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  • Title: Histologic and ultrastructural changes in corneas with granular and macular dystrophy after excimer laser phototherapeutic keratectomy.
    Author: Szentmáry N, Seitz B, Langenbucher A, Schlötzer-Schrehardt U, Hofmann-Rummelt C, Naumann GO.
    Journal: Cornea; 2006 Apr; 25(3):257-63. PubMed ID: 16633022.
    Abstract:
    PURPOSE: The histologic changes after phototherapeutic keratectomy (PTK) in corneas with granular and macular dystrophy were studied. METHODS: We studied 3 corneas of 2 patients (1 granular, 2 macular dystrophy), who underwent penetrating keratoplasty (PK) at 0.8, 2.16, and 3.25 years after PTK; and 11 corneas (controls) from 10 PK patients (5 granular, 6 macular dystrophy) by light microscopy and by transmission electron microscopy. PTK was performed by using the Asclepion-Meditec MEL 60 excimer laser. RESULTS: After PTK the epithelium (15-40 versus 5-100 microm), and the upper stromal collagen lamella thickness (50-75 versus 50-100 microm) were less irregular than for the controls. In 1 eye (macular dystrophy) 10 months after PTK an acid mucopolysaccharide-positive band was detected in the subepithelial stroma, which could be removed by hyaluronic acid digestion. This fact suggests that it was "haze" formed after PTK, rather than a subepithelial recurrence of the dystrophy. All PTK corneas had deposits in the mid- and posterior stroma. Concerning controls, deposits were detected under the epithelium in all corneas. Electron microscopy of the study corneas revealed a mostly continuous basal lamina, occasionally forming projections into the subepithelial stroma, and large numbers of well-developed hemidesmosomes (5.2 +/- 0.8 per microm membrane length) present at greater density than in the controls (3.5 +/- 0.8). CONCLUSIONS: In stromal dystrophies, PTK was effective in removing large subepithelial stromal plaques. There were no subepithelial recurrences, and hemidesmosome density was increased.
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