Scleral ultrastructure and biomechanical changes in rabbits after negative lens application.

AIM: To address the microstructure and biomechanical changes of the sclera of rabbits after negative lens application by spectacle frame apparatus. METHODS: Five New Zealand rabbits of seven weeks post-natal were treated with -8 D lens monocularly over the course of two weeks. Refractive errors and axial length (AXL) were measured at the 1st, 7th and 14th days of the induction period. Ultrastructure of sclera was determined with electron microscopy. Biomechanical properties were tested by an Instron 5565 universal testing machine. RESULTS: Lens-induced (LI) eyes elongated more rapidly compared with fellow eyes with AXL values of 15.56±0.14 and 15.21±0.14 mm (P<0.01). Fibril diameter was significantly smaller in the LI eyes compared with control ones in the inner, middle, and outer layers (inner layer, 63.533 vs 76.467 nm; middle layer, 92.647 vs 123.984 nm; outer layer, 86.999 vs 134.257 nm, P<0.01, respectively). In comparison with control eyes, macrophage-like cells that engulfed fibroblasts, dilated endoplasmic reticulum, and vacuoles in fibroblasts were observed in the inner and middle stroma in the LI eyes. Ultimate stress and Young's modulus were lower in the LI eyes compared with those in the control eyes. CONCLUSION: Negative lens application alters eye growth, and results in axial elongation with changes in scleral ultrastructural and mechanical properties.

The effects of monochromatic illumination on early eye development in rhesus monkeys.

PURPOSE: Influence of longitudinal chromatic aberration (LCA) on emmetropization during early eye development has not been studied in primates. We investigated the effects of quasi-monochromatic lighting on refractive development and eye growth in rhesus monkeys. METHODS: Infant rhesus monkeys were raised under one of three lighting conditions for 51 weeks: quasi-monochromatic blue light (peak 455 nm), red light (peak 610 nm), and white light (color temperature 5000 K). All animals underwent biometric measurements using cycloplegic streak retinoscope, keratometry, and A-scan ultrasonography for refraction, corneal power, and axial components, respectively, at designated time points. RESULTS: At the 51st week, the mean difference in refraction of the white light and blue light groups, compared with that of the red light group, reached 1.71 diopters (D) and 1.43 D, respectively (both P < 0.001). Two monkeys in the red light group developed myopia at the 16th week, whereas the other seven remained hyperopic throughout the experiment. No significant difference in mean refraction was observed between the blue light group and white light group. CONCLUSIONS: Illumination from long-wavelength light during early life could be a risk factor for the development of myopia in a small proportion of rhesus monkeys that are sensitive to L-cone stimulation.

Transfer from blue light or green light to white light partially reverses changes in ocular refraction and anatomy of developing guinea pigs.

Relative to the broadband white light (BL), postnatal guinea pigs develop myopia in a monochromic middle-wavelength light (ML, 530 nm) environment and develop hyperopia in a monochromic short-wavelength light (SL, 430 nm) environment. We investigated whether transfer from SL or ML to BL leads to recuperation of ocular refraction and anatomy of developing guinea pigs. Two-week-old guinea pigs were given (a) SL for 20 weeks, (b) SL recuperation (SLR, SL for 10 weeks then BL for 10 weeks), (c) ML for 20 weeks, (d) ML recuperation (MLR, ML for 10 weeks then BL for 10 weeks), or (e) BL for 20 weeks. Two weeks after transfer from ML to BL (MLR group), ocular refraction increased from 1.95 ± 0.35 D to 2.58 ± 0.24 D, and vitreous length decreased from 3.48 ± 0.06 mm to 3.41 ± 0.06 mm. Two weeks after transfer from SL to BL (SLR group), ocular refraction decreased from 5.65 ± 0.61 D to 4.33 ± 0.49 D, and vitreous length increased from 3.18 ± 0.07 mm to 3.26 ± 0.11 mm. The MLR and SLR groups had final ocular refractions that were significantly different from those of the ML and SL groups at 20 weeks (ML vs. MLR: p < 0.0001; SL vs. SLR: p < 0.0001) but were still significantly different from the BL group (BL vs. MLR: p = 0.0120; BL vs. SLR: p = 0.0010). These results suggest that recuperation was not complete after return to BL for 10 weeks.

