Long-term healing of the central cornea after photorefractive keratectomy using an excimer laser

Using an excimer laser at 193 nm, 3-mm diameter discs were ablated from the optical zone of monkey corneas at a variety of depths up to 130 micron. Tissue was examined by light and electron microscopy 4 and 5 weeks and 6 and 8 months postoperatively. With the exception of the deepest ablation, all corneas were clear immediately postoperatively. At 1 month, ablations of 40 micron remained clear, whereas all others showed some degree of haze. By 3 months, discs at 60 micron depth were clear, and there was less haze in others. Haze was progressively lost over 6 months, but in the deepest discs it could still be discerned on slit-lamp examination. Microscopic observation showed that reepithelialization had occurred within 24 to 48 hours. Over subsequent months, a normal morphology was maintained in this layer with the exception that basal cells were slightly more elevated particularly at the disc margins where the epithelium contained more cell layers. Stromal reorganization was accompanied by an initial phase of vacuolation and invasion by keratocytes, but by 6 months postoperatively almost all vacuolation had disappeared and keratocyte numbers had almost returned to normal. By 8 months, the morphology was near normal with the exception that Bowman's membrane was absent and there was still a degree of disorder in the immediate subepithelial stromal fibers. The basement membrane of epithelial cells was reestablished but slightly more undulant than in nonirradiated areas. This undulation was retained in the 8-month postoperative specimens and at this time a normal thickness of 60 nm was displayed.