Remodelling of the corneal stroma after lamellar keratoplasty. A synchrotron x-ray diffraction study

Patients healing from lamellar keratorefractive surgeries invariably experience postoperative corneal haze. In our lamellar keratoplasty (LKP) rabbit model, visual recovery is concomitant with the invasion of the grafted tissue by viable keratocytes from adjacent host tissue, and the return of corneal clarity is attributed to the remodelling of the stromal tissue by these keratocytes. We used synchrotron x-ray diffraction techniques to elucidate the ultrastructure of the stromal collagen fibrils in rabbit corneas at various time points in the 3 months after LKP surgery. Lenticules were frozen in 50% of the cases. The average spacing of the collagen molecules, which constitute the stromal fibrils, remains unchanged by LKP in both frozen (1.69-1.73 nm) and nonfrozen (1.58-1.75 nm) cases. In the nonfrozen case, the collagen fibril diameters are initially slightly larger than normal (38.3-41.9 nm) but have receded by 2 months postoperatively [similar to the frozen cases (37.7-41.9 nm)]. The post-LKP spacing of the collagen fibrils in the nonfrozen corneas is unremarkable (56.2-69.2 nm). In contrast, the increased collagen interfibrillar spacing in the frozen case is considerable (56.7 to > 94.6 nm) and variable up to 21 days postoperatively. Because the changes in interfibrillar spacing did not always mirror pachymetry changes in the frozen cases, we suspect occasional graft malapposition or the formation of intrastromal, fluid-filled, collagen-free "lakes."