Wound healing anomalies after excimer laser photorefractive keratectomy: correlation of clinical outcomes, corneal topography, and confocal microscopy.

PURPOSE

To further the understanding of wound healing anomalies affecting visual function after myopic photorefractive keratectomy (PRK).

METHOD

Analysis of a clinical database of PRK on 133 eyes with myopia of -1.5 to -7.0 D and 43 eyes with myopia of -6.0 to -12.0 D. Visual function was analyzed by subgroups of 1) no topographic anomalies; 2) topographic central islands; and 3) topographic keyhole patterns. The natural course of healing was documented over 6 months with visual acuity measurements, clinical observation, and corneal topography. In vivo clinical-pathologic correlations were made by scanning confocal microscopy.

RESULTS

Topographic anomalies were identified 1 month post-PRK in 48 eyes (40.3%) with low-moderate myopia and in 14 eyes (32.5%) with moderate-high myopia. For patients with 6 month follow-up, these rates declined to 25% and 23%, respectively. At 1 month post-PRK, topographic anomalies significantly reduced uncorrected and best-corrected visual acuity and refractive predictability. By 6 months post-PRK, the small number of eyes with persistent anomalies had visual outcomes similar to patients with normal topography. A simple approach to anti-island pre-treatment reduced islands slightly and keyhole anomalies significantly (anti-island pre-treatment vs no pretreatment: islands 25% vs 31.8%; keyholes 2.3% vs 17.6%; p = 0.021) but with decreased predictability of induced refractive change at 1 month post-PRK. Confocal microscopy in vivo demonstrated prominent deposition of subepithelial extracellular material 1 to 2 months after PRK that diminished by 6 to 8 months, but persisted in the presence of central islands. Scar formation appeared to represent an elevated plaque of new collagen with active keratocytes.

CONCLUSIONS

Topographic anomalies of wound healing are common after PRK. Vision and predictability are reduced by anomalies 1 month post-PRK but anomalies often resolve by 6 months. Marked improvement of vision occurs even when anomalies persist. Central islands appear to consist of persistent dense subepithelial extracellular deposits. Local scars are caused by new collagen deposition.