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      Resposta cicatricial corneana em diferentes modalidades de cirurgia refrativa Translated title: Corneal wound healing response following different modalities of refractive surgical procedures


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          A resposta cicatricial corneana secundária a procedimentos refrativos, representa assunto de alta relevância, pois influencia diretamente nos resultados pós-operatórios. Modificações técnicas nos atuais procedimentos, como a criação automatizada do retalho corneano ("flap") através de pulsos ultra-rápidos de laser ("Femtosecond laser"), novas modalidades de ceratectomia superficial como a criação de um retalho epitelial com ou sem tratamento prévio com álcool (LASEK ou Epi-LASIK) e a utilização de quimioterápicos como a mitomicina C, vêm sendo propostas como técnicas alternativas aos tradicionais LASIK e PRK. Inúmeras vantagens teóricas vêm impulsionando a difusão dessas novas técnicas, entretanto, melhor entendimento da resposta cicatricial subseqüente a esses procedimentos se faz necessário. O presente texto propõe revisão das principais características da cicatrização corneana que ocorrem após diferentes técnicas de cirurgia refrativa.

          Translated abstract

          The corneal wound healing response following refractive procedures represents a subject of high relevance, due to its direct influence on the postoperative results. Technical modifications of current refractive procedures, like the automated flap creation with the femtosecond laser, LASEK, PRK with mitomycin C and Epi-LASIK have been proposed as alternatives to traditional LASIK and PRK. Several theoretical advantages have encouraged the diffusion of these new techniques; however, a better understanding of the corneal wound healing response following these procedures is required. The present text proposes a review of the corneal wound healing characteristics following different modalities of refractive surgical procedures.

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          Most cited references73

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          Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation

          Programmed cell death (PCD) plays a key role in developmental biology and in maintenance of the steady state in continuously renewing tissues. Currently, its existence is inferred mainly from gel electrophoresis of a pooled DNA extract as PCD was shown to be associated with DNA fragmentation. Based on this observation, we describe here the development of a method for the in situ visualization of PCD at the single-cell level, while preserving tissue architecture. Conventional histological sections, pretreated with protease, were nick end labeled with biotinylated poly dU, introduced by terminal deoxy- transferase, and then stained using avidin-conjugated peroxidase. The reaction is specific, only nuclei located at positions where PCD is expected are stained. The initial screening includes: small and large intestine, epidermis, lymphoid tissues, ovary, and other organs. A detailed analysis revealed that the process is initiated at the nuclear periphery, it is relatively short (1-3 h from initiation to cell elimination) and that PCD appears in tissues in clusters. The extent of tissue-PCD revealed by this method is considerably greater than apoptosis detected by nuclear morphology, and thus opens the way for a variety of studies.
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            Riboflavin/ultraviolet-a–induced collagen crosslinking for the treatment of keratoconus

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              Stress-strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking.

              To evaluate the biomechanical effect of combined riboflavin-ultraviolet A (UVA) treatment on porcine and human corneas. Department of Ophthalmology, Technical University of Dresden, Dresden, Germany. Corneal strips from 5 human enucleated eyes and 20 porcine cadaver corneas were treated with the photosensitizer riboflavin and irradiated with 2 double UVA diodes (370 nm, irradiance = 3 mW/cm2) for 30 minutes. After cross-linking, static stress-strain measurements of the treated and untreated corneas were performed using a microcomputer-controlled biomaterial tester with a prestress of 5 x 10(3) Pa. There was a significant increase in corneal rigidity after cross-linking, indicated by a rise in stress in treated porcine corneas (by 71.9%) and human corneas (by 328.9%) and in Young's modulus by the factor 1.8 in porcine corneas and 4.5 in human corneas. The mean central corneal thickness was 850 microm +/- 70 (SD) in porcine corneas and 550 +/- 40 microm in human corneas. Riboflavin-UVA-induced collagen cross-linking led to an increase in mechanical rigidity in porcine corneas and an even greater increase in human corneas. As collagen cross-linking is maximal in the anterior 300 microm of the cornea, the greater stiffening effect in human corneas can be explained by the relatively larger portion of the cornea being cross-linked in the overall thinner human cornea.

                Author and article information

                Arquivos Brasileiros de Oftalmologia
                Arq. Bras. Oftalmol.
                Conselho Brasileiro de Oftalmologia (São Paulo, SP, Brazil )
                February 2005
                : 68
                : 1
                : 140-149
                [01] orgnameUniversidade de São Paulo
                [02] orgnameRefracta - Rio
                [03] orgnameInstituto Paulista de Estudo e Pesquisa em Oftalmologia
                [05] orgnameThe Cleveland Clinic Foundation orgdiv1Cole Eye Institute orgdiv2Departamento de Córnea
                [04] orgnameThe Cleveland Clinic Foundation orgdiv1Cole Eye Institute orgdiv2Departamento de Cirurgia Refrativa
                S0004-27492005000100027 S0004-2749(05)06800127

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 73, Pages: 10

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                Ceratomileuse assistida por excimer laser in situ,Refractive errors,Epithelium corneal,Keratomileusis, laser in situ,Wound healing,Córnea,Erros de refração,Epitélio da córnea,Cicatrização de feridas


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