To investigate the origin, composition, and persistence of the interface particles that frequently are observed after LASIK.
Design
Small case series and experimental animal study.
Methods
Four patients received LASIK using a Schwind Supratome (Schwind, Kleinostheim, Germany) and a MEL 70 G-Scan excimer laser (Asclepion, Jena, Germany) and were examined over the course of 1 year using slit-lamp and in vivo confocal microscopy. Four rabbits received a monocular microkeratome incision and were examined immediately after surgery without lifting the flap. After monthly evaluation for 4 months using in vivo confocal microscopy, 2 corneas were processed for histologic analysis and were sectioned serially. To measure the iron content, atomic absorption spectrometry was performed on 2 operated and 2 unoperated rabbit corneas. The chemical composition of the metal and plastic parts of the microkeratome blade was identified using energy dispersive x-ray fluorescence (metal part), and Raman and infrared spectroscopy (plastic part). Before and after oscillation in air, the microkeratome blade and motor-head were examined using light and fluorescence microscopy. In serial sections, interface particles were identified by fluorescence microscopy and their chemical composition was determined using Coherent Antistokes Raman Scattering microscopy.
Results
In LASIK patients, thousands of brightly reflecting particles (up to 30 μm) were observed throughout the interface. The highest particle density was detected where the microkeratome blade had first entered the cornea. Both in the center and at the flap edge, the morphologic features, distribution, and density of these particles remained unaltered throughout the 1-year observation period. In rabbit corneas, interface particles were observed immediately after the microkeratome incision, even though the flap had not been lifted. These particles were similar to those observed in humans and persisted unaltered throughout the study. The operated and unoperated rabbit corneas had comparable iron content, demonstrating that the particles were not fragments of the uncoated steel blade. Only a few particles were observed on the unused microkeratome motor head and blade, whereas numerous fluorescent particles were detected after oscillation in air, the amount of particles increasing with oscillation time. Interestingly, the only fluorescent part of the microkeratome was the plastic segment of the blade. This plastic (polyetherimide) emitted fluorescence identical to that of the observed particles, whereas all metal parts of the microkeratome blade and motor head were nonfluorescent. In serial sections, interface particles showed fluorescent properties equivalent to polyetherimide and exhibited molecular resonance at 1780 and 3100 cm−1, in accordance with the Raman spectrum of polyetherimide.
Conclusions
Numerous plastic particles are generated during microkeratome oscillation and are deposited at the interface during LASIK. The particles persist unaltered for at least 1 year.
1Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
2Department of Chemistry, Aarhus University, Aarhus, Denmark
Correspondence to Torben Møller-Pedersen, MD, PhD, Department of Ophthalmology, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark.
Supported in part by The Faculty of Health Sciences at Aarhus University, The Danish Medical Research Council, The Danish Association for Prevention of Eye Diseases and Blindness, The Novo Nordisk Foundation, The Institute of Experimental Clinical Research at Aarhus University Hospital, The Synoptik Foundation, Ingeniør August Frederik Erichsens Legat, Ingrid Munkholms Legat, The Hørslev Foundation, Fonden til Lægevidenskabens Fremme, Alice og Jørgen A. Rasmussens Memorial Grant, Jørgen Bagenkop Nielsens Myopia Foundation, The Research Foundation at Aarhus University, The Danish Eye Research Foundation, The Danish Medical Association Research Foundation, Svend H. A. Schrøders Foundation, The Toyota Foundation, Jacob Madsens Foundation, Ib Henriksens Foundation, and The Anniversary Foundation for King Christian IX and Queen Louise.
ABSTRACT