Effects of the chromatic defocus caused by interchange of two monochromatic lights on refraction and ocular dimension in guinea pigs.

To investigate refractive and axial responses to the shift of focal plane resulting from the interchange of two monochromatic lights separately corresponding to the peak wavelengths of the cones absorption spectrum in retina, fifty 2-week-old pigmented guinea pigs were randomly assigned to five groups based on the mode of illumination: short-wavelength light (SL), middle-wavelength light (ML) and broad-band white light (BL) for 20 weeks, SL for 10 weeks followed by ML for 10 weeks (STM), as well as ML for 10 weeks followed by SL for 10 weeks (MTS). Biometric and refractive measurements were then performed every 2 weeks. After 10 weeks, SL and STM groups became more hyperopic and had less vitreous elongation than BL group. However, ML and MTS groups became more myopic and had more vitreous elongation. After interchange of the monochromatic light, the refractive error decreased rapidly by about 1.93D and the vitreous length increased by 0.14 mm in STM group from 10 to 12 weeks. After that, there were no significant intergroup differences between STM and BL groups. The interchange from ML to SL quickly increased the refractive error by about 1.53D and decreased the vitreous length by about 0.13 mm in MTS group after two weeks. At this time, there were also no significant intergroup differences between MTS and BL groups. The guinea pig eye can accurately detect the shift in focal plane caused by interchange of two monochromatic lights and rapidly generate refractive and axial responses. However, an excessive compensation was induced. Some properties of photoreceptors or retina may be changed by the monochromatic light to influence the following refractive development.

Inhibition of corneal fibrosis by Smad7 in rats after photorefractive keratectomy.

BACKGROUND: Haze or corneal subepithelial fibrosis is one of the common complications after refractive surgery procedures, such as photorefractive keratectomy (PRK), laser epithelial keratomileusis, and epipolis laser in situ keratomileusis, which would result in refractive regression, decreased visual quality, and corneal opacification. Haze directly resulted from corneal fibrosis mediated by transforming growth factor ß (TGFß). Smad7, an inhibitory Smad, can inhibit TGFß signal transduction. Recently, the effects of Smad7 on the inhibition of fibrosis in several organs have been studied, while little is known about the effects on cornea after PRK. This study was aimed to determine the effects of lentiviral-mediated Smad7 gene expression on corneal fibrosis in rats after PRK. METHODS: Four different experimental groups were established using right eyes of Sprague-Dawley rats. Thirty-two eyes underwent de-epithelialization only and served as a sham operation group (group 1). Ninety-six eyes underwent PRK operation and were further divided into group 2 (the PRK group) without lentivector administration, group 3 (the Lv-blank group) with control lentiviral vector without Smad7 administration, and group 4 (the Lv-Smad7 group) with Smad7 expressing lentiviral vector Smad7 administration. At 1 day, 1 week, 1 month, and 3 months after PRK, the transfection efficiency was determined by measuring the fluorescence signal as well as Smad7 protein and mRNA levels. Corneas were further processed for immunoblotting to assess the phosphorylation of Smad2 as a downstream event of TGFß/Smad signaling. The expression of fibrotic markers, such as α-smooth muscle actin (α-SMA), Type III collagen (collagen III), and cell cycle-related marker Ki67, was measured by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Lentivirus-mediated exogenous Smad7 gene expression in rat corneal tissue resulted in reduced activation of TGFß/Smad signaling caused by downregulation of phosphorylation of Smad2. Smad7 also downregulated the expression of TGFß2. Markers of cell proliferation and fibrosis, including Ki67, α-SMA, and collagen III, were inhibited by Smad7 up to 3 months after PRK operation. CONCLUSION: Smad7 gene transfer inhibits fibrogenic responses of cornea in rats after PRK.

Expression of Smad7 inhibits fibrogenic responses of keratocytes to transforming growth factor ß2.

