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November 1990

Corneal Epithelial and Stromal Reactions to Excimer Laser Photorefractive Keratectomy: II. Unpredictable Corneal Cicatrization

Author Affiliations

Boston, Mass

Arch Ophthalmol. 1990;108(11):1540-1541. doi:10.1001/archopht.1990.01070130042025

The recent use of lasers as a surgical tool in ophthalmology has demonstrated the importance of healing to obtain the desired outcome. Since the basic response of wounded tissue is to repair the defect, the surgeon is confronted with a wound and healing phenomenon that alters the biochemistry, morphologic features, and tissue function unpredictably. Clearly, understanding this phenomenon is of utmost importance.

Several studies have shown that the 193-nm argon fluoride excimer laser discretely removes corneal tissue by photoablation without thermal damage to surrounding tissue.1-4 Ultrastructural analysis of the walls of the ablated areas shows damage to the adjacent structures confined to a 60- to 200-nm-wide zone.2 Nonpenetrating incisions reaching within 40 μm of Descemet's membrane result in endothelial cell loss beneath the line of irradiation.1-3 Corneal ridging, epithelial cell damage, stromal swelling, and difficulty in making incisions to predictable depths are reasons for caution in human

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