Research opens new prospects in wound healing control after refractive surgery

BARCELONA — Refractive surgeons still face significant challenges in terms of controlling the wound healing response after refractive procedures. The "scar war" needs an appropriate strategy, which first entails a clear understanding of what causes corneal scarring, seen visually as haze and light scatter, according to a speaker here.

"The most important cause is activation of quiescent corneal keratocytes: They lose expression of corneal crystalline proteins and transform into myofibroblasts that secrete alpha-smooth muscle actin (aSMA)," Gregory Schultz, MD, keynote lecturer at the Clinical Research Symposium of the European Society of Cataract and Refractive Surgeons, said. "This process accounts for about 70% of the light-scatter effects."

The two proteins that regulate the expression of corneal crystallines aSMA and collagen genes are the transforming growth factor beta and the connective tissue growth factor. By reducing the expression of these two proteins haze can be controlled, he said.

Specific agents such as neutralizing antibodies, trichostatin, ribozymes, antisense oligonucleotides, siRNA and TNFa blockers have been tested in vitro and in vivo animal models, he said. Their effects in reducing haze look promising.