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Roger W. Beuerman, PhD; Marguerite B. McDonald, MD; R. Stewart Shofner, MD; Charles R. Munnerlyn, PhD; Terrance N. Clapham; Bayardo Salmeron, MD; Herbert E. Kaufman, MD

Arch Ophthalmol. 1994;112(8):1103-1110.

Abstract
Objective
To evaluate histological changes in the primate cornea after excimer laser photorefractive keratectomy (PRK) and to correlate them with clinical observations.

Methods
Sixteen African green monkey (Cercopithecus aethiops sabaeus) corneas were examined by light and transmission electron microscopy 6 weeks to 18 months after 1.5- or 3-diopter PRK.

Results
All specimens had a smooth stromal surface surrounded by a smooth, centrally tapered Bowman's layer. Epithelial thickness appeared to peak 12 months after PRK. The trend was for the epithelium to be thickest in the central-treated area; this phenomenon was more obvious in the 3-diopter—treated corneas. The numbers of activated keratocytes beneath the treated zone peaked at 4 months and decreased thereafter, while the numbers in the untreated areas decreased in the first 2 months after surgery, increased by 4 months, and did not change thereafter. Regenerated basal lamina averaged 86% intact over ablated areas; thickness was normal and no duplications were seen. Overall, the density of hemidesmosomes was significantly less in ablated areas compared with unablated areas.

Conclusions
These findings support the relationship between clinical observations of corneal haze after PRK, reestablishment of the epithelial cell layer, and the potential for stromal remodeling by active fibroblastic keratocytes beneath the ablation zone. Overall, quantification of several morphological parameters indicated that the values for the treated zone tended, with time, to approach those of the untreated cornea after PRK.

Author Affiliations
From the LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans. Dr Munnerlyn and Mr Clapham are employed by and have proprietary and financial interests in VISX Inc. At the time this study was done, Drs McDonald and Kaufman were consultants to VISX Inc. Dr Shofner currently has a financial interest in VISX Inc.

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