Ultrastructural and Three-Dimensional Study of Post-LASIK Ectasia Cornea

INTRODUCTION: Post-laser in situ keratomileusis (LASIK) corneal ectasia is a serious late postoperative complication. Here, we report the ultrastructural features of the post-LASIK cornea of two patients. METHODS: Two normal corneas (age 24 and 37 years old) and two post-LASIK ectaic corneas from two patients (A and B) were studied. The patient A (age 27 years) underwent penetrating keratoplasty and patient B (age 31 years) underwent deep-anterior lamellar keratoplasty. The excised corneas were processed for light and electron microscopy. A total of 120 images for three-dimensional (3D) reconstruction were taken by using the software Recorder and using a bottom mounted camera Quemesa attached to a JOEL 1400 transmission electron microscope. The 3D images were constructed using Visual Kai software. RESULTS: In the post-LASIK cornea, the hemidesmosomes, the basement membrane, and Bowmans layer were abnormal. The stromal lamellae were thin and disorganized. The collagen fibrils (CFs) diameter and interfibrillar spacing had decreased. Aggregated microfibrils were present in the Bowman's layer and all parts of the stroma. A large number of microfilaments were present at the detachment end of the flap and residual stroma. The 3D images showed the presence of collagen microfibrils and proteoglycans (PGs) within the CF of the normal and post-LASIK cornea. The collagen microfibrils and PGs within the CFs had degenerated in the post-LASIK cornea. CONCLUSION: Collagen microfibrils and PGs within the CFs were degenerated, leading to the degeneration of CFs, followed by the disorganization of lamellae in post-LASIK cornea. The CFs diameter and interfibrillar spacing decreased. Microsc. Res. Tech. 77:91-98, 2014. (c) 2013 Wiley Periodicals, Inc.