Different epithelial cleavage planes produced by various epikeratomes

1
Different epithelial cleavage planes produced by
various epikeratomes in Epi-LASIK
Doh Lee, M.D., Ph.D.1, Suk kyue Choi, M.D.1, Jin
Hyoung Kim, M.D.1, Jae Bum Lee, M.D., Ph.D.2, Hyo
Myung Kim, M.D., Ph.D.3, Hung Won Tchah M.D.,
Ph.D.4, Tae Won Hahn , M.D., Ph.D.5, Mee Joo,
M.D. Ph.D.6, Chang Il Ha, M.D.1 Department of
Ophthalmology, Ilsan Paik Hospital, College of
Medicine, Inje University, Goyang, Korea1 Younse
Plus Eye Hospital, SungNam, Korea2 Department of
Ophthalmology, College of Medicine, Korea
University, Seoul, Korea3 Department of
Ophthalmology, College of Medicine, Ulsan
University, Seoul, Korea4 Apgujung St. Marys Eye
Center, Seoul, Korea5 Department of Pathology,
Ilsan Paik Hospital, College of Medicine, Inje
University, Goyang, Korea6

2
Purpose

• To determine the anatomic cleavage planes
  produced by
• various epikeratomes in Epi-LASIK
• I. Moria Epi-K Epikeratome?
• (Moria, Antony, France)
• II. Amadeus II Epikeratome?
• (Advanced Medical Optics, Santa Ana,
  CA, USA)
• III. Centurion SES Epikeratome?
• (Norwood Abbey Ltd., Melbourne,
  Australia)

3
Material Method

• Sixteen eyes (8 patients) were included in this
  study
• Three epikeratomes were each used to collect four
  epithelial flaps from two patients in the
  Epi-LASIK procedure (n12)
• Four epithelial flaps from two patients were also
  obtained by LASEK (n4)
• Immunohistochemical staining monoclonal
  antibodies against Integrin ß1, Integrin ß4,
  Laminin 5, and Collagen type VII was performed

4
Material Method

• Groups
• Group 1 Moria Epi-K Epikeratome?
• Group 2 Amadeus II Epikeratome?
• Group 3 Centurion SES Epikeratome?
• Group 4 LASEK

5
Results

• Immunohistochemical staining demonstrated
  expression of Integrin ß1 and Integrin ß4 in all
  epithelial flaps
• The expression of both Laminin 5 and Collagen
  type VII exhibited a linear or dotted pattern
  that differed based on the epikeratome used in
  Epi-LASIK.
• The expression of Laminin 5 and Collagen type
  VII exhibited a dotted pattern in the epithelial
  flaps obtained using LASEK

6
Results

• Immunohistochemical expression characteristicsa
• in epithelial flaps produced by various
  epikeratomes

7
Results
Expression patterns of collagen type VII of
epithelial flap ( immunochemical stain )
A. Dotted pattern B. Linear pattern
C. Mixture of linear and dotted pattern
8
Results
Immunochemical staining of Group 1 The staining
of integrin ß1 is intercellular and pericellular
in all epithelial cell layers of the epithelial
flaps (A, B) The staining of integrin ß4 is
found predominantly in the basal cell membrane of
the epithelial flaps with linear pattern. The
staining of laminin 5 is expressed by linear
pattern and the staining of collagen type VII is
expressed by mixed pattern (C, D)
9
Results
Immunochemical staining of Group 2 The staining
of integrin ß1 and integrin ß4 is expressed by
same pattern the epithelial flaps. But integrin
ß4 staining was focally present (A, B) The
staining of Laminin 5 is expressed by dotted
pattern and collagen type VII is not expressed at
the same area (C, D)
10
Results

• Immunochemical staining of
• Group 3
• The staining of integrin ß1 and
• integrin ß4 is expressed as like
• cases of other groups
• (A, B)
• The immunochemical stain of
• laminin 5 and collagen type VII
• is expressed linearly, continuously
• and thickly. In same area of
• epithelial flap, the stained area of
• Laminin 5 is located superiorly
• and the stained area of collage
• type VII is located inferiorly
• (C, D)

11
Results
Immunochemical staining of Group 4 The
staining of integrin ß1 and integrin ß4 is
expressed as like cases of other groups (A, B)
The immunochemical stain of laminin 5 and
collagen type VII is expressed by dotted and
focal pattern (C, D)
12
Conclusion

• Different epikeratomes may produce different
  cleavage planes and differences in the anatomical
  characteristics of the cleavage planes may
  influence the wound healing process after
  Epi-LASIK
• Repositioning of the epithelial flap appears to
  be ideal in Epi-LASIK using the Centurion SES
  Epikeratome?
• Discarding of the epithelial flap may be
  preferable in Epi-LASIK using the Amadeus II
  Epikeratome?
• However, because the role and fate of the
  basement membrane after Epi-LASIK are not yet
  known in detail, further investigations in a
  clinical setting or animal models are needed to
  elucidate the wound healing process after
  Epi-LASIK