title: Adhesion of laser in situ keratomileusis-like flaps in the cornea: Effects of crosslinking, stromal fibroblasts, and cytokine treatment.
abstract: OBJECTIVE
  To evaluate 3 approaches, both cellular and acellular, to improve the healing of laser in situ keratomileusis flaps in bovine corneas.
  
  
  METHODS
  School of Optometry and Vision Sciences and Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, United Kingdom.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Laser in situ keratomileusis-like flaps were created in bovine corneas, and the flap bed was treated with tumor necrosis factor-α, interleukin-1α, Fas ligand, transforming growth factor-β(1), or activated stromal fibroblasts. In separate experiments, flaps were created and repositioned. The corneas were then crosslinked using ultraviolet-A (UVA) light. All samples were then placed in organ culture for up to 4 weeks. Untreated samples acted as controls.
  
  
  RESULTS
  All treatments increased the adherence of the stromal flap. This was achieved at the expense of corneal clarity except in the case of crosslinking (CXL). In this case, the flap adhesion force immediately increased while the cornea remained clear. The force then decreased gradually during organ culture, although it remained at twice the level of the control corneas after 3 weeks in culture.
  
  
  CONCLUSIONS
  The results suggest that riboflavin-UVA CXL is a hopeful approach for increasing the adherence strength of corneal flaps while keeping the cornea clear. Further studies are necessary to confirm the durability of the strengthening effect and to exclude serious late complications.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University,Cardiff, United Kingdom.
authors.forename: Shengli
authors.initials: S
authors.lastname: Mi
authors.forename: Erin P
authors.initials: EP
authors.lastname: Dooley
authors.forename: Julie
authors.initials: J
authors.lastname: Albon
authors.forename: Michael E
authors.initials: ME
authors.lastname: Boulton
authors.forename: Keith M
authors.initials: KM
authors.lastname: Meek
authors.forename: Christina S
authors.initials: CS
authors.lastname: Kamma-Lorger
mesh_terms: D000818:Animals; D002417:Cattle; D002452:Cell Count; D003315:Cornea / Q000187:drug effects / Q000502:physiology* / Q000601:surgery; D003319:Corneal Stroma / Q000166:cytology; D003432:Cross-Linking Reagents / Q000494:pharmacology*; D016207:Cytokines / Q000494:pharmacology*; D053222:Fas Ligand Protein / Q000494:pharmacology; D005347:Fibroblasts / Q000502:physiology*; D007150:Immunohistochemistry; D053582:Interleukin-1alpha / Q000494:pharmacology; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer; D008954:Models, Biological; D009924:Organ Culture Techniques; D017319:Photosensitizing Agents / Q000494:pharmacology; D013524:Surgical Flaps; D000267:Tissue Adhesions; D053773:Transforming Growth Factor beta1 / Q000494:pharmacology; D014409:Tumor Necrosis Factor-alpha / Q000494:pharmacology; D014466:Ultraviolet Rays; D014945:Wound Healing / Q000502:physiology*
chemical_list: D003432:Cross-Linking Reagents; D016207:Cytokines; D053222:Fas Ligand Protein; D053582:Interleukin-1alpha; D017319:Photosensitizing Agents; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha