Epithelial-Stromal Interactions in Human Keratotomy Wound Healing

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Abstract
Objective: To evaluate epithelial-stromal interactions in the healing of stromal wounds and the relationship of such interactions to regional variations in healing throughout keratotomy wounds. Methods: Ten radial keratotomy autopsy specimens were studied by using light and transmission electron microscopy. Results: Underneath epithelial plugs, the epithelialstromal interface was characterized by three adjacent morphological zones: a duplicated basement membrane complex, a zone that resembled Bowman's layer, and a third zone with collagenous fiber orientation parallel to the plugs. Scar tissue orientation was transverse at the base of the plug, and sagittal in deeper wound regions. Conclusions: Basement membrane duplication and a Bowman's layer-like region underneath a plug may result from complicated epithelial-stromal interaction. Asymmetrical organization of the scar, with subepithelial transverse and sagittal deeper scar tissue orientation, may characterize radial keratotomy wound healing, and may relate to variations in final refractive effect.