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Most basal cells in epi-LASIK flaps are not viable, histology study shows
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SAN FRANCISCO — Up to 90% of basal epithelial cells in epi-LASIK flaps may be dead or crucially damaged when they are replaced onto the stroma, a histology study showed. Most superficial and intermediate cells in the flaps may still be viable, however.
At the American Society of Cataract and Refractive Surgery meeting here, Shigeru Kinoshita, MD, described a histologic study he performed on epi-LASIK flaps that were created using three brands of microkeratome. The microkeratomes used were the Gebauer device now distributed by CooperVision Surgical, the Norwood EyeCare Epikeratome and the Moria Epi-K device.
Small peripheral sections of epithelial flaps created by each device were trimmed off with fine scissors immediately after the excimer laser ablation during epi-LASIK. The sections were processed for transmission electron microscopy (TEM) or confocal microscopy. About half of the 22 samples showed an intact basement membrane on TEM. Staining indicated that 90% of the cells in the basal layer were dead or damaged.
Dr. Kinoshita said the high percentage of non-viable cells in the basal layer was “probably due to mechanical damage from the epikeratome cut.” He said epi-LASIK is a worthwhile surgical procedure, but the instrumentation must be improved in order to make the basal cells more biologically active.