Histologic study of a pair of human corneas after anterior radial keratotomy

Two corneas were obtained from a man who underwent anterior radial keratotomy in both eyes less than three months before his death. The corneas were obtained and fixed 16 hours after death and prepared for histologic evaluation four days later. Both corneas showed epithelial ingrowth in the surgical wounds, epithelial inclusion cysts in some areas, and ridges or protrusions of the posterior cornea beneath the incisions. The incisions ranged in depth from 48% to 63% of the full thickness of the cornea in the right eye and from 69% to 98% in the left eye, demonstrating the difficulties involved in maintaining a precise and predictable depth of incision, which may, in turn, be related to variations in visual results. Signs of endothelial stress, in the form of collagen and fibrils on the posterior Descemet's membrane, apparently predated the refractive surgery. Precautions such as specular microscopy may be needed to rule out this kind of surgery in patients with the early signs of some types of potential corneal disease.