BACKGROUND: Transforming growth factor ß (TGFß) is one of the most important growth factors in the development of fibrosis and scarring on cornea. Smad7, an inhibitory Smad, can inhibit TGFß signal transduction. In recent years, effects of lentiviral-mediated Smad7 on inhibition of fibrosis on some organs have been studied, while little is known about the effects on cornea. This study aimed to determine the effects of lentiviral-mediated Smad7 gene expression on keratocyte proliferation and fibrosis induced by TGF ß2 in vitro. METHODS: Keratocytes were cultured from corneal tissue isolated from Sprague-Dawley (SD) rats and transfected with Smad7 expressing lentiviral vector (Lv-Smad7) or non-functioning control vector (Lv-blank). Following the exposure to TGFß2, keratocytes were processed for immunoblotting to assess the phosphorylation of Smad2 as down-stream event of TGFß/Smad signaling. Expression of fibrotic markers α-smooth muscle actin (α-SMA), type III collagen (collagen III) were measured by Western blotting and quantitative real time polymerase chain reaction (PCR). Overall cell proliferation was determined by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and the expression of cell cycle-related marker Ki67 at both mRNA and protein levels. RESULTS: The Smad7 gene transfer suppressed TGFß/Smad signaling in keratocytes by down-regulating phosphorylation of Smad2. Markers of cell proliferation and fibrosis including Ki67, α-SMA, collagen III were inhibited by introduction of Smad 7 into TGFß exposed keratocytes. Consequently, the rate of cell proliferation was attenuated. CONCLUSION: Smad7 gene transfer inhibited fibrogenic responses of keratocytes to TGFß2.

[Relationship between best corrected visual acuity and refraction parameters in myopia].

OBJECTIVE: To explore the relationship between best corrected visual acuity (BCVA) and refraction parameters in myopia. METHODS: Two thousand two hundred and seventy-four patients (4245 eyes) with different degrees of myopia were collected. Their BCVA, diopter of spherical (DS), diopter of cylinder (DC), astigmatism axis, axial length (AL) and corneal thickness were detected. The influence of those parameters on BCVA was studied and the mathematical model of the relationship between BCVA and other parameters including the age and gender of patients was established. RESULTS: The logistic regression analysis showed that there were correlations between the BCVA (y) and DS (x1), DC (x2), gender (x3), AL (x4), corneal thickness (x5), astigmatism axis (x6) and age (x7) (P<0.05): y=0.580 6-0.034 0 x1-0.046 8 x2+0.056 5 x3+0.016 5 x4+ 0.0007 x5+0.000 2 x6-0.005 8 x7. CONCLUSION: For people with myopia, age, gender and corneal thickness have small effect on BCVA, while the DS, DC, AL and astigmatism axis have significant effect on BCVA. The BCVA would decline following the extension of DS, DC and AL. It is helpful to assess the vision of myopia by analyzing the refraction parameters comprehensively.

Effects of different monochromatic lights on refractive development and eye growth in guinea pigs.

We investigated whether different monochromatic lights with similar luminance or identical light quantum number produce predictable changes in refractive state and eye growth in early eye development in guinea pigs. In experiment I, three groups of guinea pigs (two weeks of age, n=18 in each group) were reared for 12 weeks under LED lighting of 430 nm (short-wavelength light, SL), 530 nm (middle-wavelength light, ML), and broad-band light (BL). The lighting conditions were set to provide equal levels of luminance. All animals underwent refraction and biometric measurements every 2 weeks. In experiment II, the lighting conditions were set at equal quantum number and another three groups of guinea pigs were raised and tested for 20 weeks. In experiment I, compared to the BL group, refraction of the ML group was less hyperopic (P<0.001) with a faster vitreous extension (P<0.001), while the SL group was more hyperopic with a slower vitreous elongation (P<0.001). The mean difference in refraction between the SL and ML groups reached about 4.5 D at maximum. The refractive changes and eye growth in experiment II were very similar to experiment I during the first 12 weeks, but the difference in refraction between the SL and ML groups reached 6.05 D after 20 weeks of treatment, which was greater than the longitudinal chromatic aberration (approximately 1.5 D) in the guinea pigs eyes. The results suggest that the guinea pigs' eyes overcompensated in response to narrow-band light, which resulted in an exaggerated and inaccurate refractive growth.

Physical characteristics of ocular structures in Chinese children with emmetropia.

