How has confocal microscopy helped us in refractive surgery?

Area of Science:

• Ophthalmology
• Corneal Science
• Surgical Technology

Background:

• Refractive surgery, including laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), aims to correct vision but can induce changes in corneal structure.
• Understanding these changes is crucial for assessing long-term outcomes, corneal stability, and patient safety.

Purpose of the Study:

• To review the applications of in-vivo confocal microscopy (IVCM) in refractive surgery.
• To highlight current advancements and findings in the field.

Main Methods:

• In-vivo confocal microscopy allows for non-invasive, high-resolution imaging of the cornea at a cellular level.
• Review of existing studies examining corneal healing, cellular changes, and complications post-refractive surgery using IVCM.

Main Results:

• LASIK is associated with a progressive decline in keratocyte density in the flap and residual bed over three years, potentially affecting corneal integrity.
• Sub-basal nerve density significantly decreases post-LASIK, with partial recovery observed over two years; PRK shows complete nerve recovery by two years.
• IVCM effectively detects infectious organisms and inflammatory cells in vivo without the need for stains, aiding in the diagnosis of complications.

Conclusions:

• In-vivo confocal microscopy is a valuable tool for evaluating corneal healing, long-term stability, and complications after refractive surgery.
• Its ability to visualize cellular detail, microorganisms, and measure corneal thickness non-invasively underscores its unique diagnostic capabilities.