[Is there a future for the Excimer laser in refractive surgery?].

The refractive surgery concerns all the surgical procedures implicated in the refractive power change of the cornea. Its clinical results are just known, and a new physical procedure is becoming capable to replace surgery: the Excimer laser. Without any instrumental contact with the corneal surface, the laser beam is able to remodel the corneal tissue, and to treat astigmatism, myopia, hypermetropia. Millions of people could be treated by such a laser, and could leave their glasses. Biological effects on rabbit and monkeys are presented. An argon fluoride excimer laser (193 nm) with a moving slit delivery system was used to perform anterior myopic keratomileusis in both eyes of 37 rabbits and 15 monkeys. Histological analysis of the corneas was made after ablation and at intervals up to 20 months. By slit examination at the longer follow up time, 60% of treated rabbits and 40% of treated monkeys keep a clear cornea, but the others had central spotty subepithelial haze. Light and electron microscopy documented corneal healing. In the clear corneas a good reconstitution of the epithelium, its basal lamina was observed, and anterior stromal corneas contained few active fibrocytes with a good preservation of the connective lamellar structure. On the contrary, in the cornea with opacification focal areas of 20 microns thick subepithelial scarring were present and the interface between epithelial cells and anterior stroma remained disturbed by incomplete, disrupted or duplicated basal lamina. Differences between the responses of monkeys, rabbits corneas to the same photoablation procedure remain unclear.(ABSTRACT TRUNCATED AT 250 WORDS)