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Abstract
To report corneal histopathology associated with keratectasia after laser in situ
keratomileusis (LASIK) and to evaluate the thickness of the calculated residual stromal
bed in two cases and those in the literature.
Interventional case reports.
Three eyes of two patients developed keratectasia after LASIK. Corneal specimens after
penetrating keratoplasty in one eye of each patient were studied histopathologically,
and the residual stromal bed was directly measured. For comparison, residual stromal
bed thicknesses were calculated from published cases of keratectasia.
Two eyes of a 26-year-old woman and one eye of a 22-year-old woman developed keratectasia
after LASIK. Calculated residual stromal bed thicknesses were 210, 213, and 261 microm.
Histologic sections revealed focal scarring in the flap plane. The cornea specimens
measured 75 and 118 microm thinner than calculated values immediately after LASIK.
Transmission electron microscopy of one case revealed an average lamellar thickness
of 0.94 microm. In 28 (49%) of 57 previous cases of keratectasia, the calculated residual
stromal bed thicknesses were greater than 250 microm.
Both the flap and the stromal bed of the cornea may thin after LASIK. A residual stromal
bed thickness of 250 microm does not preclude the development of keratectasia after
LASIK.