PURPOSE: To evaluate whether accommodation has effects on eye elongation. METHODS: Two hundred seventy-three eyes with a refractive error between +1.0 and -0.5 diopters were divided into three groups: pre-school children, grade-school children, and middle-school children. Ocular structures were measured using autorefraction and A-scan ultrasonography. RESULTS: There was a negative correlation between age and corneal power (r = -0.227, P = .0001), lens thickness (r = -0.263, P = .00001), and Gullstrand lens power (r = -0.452, P << .0001). There was a positive correlation between age and axial length (r = -0.432, P << .0001) and vitreous chamber depth (r = 0.505, P << .0001). Mean corneal power (P < .001) and lens power (P < .001) were significantly greater in pre-school children than in grade-school children, whereas axial length (P < .001) and vitreous chamber depth (P < .001) were greater in grade-school children. Mean lens thickness (P = .01) and lens power (P = .07) were higher in grade-school children than in middle-school children, whereas axial length (P = .024) and vitreous chamber depth (P < .001) were higher in middle-school children. CONCLUSION: Ocular structures may play different roles in maintaining emmetropia. Accommodation during near work and its potential attendant hyperopic defocus could potentially drive eye elongation.

Clinic study on silicone hydrogel contact lenses used as bandage contact lenses after LASEK surgery.

AIM: To compare the clinical performance of two types of silicon hydrogel contact lenses used as bandage lenses after LASEK surgery. METHODS: A prospective, double-masked study was conducted on 42 eyes of 21 patients who received binocular LASEK surgeries. The interocular difference in spherical equivalent power was less than -1.50D. Patients were randomly assigned to wear Galyfilcon A (Lens A) bandage contact lens in one eye and Balafilcon A (Lens B) in the fellow eye after the surgery. The responses to a subjective questionnaire on comfort of wearing, corneal epithelial status, conjunctival hyperemia, limbal neovascularization, lens fitting and contact lens debris were assessed 1 and 5 days postoperatively. Corneal endothelium was assessed before and 5 days after the surgery upon bandage lens removal. RESULTS: There was no difference between the two groups in terms of conjunctival hyperemia, limbal neovascularization, contact lens fitting, corneal epithelial status, corneal endothelium cell density (CD) and endothelium cell size (CS) at any postoperative visit. Complaints of discomfort, including foreign body sensation, pain and intolerance were statistically more among Lens B wearers at any postoperative visit (P<0.05). Lens B appeared to attract much more debris than Lens A at the 5-day post-operative follow-up visit (P<0.01). CONCLUSION: The two types of silicon hydrogel lenses investigated in this study demonstrated similar clinical performance in terms of corneal responses and lens fitting. However, Lens A showed a better performance in terms of comfort of wearing and deposit resistance.

[A compare study on cornea biomechanical properties in normal and keratoconic eyes].

OBJECTIVE: To compare the corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA) in normal and keratoconic eyes. METHODS: It was a case-control study. Random selected 96 normal eyes and 46 keratoconic eyes in the same period were included in this study. Normal eyes were divided into 2 groups: high corneal astigmatism (> or = 3.00 D) and low-to-moderate corneal astigmatism (< 3.00 D). Keratoconic eyes were also divided into 3 groups based on Amsler-Krumeich classification: mild (stage I), moderate (stage II) and severe (stage III/IV). CH and CRF were compared between groups and the areas under ROC curves of the CH and CRF were calculated. RESULTS: The mean CH and CRF were (7.1 +/- 1.6) mm Hg and (6.3 +/- 1.5) mm Hg in keratoconic eyes compared with (10.1 +/- 1.3) mm Hg and (10.5 +/- 1.6) mm Hg in normal eyes. The difference were statistically significant(t = -11.813, -14.943; P < 0.001). In normal eyes, there was no difference of CH or CRF between the high corneal astigmatism and low-to-moderate corneal astigmatism (t = 0.373, 0.095; P > 0.05). In keratoconic eyes, there was a significant negative correlation between CH and the keratoconus grade (r = -0.627, P < 0.001) and the same relationship was found between CRF and the keratoconus grade (r = -0.587, P < 0.001). In multiple linear regression analysis,CH was correlated with central corneal thickness (CCT) and corneal curvature (r = 0.320, -0.375; P < 0.05) and CRF was correlated with corneal curvature in keratoconic eyes (r = -0.441, P < 0.01) , while they were only correlated with CCT in normal eyes (r = 0.367, 0.459; P < 0.001). The areas under ROC curves of the CH and CRF were 0.9282 and 0.9731 (Z = 20.462, 38.305; P < 0.0001), the difference between them was significant (Z = 7.134, P = 0.008). CONCLUSIONS: The CH and CRF were significantly lower in keratoconic eyes than in normal eyes, especially on CRF. The long-term follow-up of CH and CRF may provide information for evaluation of progression of keratoconus. They may be included as indicators for detecting keratoconus.

