A randomized clinical trial of the nonsteroidal eyedrop diclofenac after strabismus surgery

OBJECTIVE: This study aimed to compare the anti-inflammatory and analgesic effects of topical diclofenac sodium 0.1% (Voltaren) with prednisolone sodium phosphate 1% ophthalmic solution after strabismus surgery. DESIGN: A prospective, double-masked, randomized, two-center clinical trial. PARTICIPANTS: Eighty eyes of 52 patients undergoing strabismus surgery were examined. INTERVENTION: For 1 week after surgery, the eye that was operated on received one drop of either diclofenac or prednisolone four times a day. MAIN OUTCOME MEASURES: The diclofenac- and prednisolone-treated eyes were compared on postoperative days 3 and 7 with respect to signs of inflammation (e.g., erythema, edema, discharge), patient comfort, and conjunctival incisional healing. RESULTS: On postoperative day 7, in eyes that received prednisolone, the conjunctival defects were larger (P = 0.004) and more frequent (P = 0.02). For all subjects, despite adequate statistical power, there was no statistically significant difference in inflammatory scores between eyes that received diclofenac or prednisolone. In cases of bilateral surgery, however, there was less postoperative erythema and edema in the diclofenac-treated eyes. CONCLUSIONS: In the first week after strabismus surgery, topical diclofenac proved at least as effective as prednisolone in controlling inflammation and discomfort with less delay in incisional wound healing. Topical diclofenac, a nonsteroidal anti-inflammatory agent, may be considered for use after strabismus surgery in place of corticosteroids.     

Conjunctival wound closure by saline injection in sutureless, scleral tunnel incision phacoemulsification

PURPOSE: To compare two methods of conjunctival closure in phacoemulsification. SETTING: Frimley Park Hospital NHS Trust, Surrey, England. METHODS: This prospective, randomized study comprised 40 patients (40 eyes) who had phacoemulsification via superior axis scleral tunnels and implantation of a poly(methyl methacrylate) intraocular lens with a 5.5 mm optic diameter. In 24 eyes, the conjunctival wound was closed manually with a Moorfields forceps (Group A). In 16, 0.5 ml of balanced salt solution was injected subconjunctivally to reappose the conjunctival wound (Group B). Conjunctival reapposition was assessed by measuring the maximum radial distance of bare sclera preoperatively and during outpatient clinic visits at 1, 7, and 28 days postoperatively. RESULTS: Follow-up was obtained on 38 eyes. One day after surgery, total wound closure was achieved in 15 of 16 eyes in Group B; however, closure was still incomplete in 13 of 22 Group A eyes. At 7 days postoperatively, the size of the conjunctival wound remained significantly smaller in Group B eyes (P < .01). CONCLUSION: The saline injection produced a faster rate of conjunctival wound closure than standard manual reapposition.     

Wound healing of scleral self-sealing incision: a comparison of ultrasound biomicroscopy and histology findings

PURPOSE: The goal of this study was to compare the morphologic findings of wound healing in scleral self-sealing incisions using ultrasound biomicroscopy and histology. METHODS: Using a slit-knife, we made a scleral self-sealing incision in the rabbit eye. At various time points postoperatively, ultrasound biomicroscopy was performed to evaluate wound healing; the eyes then were enucleated and studied histologically. We also performed ultrasound biomicroscopy at various time points postoperatively in patients who received a scleral self-sealing incision during cataract surgery. RESULTS: In rabbit eyes, on days 1 and 2 postoperatively, we detected the scleral wound; thereafter, detection became increasingly difficult. On day 7 postoperatively, the wound was undetectable. By light-microscopic observation, the scleral wound was open at 1 day postoperatively. On day 2 postoperatively, fibrovascular tissue barely extended into the wound; on day 5 postoperatively, connective tissue extended through the full thickness of the wound. On day 7 postoperatively, the connective tissue became dense and aligned with the lamella. In human eyes, using ultrasound biomicroscopy, the scleral incision was detectable until 5 days postoperatively, but undetectable at 7 days postoperatively. CONCLUSIONS: Ultrasound biomicroscopy demonstrates the stages of wound healing of scleral self-sealing incisions. We believe that careful observation is necessary for approximately 7 days following self-sealing incision cataract surgery.     

Psychologic factors involved in the decision to undergo reconstructive surgery after burn injury

We have developed a new in vivo model for the study of fetal wound healing. Fetal ICR mice (total gestation, 21 days) received a full-thickness incisional wound in the hind limb at gestational day 14 (N = 100). The wound was made with a 28.5-gauge needle that was passed transplacentally into the amniotic cavity. The wounds were analyzed histologically on postoperative days 0, 1, 3, and 5 by hematoxylin-eosin and Mallory's trichrome stains. Once the wounding technique was mastered, the overall mortality rate for this model was 20% by postwounding day 5. Each fetus healed their wound without scar by postwounding day 3. In 3 animals, 5 microliters of human transforming growth factor beta 1 (25 micrograms per microliter) was injected into the wound site, resulting in scar and an inflammatory cell infiltrate, indicating that the 14-day-gestation fetal mouse can be manipulated if necessary. This model offers the advantages of an in vivo system that can be studied at an early gestational age. Furthermore, it is inexpensive, easy to manipulate, and can be studied with commercially available murine probes.     

