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Ex Vivo Corneal Organ Culture Model for Wound Healing Studies
Published on: February 15, 2019
Corneal Molecular and Cellular Biology for the Refractive Surgeon: The Critical Role of the Epithelial Basement
Purpose:
To provide an overview of the recent advances concerning the corneal molecular and cellular biology processes involved in the wound healing response after excimer laser surface ablation and LASIK surgery.
Methods:
Literature review.
Results:
The corneal wound healing response is a complex cascade of events that impacts the predictability and stability of keratorefractive surgical procedures such as photorefractive keratectomy and LASIK. The generation and persistence of corneal myofibroblasts (contractile cells with reduced transparency) arise from the interaction of cytokines and growth factors such as transforming growth factor beta and interleukin 1 produced by epithelial and stromal cells in response to the corneal injury. Myofibroblasts, and the opaque extracellular matrix they secrete into the stroma, disturb the precise distribution and spacing of collagen fibers related to corneal transparency and lead to the development of vision-limiting corneal opacity (haze). The intact epithelial basement membrane has a pivotal role as a structure that regulates corneal epithelial-stromal interactions. Thus, defective regeneration of the epithelial basement membrane after surgery, trauma, or infection leads to the development of stromal haze. The apoptotic process following laser stromal ablation, which is proportional to the level of attempted correction, leads to an early decrease in anterior keratocyte density and the diminished contribution of these non-epithelial cells of components such as perlecan and nidogen-2 required for normal regeneration of the epithelial basement membrane. Haze persists until late repair of the defective epithelial basement membrane.
Conclusions:
Defective regeneration of the epithelial basement membrane has a critical role in determining whether a cornea heals with late haze after photorefractive keratectomy or with scarring at the flap edge in LASIK.
Insights
Defective epithelial basement membrane regeneration after laser eye surgery can lead to corneal haze or scarring. This impacts the predictability and stability of refractive procedures like LASIK.
Area of Science:
- Corneal molecular and cellular biology
- Ophthalmology
- Regenerative medicine
Background:
- Corneal wound healing is crucial for refractive surgery outcomes.
- Myofibroblasts and extracellular matrix deposition can cause corneal opacity (haze).
- The epithelial basement membrane regulates epithelial-stromal interactions.
Purpose of the Study:
- To review advances in corneal wound healing after laser eye surgery.
- To understand the molecular and cellular mechanisms involved.
- To correlate healing processes with refractive surgery outcomes.
Main Methods:
- Comprehensive literature review of corneal wound healing.
- Analysis of cellular and molecular responses to laser ablation and LASIK.
- Examination of the role of epithelial basement membrane regeneration.
Main Results:
- Corneal myofibroblast generation, driven by cytokines, leads to haze.
- Defective epithelial basement membrane regeneration is linked to haze and scarring.
- Apoptosis of keratocytes after laser ablation impairs basement membrane repair.
Conclusions:
- Epithelial basement membrane regeneration is critical for corneal healing post-refractive surgery.
- Impaired regeneration leads to late haze (PRK) or flap edge scarring (LASIK).
- Understanding these processes improves refractive surgery predictability and stability.
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