[The effects on corneal wound healing of LASIK with ultra-thin corneal flaps and LASEK in rabbits].

OBJECTIVE: To evaluate the corneal wound-healing response of LASIK with ultra-thin corneal flaps and LASEK in rabbits. METHODS: It was an experimental study. Thirty-two adult New Zealand rabbits were divided into 2 groups with 16 each. Two surgical procedures, LASIK with ultra-thin corneal flaps and LASEK were performed on the right eye of each group, with the left eye as control. A myopic ablation of 10 diopters was performed in each group. Corneal wound-healing and histopathological changes of the ablation zone were studied through slit lamp, light microscope and transmission electronic microscope. The expression levels of collagen I , collagen III, fibronectin (FN) and transforming growth factor beta-1 (TGF-beta1) were investigated by immunohistochemistry and RT-PCR assays. RESULTS: In the group of LASIK with ultra-thin corneal flaps, the corneas were clear without haze followed by slight wound healing and fast recovery. While in the group of LASEK, corneal wound healing was obviously delayed. There was haze in grade 1 (62.5%) and grade 2 (37.5%) in 1 month, with grade 0.5 (43.75%) and grade 1 (56.25%) in 3 months. 1 month and 3 months after surgery, proteins and mRNA of collagen III, FN and TGF-beta1 were expressed in the anterior corneal stromal layer in each group. But the expression was much higher in the group of LASEK (t = 18.47, 11.98, P < 0.05). The protein and mRNA expression of collagen I had no difference between the two groups (t = 0.72, 0.36, 0.47, 2.38, P > 0. 05). The mRNA expression of collagen I, collagen III, FN and TGF-beta1 had no statistical difference between the groups of control and LASIK with ultra-thin flap in 3 months (t = 2.42, 1.54, -0.83, P > 0.05). CONCLUSION: According to the animal experiments, it was suggested that the corneal wound-healing response of LASIK with ultra-thin corneal flaps was much better than that of LASEK.

[Agreement measurement of ocular wavefront aberrations with three different aberrometers].

OBJECTIVE: To assess the repeatability and difference of ocular wavefront aberrations measured with ray-tracing, dynamic skiascopy, and Hartmann-Shack aberrometers. METHODS: It was an agreement study. Ocular aberrations data obtained by using iTrace (Tracey Technologies), OPD SCAN (Nidek) and WASCA (Zeiss) wavefront aberrometers were analyzed. Eighty six eyes of 45 patients were measured three times. The difference between the measurement and the mean of three consecutive measurements were analyzed to verify the reproducibility. The difference in sphere, cylinder, spherical equivalent (SEQ) and high order aberration (HOA) errors obtained from different aberrometers were evaluated. RESULTS: Repeatability errors of these three wavefront analyzer were found to be low. Comparisons on the same eye showed that there was a significant difference (P < 0.01) in sphere and cylinder between ray-tracing aberrometer and the others in high SEQ group (>or= -6.00 diopter). For HOA, all aberrometers obtained similar results in low SEQ group (< -6.00 diopter). In the high SEQ group, the ray-tracing aberrometer showed statistically higher data in HOA and coma (P < 0.01), and there was no significant difference between the skiascopy and the Hartmann-Shack aberrometer. The iTrace-OPD and iTrace-WASCA HOA difference correlated with spherical equivalent in the high SEQ group (r = -0.418, -0.399, P < 0.01). CONCLUSION: All devices produced similar results of reproducibility, but showed varying results in the ocular total wavefront reading.

Morphologic and histopathologic changes in the rabbit cornea produced by femtosecond laser-assisted multilayer intrastromal ablation.

