title: Corneal cell response after flap creation using a mechanical microkeratome or a 200 kHz femtosecond laser.
abstract: OBJECTIVE
  To compare the inflammatory cell response within the corneal flap interface created by a mechanical microkeratome and a femtosecond laser.
  
  
  METHODS
  Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
  
  
  METHODS
  Experimental in vitro study.
  
  
  METHODS
  Corneoscleral buttons of 12 enucleated human eyes not suitable for transplantation were put into organ culture. Corneal flaps were created using a 200 kHz femtosecond laser (Visumax) (femtosecond group) or a mechanical microkeratome (Amadeus) (microkeratome group). Flaps were not lifted after treatment. In 2 corneas, no treatment was performed (control group). Corneas were kept in organ culture for 12 hours thereafter. To evaluate cell-mediated immune reaction, immunofluorescent staining for leucocytes (cluster of differentiation 45) and specifically for dendritic cells (human leukocyte antigen-DR) was performed in every group. A terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was used to determine apoptosis reaction.
  
  
  RESULTS
  The ratio of dendritic cells in the femtosecond group compared with the microkeratome group was 1.2 (P=.02), the ratio of leucocytes was 1.4 (P=.06), and the ratio of apoptotic cells was 1.0 (P=.59). There was no marked significant difference in the distribution of inflammatory cell reaction. The control group showed neither specific inflammatory reaction nor apoptosis.
  
  
  CONCLUSIONS
  This in vitro series of human corneas showed similar inflammatory tissue reaction after femtosecond laser-assisted and microkeratome-assisted flap creation (P<.05).
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. wolfgang.j.mayer@med.uni-muenchen.de
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Mayer
authors.forename: Martin
authors.initials: M
authors.lastname: Grueterich
authors.forename: Armin H
authors.initials: AH
authors.lastname: Wolf
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Lackerbauer
authors.forename: Kirsten
authors.initials: K
authors.lastname: Eibl
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
authors.forename: Daniel
authors.initials: D
authors.lastname: Kook
mesh_terms: D000938:Antigen-Presenting Cells / Q000276:immunology*; D017209:Apoptosis; D060527:Corneal Keratocytes / Q000276:immunology*; D003319:Corneal Stroma / Q000601:surgery; D003713:Dendritic Cells / Q000276:immunology; D019084:Fluorescent Antibody Technique, Indirect; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology*; D007074:Immunoglobulin G / Q000378:metabolism; D020287:In Situ Nick-End Labeling; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer; D017493:Leukocyte Common Antigens / Q000378:metabolism; D007962:Leukocytes / Q000276:immunology; D013508:Ophthalmologic Surgical Procedures; D009924:Organ Culture Techniques; D013524:Surgical Flaps; D014019:Tissue Donors
chemical_list: D006684:HLA-DR Antigens; D007074:Immunoglobulin G; D017493:Leukocyte Common Antigens; C516769:PTPRC protein, human