Activation and detoxification of dinitropyrenes by cytosol and microsomes from Aroclor-pretreated rats in the Ames and umu assays

PURPOSE: To evaluate the efficacy of topical mitomycin C in treating conjunctival and corneal epithelial dysplasia and neoplasia. METHODS: Seven eyes of seven patients with conjunctival and corneal epithelial dysplasia and neoplasia were treated with one drop of topical mitomycin C 0.04% four times a day for 7 days in alternate weeks. The patients' charts were reviewed retrospectively. Patients with either multiple recurrences or extensive ocular surface involvement were treated. In all eyes, the diagnosis of epithelial dysplasia or neoplasia was confirmed by histopathology before the onset of therapy. Patients were examined at least every 14 days during treatment and examined at intervals after completion of treatment. RESULTS: With topical mitomycin C, six eyes of seven patients had complete clinical regression of their conjunctival and corneal epithelial dysplasia and neoplasia. One eye of one patient had partial clinical regression of conjunctival and corneal epithelial dysplasia. Follow-up after completion of topical mitomycin C therapy and excision of residual disease ranged from 2 to 16 months (mean, 9 months; SD, 4.3 months) and was without clinical sign of recurrence. Topical mitomycin C therapy was associated with transitory ocular discomfort, conjunctival injection, tearing, photophobia, and punctate epithelial keratopathy. CONCLUSION: In this small series of eyes, topical mitomycin C was effective as a treatment for conjunctival and corneal epithelial dysplasia and neoplasia.     

Reconstruction of filtering blebs with free conjunctival autografts

BACKGROUND: Situations arise in which the surgical repair or revision of filtering blebs is either technically impossible or inadequate, and total reconstruction becomes necessary. This is most frequently encountered in eyes that have undergone multiple procedures, resulting in significant bulbar conjunctival scarring and episcleral fibrosis. METHODS: To preserve the pre-existing filtration site, the authors successfully treated five such patients in whom conjunctival scarring adjacent to and surrounding the blebs precluded local revision, by transplanting free conjunctival autografts. Two patients required grafting from the fellow eye. Specific modifications from previously reported conjunctival flap techniques were used to enhance graft healing and continued filtration. RESULTS: Satisfactory intraocular pressure control was maintained in all patients receiving minimal to no anti-glaucomatous medications with an average follow-up of 42.6 months (range, 7-90 months). No patient had a significant decrease in visual acuity or surgical complications. CONCLUSION: Free conjunctival autografting techniques are a useful adjunct in the surgical revision of leaking, failed, or migrating filtration blebs.     

Dexon and nylon-sutured wound reaction in conjunctival flap after trabeculectomy combined with or without topical application of mitomycin-C

In this study, rabbits were used to evaluate the sutured wound reaction with Dexon or nylon in the conjunctival flap 1, 4, 7, 14 and 28 days after trabeculectomy surgery with or without the use of mitomycin-C. Four major treated groups were used to compare their wound healing reaction; group 1--nylon-suture and non-mitomycin treatment; group 2--nylon-suture and mitomycin treatment; group 3--Dexon-suture and non-mitomycin treatment; group 4--Dexon-suture and mitomycin treatment. One day after surgery, the number of polymorphs was the greatest most in the nylon-sutured and non-mitomycin treated tissues (86 +/- 2). Four days after surgery, the number of polymorphs was the greatest most in Dexon-sutured and non-mitomycin treated tissues (109 +/- 87). The number of fibroblasts was the greatest most in nylon-sutured and non-mitomycin treated tissues (111 +/- 23). Seven days after surgery, the number of polymorphs was the greatest most in Dexon-sutured and mitomycin treated tissues (32 +/- 12). The number of fibroblasts was the greatest most in nylon-sutured and non-mitomycin treated tissues (126 +/- 15). Fourteen days after surgery, the number of fibroblasts was the greatest most in Dexon-sutured and non-mitomycin tissues (43 +/- 10). The number of goblet cells was the greatest most in nylon-sutured and non-mitomycin treated tissues (4 +/- 2). Twenty-eight days after surgery, the number of fibroblasts was the greatest most in Dexon-sutured and mitomycin treated tissues (40 +/- 15). The number of goblet cells was the greatest most in nylon-sutured and non-mitomycin treated tissues (4 +/- 2). Our conclusions are as follows: 1). The concentration of mitomycin in conjunctival wound edge should be maintained at as low a level as possible because the mitomycin will delay the wound healing process; 2). Nylon material is better than Dexon for conjunctival wound suture because nylon could induce a great quantity of fibroblasts before Dexon did.     