PURPOSE: To observe morphologic and histopathologic changes in the midperiphery of the rabbit cornea produced by femtosecond laser-assisted multilayer intrastromal ablation, determine whether this method may be used to correct myopia, and study how the cornea heals when the epithelium is not injured. METHODS: The right eyes of 10 New Zealand White rabbits were used for the experiments. A 60-kHz femtosecond laser delivery system was used, and three lamellar layers of laser pulses were focused starting at a corneal depth of 180 microm and ending at 90 microm from the surface, with each successive layer placed 45 microm anterior to the previous layer. In the interface of the applanation contact lens cone, a 6-mm diameter aluminum circle was placed at the center to block the laser, and ablation was limited to the midperiphery of the cornea. The laser settings were spot/line separation, 10 microm; diameter, 8.5 mm; energy for ablating the stroma, 1.3 microJ. Topography examination was used to document changes in corneal power. Light microscopy, transmission electron microscopy (TEM), and confocal microscopy in vivo were applied to observe changes in the cornea. RESULTS: There was significant change in mean corneal power between baseline and postoperative month 3 (n = 8; P = 0.0001), with a decrease from 46.82 D to 44.42 D. There was no haze formation or refractive regression throughout the follow-up. There were no corneal structural abnormalities under light microscopy. Activated keratocytes and necrotic debris were visible under confocal microscopy. Fibroblasts were observed, and no myofibroblasts appeared under TEM. CONCLUSIONS: Multilayer intrastromal ablation by the femtosecond laser with intact epithelium in the midperiphery of the corneal stroma can flatten the cornea without causing haze formation or refractive regression. This procedure allows the cornea to heal differently than when traditional corneal refractive surgery is performed and the epithelium is damaged.

Incidence of myopia in high school students with and without red-green color vision deficiency.

PURPOSE: To investigate the influence of color vision on myopia development by testing refraction error and axial length of the eye for high school students with and without color vision deficiency (CVD). METHODS: A school-based cross-sectional, cluster sample study was conducted to test the color vision and refractive error of 16,539 high school students. Students were screened for CVD using a pseudoisochromatic plate. CVD was confirmed in students failing the test using a Farnsworth-Munsell 100-Hue Test which also served to classify the subtype (protan or deutan). Three classmates of each CVD subject, matched in five myopia risk factors, were chosen to form the normal color vision (CN) control group. Ophthalmic examinations were performed to determine refractive status and axial length. RESULTS: Of the students, 309 were found to have red-green CVD and 927 were selected as the CN control group. The prevalence of myopia in the CVD group (45.6%) was significantly lower than that of the CN group (65.8%; P<0.001). The CVD group was also less myopic in refraction (P<0.001) than CN, and protan subjects had shorter axial lengths than those in the control group (P=0.007). CONCLUSIONS: Color vision deficiencies appear to influence the development of myopia. The observed lower incidence of myopia in people with CVD may be linked to the reduced functionality of the L/M chromatic mechanism.

[The effect of the flap thickness on forward shift of posterior corneal surface in excimer laser surgery correcting high myopia].

OBJECTIVE: To investigate the influence of flap thickness of laser in situ keratomileusis (LASIK) and subepithelial keratomileusis on the forward shift of the posterior corneal surface in high myopia METHODS: It was a case-control study. In this study, 151 right high myopic eyes of patients [spherical equivalent range - 6.00 to - 10.00 diopter, 46 subepithelial keratomileusis eyes (epithelial sheet group), 64 LASIK eyes with 110 microm flap thickness (thin flap group) and 41 LASIK eyes with 130 microm flap thickness (normal flap group)] were evaluated preoperatively and postoperatively with the Pentacam to determine the shape change in the posterior corneal surface. Changes in posterior shape were calculated by comparing refraction and elevation of posterior corneal surface in the part corresponding to the pupil center preoperatively and postoperatively. RESULTS: The mean estimated residual bed thickness (RBT) of epithelial sheet eyes, thin flap eyes and normal flap eyes was (362 +/- 23), (320 +/- 25) and (300 +/- 21) microm, respectively. The RBT difference between epithelial sheet group and thin or normal flap group was statically significant (F = 85.685, P <0.001) and the difference between 2 LASIK groups was also significant (P < 0.05). There was no significant difference between three groups in ablation depth (P > 0.05). The mean posterior corneal refraction and elevation change of epithelial sheet eyes, thin flap eyes and normal flap eyes in the pupil center was (-0.12 +/- 0.14)D and (0.9 +/-1.8) microm, ( -0.20 +/- 0.22)D and (1.3 +/- 1.6) microm, (-0.21 +/- 0.18)D and (1.5 +/- 1.5) microm, respectively. A significant correlation between posterior elevation and refraction change was present in all 3 groups. The amount of posterior corneal elevation change correlated significantly with the ablation depth in thin flap group and normal flap group (r = 0.265, 0.311; P <0.05). CONCLUSION: In treating high myopia, both subepithelial ablation and LASIK surgery induce tiny forward shift of posterior corneal surface when the RBT was thick enough. Deeper ablation or thicker corneal flap may increase the trend of forward shift of posterior corneal surface.

