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A Prospective, Long-term Study

Beatrice E. Frueh, MD; Robin Cadez, MD; Matthias Böhnke, MD, PhD

Arch Ophthalmol. 1998;116:1425-1431.

Objective  To assess corneal morphological characteristics in vivo after photorefractive keratectomy (PRK) in humans.

Methods  Eighteen eyes were examined before and after PRK by means of in vivo confocal microscopy. Epithelial, stromal, and endothelial morphological characteristics were recorded. Minimum follow-up was 12 months.

Results  Immediately after PRK, the anterior stroma showed marked intercellular edema. At 1 month, fine linear structures were noted in the anterior stroma and midstroma, and a thin hyperreflective scar was present. The linear structures and the scar tissue were more marked at 4 months but were still present up to 26 months. Anterior stromal keratocyte density increased significantly 1 and 4 months after PRK, whereas midstromal and posterior keratocytes and endothelial cell densities did not change. Basal epithelial nerves were recognizable as early as 1 month after PRK. Contact lens–related microdots in the stroma remained unaffected.

Conclusions  The stromal linear structures represent a finding that is detectable only by confocal microscopy at high magnification, is not related to previous contact lens wear, and is still visible 26 months after PRK. The extension of these structures as far as the midstroma indicates that the permanent corneal changes caused by PRK affect deeper stromal layers than the immediate subepithelial region.

From the Department of Ophthalmology, Inselspital, University of Berne, Berne, Switzerland.

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