The ultrastructure of well-healed lenticules in keratomileusis

Two well-healed hyperopic keratomileusis homoplastica lenticules, one 4 years old, the other 5 months old, were removed from the same patient following postoperative complications of triplopia and aniseikonia. The lenticules were examined by light and electron microscopy. Both lenticules were repopulated with keratocytes throughout the lamellae. Degenerated keratocytes were observed in the 5-month-old lenticule and recipient stroma, and in the 4-year-old lenticule; no degenerated keratocytes were seen in the recipient stroma of the 4-year-old lenticule. These findings may have resulted from toxic constituents of the solutions used to preserve the donor cornea. The basement membrane was thickened in both lenticules. The epithelial cell layer was irregular in the periphery of the lenticule where Bowman's membrane was disrupted. These findings suggest that careful surgical technique that minimizes damage to Bowman's layer and basement membrane may promote more rapid epithelial healing. The histologic results suggest that the cause of this patient's triplopia was irregular astigmatism.