title: Immunohistological evaluation of the healing response at the flap interface in patients with LASIK ectasia requiring penetrating keratoplasty.
abstract: To evaluate the healing response at the flap interface in corneas with LASIK ectasia that required penetrating keratoplasty (PK).
  
  
  
  Corneas of five patients who developed corneal ectasia after LASIK (range: 2.5 to 5 years postoperative) were collected after corneal transplant surgery. The corneas were bisected and processed for conventional histologic analysis and immunofluorescence.
  
  
  
  Light microscopy showed a hypocellular fibrotic scar at the wound margin compared with the adjacent corneal stroma in all eyes. All corneas had positive staining for alpha-smooth muscle actin (SMA), a myofibroblast marker. In one eye, alpha-SMA cells were located in the fibrotic scar region in the area of the semicircular ring of haze along the margin of the LASIK flap corresponding to an area of epithelial ingrowth. In all other eyes, alpha-SMA positive cells were fewer and mainly located in the superficial stroma under the epithelial wound margin surface. Type III collagen was minimal or absent in the central zone and wound margin of all corneas except for the cornea with epithelial ingrowth present in the hypercellular fibrotic scar region. Chondroitin sulfate was stronger in the periphery of the flap wound coinciding with a higher presence of alpha-SMA-positive cells in that region. Positive staining for matrix metalloproteinase 9 (MMP-9) in the paracentral wound margin scar was seen.
  
  
  
  A wound-healing process characterized by absence of significant fibrosis and myofibroblasts at the wound edge in the flap interface was noted in all keratectatic eyes. However, changes in the composition of collagen and the presence of MMP-9 at the wound edge several years after LASIK indicates active wound remodeling that may explain the ongoing loss of tissue and tendency of the cornea to bulge.
authors.affiliation: Department of Ophthalmology, LSU Eye and Neuroscience Center, Louisiana State University Health Sciences Center, New Orleans 70112, USA. sesque@lsuhsc.edu
authors.forename: Salomon
authors.initials: S
authors.lastname: Esquenazi
authors.forename: Isi
authors.initials: I
authors.lastname: Esquenazi
authors.forename: Lev
authors.initials: L
authors.lastname: Grunstein
authors.forename: Juicheng
authors.initials: J
authors.lastname: He
authors.forename: Haydee
authors.initials: H
authors.lastname: Bazan
mesh_terms: D000199:Actins / Q000378:metabolism; D000328:Adult; D002809:Chondroitin Sulfates / Q000378:metabolism; D024061:Collagen Type III / Q000378:metabolism; D003316:Corneal Diseases / Q000209:etiology* / Q000378:metabolism / Q000601:surgery*; D003319:Corneal Stroma / Q000378:metabolism* / Q000601:surgery; D019781:Corneal Topography; D004108:Dilatation, Pathologic / Q000209:etiology / Q000378:metabolism / Q000601:surgery; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007632:Keratan Sulfate / Q000378:metabolism; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D015948:Keratoplasty, Penetrating; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008856:Microscopy, Fluorescence; D013524:Surgical Flaps; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000199:Actins; D024061:Collagen Type III; D002809:Chondroitin Sulfates; D007632:Keratan Sulfate; D020780:Matrix Metalloproteinase 9