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We thank Dr Polack for his interest in our article describing keratocyte loss after removal of the corneal epithelium. Polack attributes all of these changes in the superficial keratocytes to mechanical trauma from the débridement procedure. We disagree with this interpretation. We have found that the keratocyte loss occurs after removal of the epithelium with the excimer laser, in which no mechanical scraping is performed, and we have also demonstrated repeatedly that the mechanical removal of the epithelium under a fluid bath consisting of a corneal preservation medium does not result in the death of the keratocytes. This finding is inconsistent with a simple mechanical explanation.Similarly, Nakayasu1 devised a technique for an atraumatic removal of epithelium from the rat cornea using a gel, and he found that the keratocyte loss still occurred; he therefore concluded that the keratocyte changes were not explained by mechanical trauma.Because
Campos M, Szerenyi K, Lee M, McDonnell JM, Lopez PF, McDonnell PJ. Keratocyte Loss After Corneal Deepithelialization in Primates and Rabbits-Reply. Arch Ophthalmol. 1994;112(12):1509. doi:10.1001/archopht.1994.01090240015004