap melting after excimer laser in situ keratomileusis].
OBJECTIVE
To study the immunohistochemical and clinical characteristics of the corneal epithelial cells implanted under the flap accompanied by the flap melting after excimer laser in situ keratomileusis (LASIK) and the method of management.


METHODS
In eight eyes (In 4 eyes a part of the flap melted.) with corneal epithelial cells implanted under the flap after LASIK, the corneal flap was torn again. The implanted tissue was removed. After washing between the interfaces, the flap was repositioned. The implanted tissue was immunohistochemically stained by using four kinds of monoclonal antibodies and using terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling (TUNEL) method.


RESULTS
Early in the course, the disorder appeared on the temporal side, expanded and thickened. The defective periphery of the corneal flap presented as a partial lunar eclipse. The melting process was self-limited in 3 months. The result was good after the implanted tissue was removed. The implanted material was stained by using HE, immunohistochemical and TUNEL methods. Some vesicle-like degeneration in the implanted layer was found. There was lysozyme in the vesicles, and the cells of implanted layer possessed a trend of apoptosis. All the cells were dead in the vesicles.


CONCLUSIONS
The progress of corneal epithelial implantation under corneal flap after LASIK may include 3 periods: epithelial implantation, corneal flap melting and self-limitation. Early in the course, the implanted material presented as a thin film. Afterwards, it becomes a non-structural material. Possibly the melting of the corneal flap is caused by apoptosis. Therefore, the implanted epithelium should be removed early.
Du
Z
Z
Ophthalmic Center, The Second Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing 400010, China.
Guo
H
H
Zheng
Q
Q
D000328:Adult; D017209:Apoptosis; D003318:Corneal Opacity / Q000473:pathology / Q000601:surgery*; D019938:Cyclin D1 / Q000032:analysis; D019573:Epithelium, Corneal / Q000737:chemistry / Q000473:pathology / Q000637:transplantation*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D008297:Male; D009113:Muramidase / Q000032:analysis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D013524:Surgical Flaps; D014792:Visual Acuity
D019253:Proto-Oncogene Proteins c-bcl-2; D019938:Cyclin D1; D009113:Muramidase