This is an interesting literature review that looks into the recent advances concerning the corneal molecular and cellular processes that are involved in the wound healing response after excimer laser surface ablation and LASIK surgery. It talks about the complex cascade of events that impact the predictability and stability of kerato-refractive procedures. There have been enough studies done that show the interaction between cytokines and growth factors and generation of myofibroblasts. These cellular products along with extracellular matrix reorganisation bring about the occurrence of late corneal haze that can have a considerable impact on the final vision. The epithelial basement membrane and its regeneration has been shown to be a rate-limiting step that controls these cytokines and growth factors and brings about the reduction in stromal changes. Due to laser ablation there is a delay in regeneration of the epithelial basement membrane, which is also limited by the amount of ablation. The haze has been noted to persist until there is late regeneration of the epithelial basement membrane and in cases where there is no recovery, complete disorganisation of extracellular matrix and increase in myofibroblastic activity has been noted. Therefore, a defective regeneration of the epithelial basement membrane has a critical role in determining the various ways in which a cornea heals with late haze after refractive surgery.
Corneal molecular and cellular biology for refractive surgeon
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