[Recovery of corneal sensitivity in extremely high myopia after laser sub-epithelium keratomileusis].

OBJECTIVE: To evaluate the changes in corneal sensitivity following laser epithelial keratomileusis (LASEK) and epiploic laser in situ keratomileusis (Epi-LASIK) in treatment of extremely high myopia. METHODS: Thirty-seven eyes of 37 patients underwent LASEK and Epi-LASIK to correct myopia, their equivalent sphere ranged from -9.50 DS to -12.50 DS, astigmatism < +/- 1.50 DC. Cornea sensitivity was measured with a Cochet-Bonnet esthesiometer at central part of the cornea. Treated eyes were divided into two groups by different operation methods: Epi-LASIK group and LASEK group. After the operation, each group was divided into two sub-groups according to the eyes with or without obvious epithelium edema. RESULTS: Obvious epithelium sheet edema happened in 6 eyes after LASEK and 3 eyes among them were due to broken epithelium sheets during the operation. By 2 weeks, 1, 2, 3 and 6 months after Epi-LASIK, corneal sensitivity recovered to 79.31%, 84.49%, 87.92%, 92.24% and 93.98% of preoperative level, respectively. Compare to the Epi-LASIK, cornea sensitivity after LASEK recovered to 69.64%, 78.57%, 83.21%, 85.70% and 87.86% of preoperative level, respectively. The recovery of corneal sensation in LASEK group was slower than that of Epi-LASIK group. The difference between these two groups was statistically significant at 2 weeks after the operation (P < 0.05). In LASEK group, there was a trend towards a great reduction in corneal sensitivity in epithelium edema eyes and the recovery was slower in these eyes. The difference of corneal sensitivity recovery between these two sub-groups was statistically significant (P < 0.05). CONCLUSION: The recovery of corneal sensitivity in extremely high myopia after Epi-LASIK is faster than that after LASEK, and reached to the platform stage by 3 months. The epithelium sheet edema after LASEK affects corneal sensitivity recovery.

[Stromal cells change after epipolis laser in situ keratomileusis and laser-assisted subepithelial keratectomy in rabbits].

OBJECTIVE: To compare the effects of epipolis laser in situ keratomileusis (Epi-LASIK) and laser-assisted subepithelial keratectomy (LASEK) on the corneal stromal cells, and to evaluate their effects on corneal haze histopathologically. METHODS: Forty-eight New Zealand white rabbits (96 eyes) were randomly treated with Epi-LASIK in one eye and LASEK in the other, and 2 rabbits (4 eyes) without any treatment were used as control. Cornea stromal cell apoptosis was evaluated by terminal deoxyribonucleotidyl transferase-mediated deoxynuridine triphosphate nick end labeling (TUNEL) assay. Stromal cells proliferation and myofibroblasts generation were evaluated by immunocytochemical analyses the expression of Ki-67 and alpha-smooth muscle actin (alpha-SMA) respectively. Myofibroblast generation was further testified by Western blot analysis of alpha-SMA. Both number of TUNEL, Ki-67 and alpha-SMA positive cells and expression of alpha-SMA were semi quantitatively analyzed to explore their effects on corneal haze. RESULTS: Many TUNEL-positive cells appeared in the central anterior stromal in early stages after both LASEK and Epi-LASIK, and the number of TUNEL-positive cells reached a peak 24 hours after either LASEK or Epi-LASIK. There were more TUNEL positive cells found in LASEK group than that in Epi-LASIK group in 1 week postoperatively (t = 3.63, 7.80, 4.34, 2.95, all P < 0.01). There were a lot of Ki-67-positive cells in anterior corneal stroma after both LASEK and Epi-LASIK, but the peak appeared at 72 hours after the treatments. The significant difference was also found in the number of Ki-67-positive cell between the two treatments in 1 week postoperatively (t = 3.81, 5.85, 5.09, 5.59, all P < 0.01). alpha-SMA-positive cells started to appear apparently at 1 week after both LASEK and Epi-LASIK, and both the peaks appeared at 1 month after the treatments, and there were still a lot of alpha-SMA-positive cells in corneal stroma at 3 months after LASEK. There were more alpha-SMA-positive cells found after 1 week in LASEK group than that in Epi-LASIK group (t = 2.97, 7.19, 6.73, all P < 0.01). CONCLUSION: There are less stromal cell apoptosis, proliferation and myofibroblast generation in Epi-LASIK than that in LASEK. Therefore, comparing with LASEK, Epi-LASIK induces less corneal haze response in correcting myopia.

