Laer in itu keratomileui flap margin: wound healing and complication imaged by in vivo confocal microcopy

PURPOE: To examine the healing repone of laer in itu keratomileui flap margin in vivo. METHOD: Forty-three eye of 43 patient who had undergone myopic (n = 39) or hyperopic (n = 4) laer in itu keratomileui were examined once after urgery. The flap margin wa imaged by in vivo confocal microcopy at variou depth, and the wound healing repone, flap alignment, and complication were evaluated. Ten eye were examined on day 3 potoperatively, 13 eye at 1 to 2 week, 10 eye at 1 to 2 month, five eye at 3 month, and five eye at 6 month or later. REULT: At 3 day after laer in itu keratomileui, the urface epithelium and baal epithelium appeared normal. Keratocyte activation wa tronget at 1 to 2 week and 1 to 2 month, and an increaed amount of haze wa oberved correpondingly. Intratromal epithelial cell forming a plug could occaionally be perceived in the wound gape. Wound contriction wa completed in mot cae by 3 to 6 month or later. Good alignment wa oberved in 12 of 43 flap (27.9%) and moderate and poor alignment in 17 of 43 flap (39.5%) and 13 of 43 flap (30.2%), repectively. Poor alignment wa not aociated with lamellar epithelial ingrowth. Epithelial ingrowth wa aociated with dene haze at the interface. Diffue lamellar keratiti wa imaged in two cornea after hyperopic laer in itu keratomileui. CONCLUION: The laer in itu keratomileui inciion wound at the flap margin appear to heal after the equence oberved in inciional wound in nonhuman primate. Complication, uch a lamellar epithelial in growth and diffue lamellar keratiti, were often oberved, particularly after hyperopic laer in itu keratomileui.