| Dennis 2005-09-24, 2:38 pm |
| http://www.ncbi.nlm.nih.gov/entrez/...8154&query_hl=5
Wound healing in the cornea: a review of refractive surgery complications
and new prospects for therapy.
Netto MV, Mohan RR, Ambrosio R Jr, Hutcheon AE, Zieske JD, Wilson SE.
The Cole Eye Institute, The Cleveland Clinic Foundation, OH 44195, USA.
PURPOSE: The corneal wound healing response is of particular relevance for
refractive surgical procedures since it is a major determinant of efficacy
and safety. The purpose of this review is to provide an overview of the
healing response in refractive surgery procedures. METHODS: Literature
review. RESULTS: LASIK and PRK are the most common refractive procedures;
however, alternative techniques, including LASEK, PRK with mitomycin C, and
Epi-LASIK, have been developed in an attempt to overcome common
complications. Clinical outcomes and a number of common complications are
directly related to the healing process and the unpredictable nature of the
associated corneal cellular response. These complications include
overcorrection, undercorrection, regression, corneal stroma opacification,
and many other side effects that have their roots in the biologic response
to surgery. The corneal epithelium, stroma, nerves, inflammatory cells, and
lacrimal glands are the main tissues and organs involved in the wound
healing response to corneal surgical procedures. Complex cellular
interactions mediated by cytokines and growth factors occur among the cells
of the cornea, resulting in a highly variable biologic response. Among the
best characterized processes are keratocyte apoptosis, keratocyte necrosis,
keratocyte proliferation, migration of inflammatory cells, and myofibroblast
generation. These cellular interactions are involved in extracellular matrix
reorganization, stromal remodeling, wound contraction, and several other
responses to surgical injury. CONCLUSIONS: A better understanding of the
complete cascade of events involved in the corneal wound healing process and
anomalies that lead to complications is critical to improve the efficacy and
safety of refractive surgical procedures. Recent advances in understanding
the biologic and molecular processes that contribute to the healing response
bring hope that safe and effective pharmacologic modulators of the corneal
wound healing response may soon be developed.
NOTE, safe and effective modulators of the corneal would healing response
are not yet developed! That's why you have keratocyte necrosis, keratocyte
apoptosis, migration of inflammatory cells and myofibroblast generation
(fibrosis). Extracellular matrix reorganization (abnormal collagen
deposition is one example) stromal remodeling (the last thing a cornea
needs) and wound contraction to help form those microstriae.
Gee. Doesn't seem like the field has a grip on corneal wound healing
variables... better forgo the refractive surgery until they figure things
out.
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