[Recovery of corneal sensitivity after laser in situ keratomileusis and laser-assisted subepithelial keratectomy].

OBJECTIVE: To compare the recovery of corneal sensitivity after laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK). METHODS: Central corneal sensitivity (CCS) was measured with a Cochet-Bonnet esthesiometer in 59 patients before and 2 weeks, 1, 3 and 6 months after myopic correction by LASIK or LASEK. Among them, 50 patients were treated with LASEK and 9 patients were treated with LASIK. RESULTS: CCS were reduced in the early period time after LASEK and LASIK, but more reduction was seen after LASIK. At every time points, the CCS after LASEK was better than that after LASIK (at 2 weeks, 1 and 3 months P < 0.01, at 6 months P = 0.031). In myopic eyes with less than 6.00 diopters (D), the CCS recovered at 3 months after LASEK (P > 0.05), but it didn't recover at 6 months after LASIK (P = 0.023). In myopic eye with more than 6.00 D, the recovery of CCS was seen at 6 months after LASEK (P > 0.05). Correlations between CCS and ablation depth were found at 3 and 6 months after LASEK (r = 0.419, 0.433, 0.413; P < 0.05), but no correlation was found after LASIK (P > 0.05). CONCLUSION: Recovery of corneal sensitivity is faster after LASEK than after LASIK. Ablation depth is related to the recovery of corneal sensitivity after LASEK.

[Clinical investigation of epipolis laser in situ keratomileusis on high myopia].

OBJECTIVE: To investigate the surgical characteristics and clinical results of Epi-LASIK on high myopia. METHODS: Epi-LASIK was performed with a rotational epikeratome, which features a blunt oscillating blade. Corneal epithelial separation was achieved mechanically without the use of alcohol. Laser ablation was performed with Zeiss Mel-80 excimer laser. After ablation, epithelial sheet was repositioned and a therapeutic contact lens was applied to the eye for 3 to 5 days. The postoperative symptom, epithelial flap, contrast sensitivity, wavefront aberration and haze formation were investigated. The period of follow-up ranged from 3 to 6 months. RESULTS: 52 eyes of 30 patients with a mean spherical equivalent (SE) of (-12.82 +/- 4.38) D were included in the clinical trial. Among which 36 eyes were pathologic myopia and 16 eyes were simple high myopia. Patient age ranged from 20 to 50 years. Integrated epithelial flap with a diameter of 8 to 9 mm was made in 49 eyes leaving an about 3 mm superior hinge. Epithelial flap contained part of stroma tissue was seen in one eye. Free epithelial flap was made in 2 eyes. 4 eyes had moderate photophobia, tearing and foreign body sensation. Other patients only had mild discomfort. No patient reported other subjective symptom after 2 days with the exception of mild foreign body sensation. In 3 months after surgery, spherical equivalent of 44 eyes (84.61) were within +/- 1.00 D of attempted refraction. No eye lost more than one line of best spectacle-corrected visual acuity (BSCVA), whereas 10 eyes (19.23%) gained one or two lines of BSCVA. Grade 0.5 haze was found in 8 eyes (15.38%) and grade 1 haze was found in 2 eyes (3.84%). In 6 months after surgery, Grade 0.5 haze was found in 3 eyes. Contrast sensitivity decreased 1 month postoperatively and recovered to preoperative lever gradually 3 months postoperatively. Higher order aberration was increased postoperatively. CONCLUSIONS: Epi-LASIK is a safe and efficient method to correct high myopia with the advantages of having mild irritating symptom and haze. Larger series with adequate follow-up are needed to observe the long term clinical results and haze.