Natural complex of cytokines is a potent stimulant to posttraumatic regeneration in rabbit cornea

We elaborated an original technique based on local application of natural complex of cytokines (NCC) secreted by autologous peripheral leukocytes. In this study, we evaluated NCC influence on the healing of penetrating corneal wounds. NCC was derived from supernatants of PHA-stimulated rabbit peripheral leukocytes. Biological tests revealed the presence of IL-1, TNF, IL-6, MIF, and LIF in the complex. Chinchilla rabbits with standard penetrating corneal wounds received daily NCC instillation. The controls were instilled with cultural media 199 with antibiotics. At 24 hours, 3, 7, 14 and 30 days post-wounding, the rabbits were euthanized. We performed morphometry of corneal cross-sections stained with hematoxylin and eosin. In NCC-treated animals, we observed more vigorous migration and activation of neutrophils and macrophages followed by augmented resorption of fibrin. The later post-injury period (14-30 days) was marked with complete healing of the endothelial defect (in the controls, the mass of proliferating cells projected into the anterior eye chamber) and mature scar tissue with a higher content of fibrous component. NCC-treated eye scars were 1.6-fold thinner than the controls'. Local application of NCC promotes effective healing of posttraumatic cornea. It regulates all stages of regeneration and prevents rude scarring.     

Hermann Pinkus Memorial Lecture--1992. Autoimmunity to collagen VII: Autoantibody-mediated pathomechanisms regulate clinical-pathological phenotypes of acquired epidermolysis bullosa and bullous SLE

An experimental model of proliferative vitreoretinopathy (PVR) induced by macrophages simulates a special form of wound healing process in the eye and mimics the development of PVR from its initial stage. We used this model for the evaluation of drug efficacy in the prevention of PVR. One mg triamcinolone acetonide (TA), 10 micrograms daunomycin-liposome (DL), 5 micrograms free daunomycin (FD) and 0.1 ml saline or empty liposomes (as controls) were injected into the vitreous in four groups of animals (30 or 40 rabbit eyes each) after macrophage injection. Retinal detachment developed in 77.5% of the control eyes on day 28, compared to 13.3% of the TA-treated eyes (P < 0.01), to 33.3% of the eyes treated with DL (P < 0.01), and 50% of the FD-treated eyes (P < 0.05). TA cleared up from the vitreous within 35-63 days (average 45.5 days). The half-time of FD clearance was 145.5 min. Although DL declined rapidly during the first 2 days, there was an average of 0.64 microgram/ml daunomycin in the vitreous on day 14. Transmission electron microscopy showed that FD at a dosage of over 5 micrograms or DL over 20 micrograms was toxic to the retina and that up to 4 mg TA was nontoxic. These results suggest that steroids such as TA, given at the inflammatory stage, can effectively and safely prevent the development of PVR, and that encapsulation in liposomes of cytotoxic agents such as daunomycin can enhance drug efficacy and reduce toxicity. The time course of initiation and development of PVR is important in the selection of particular drugs.     

Understanding and controlling the scarring response: the contribution of histology and microscopy

In response to injury, the body usually initiates a full and swift wound healing response resulting in reconstructed, repaired tissue. In certain instances, due to a variety of factors, this may not happen, an example being chronic granulating venous leg ulcers. At the other extreme, the wound may heal excessively, producing disabling hypertrophic scarring such as can occur following large, deep burn injuries. Our group is interested in the surgical treatment of the eye disease glaucoma. As will be explained, the successful surgical treatment of this disease depends on a reduced scarring response at the end of wound healing. The purpose of this article is to give an overview of our microscopic and histological experimental work which has furthered our understanding of tissue repair, particularly the scarring response and its potential modification for successful glaucoma surgery.     

Thriving older African American women: aging after Jim Crow

Success of glaucoma filtration surgery is influenced by the wound healing response. Attention has been focused on pharmacological agents to control a process that leads to excessive scarring and eventual failure of glaucoma filtration surgery. Several agents, including 5-fluorouracil and mitomycin C, as well as other antiproliferative drugs will be discussed. Newer antifibrotic agents and novel drug delivery systems are under development in tissue culture and animal models in an effort to improve efficacy and safety. This article summarizes current treatment modalities and future prospects to prevent excessive wound healing and improve the success of glaucoma filtration surgery.     

Suramin inhibits wound healing following filtering procedures for glaucoma

BACKGROUND: Trabeculectomies are the most frequently performed procedures in surgically treating eyes with glaucoma. Failures are caused by fibrosis in the external ostium of the filtering procedure. In order to inhibit the fibrotic wound healing reaction, a new pharmacological approach using suramin, which inhibits a variety of important growth factors was used. METHODS: Pigmented rabbits were used and filtering procedures performed. Suramin was applied with concentrations ranging from 10 mg/ml to 333 mg/ml once during surgery and four times following surgery. The success of the filtering procedure was assessed by intraocular pressure measurements. To evaluate possible intraocular toxic effects, treated eyes were histopathologically evaluated after 4 weeks, and the ciliary body adjacent to the site of application was examined using electron microscopy. RESULTS: With concentrations of suramin of 200 mg/ml and 333 mg/ml, the trabeculectomies were patent longer than in the controls and in eyes operated with mitomycin C, which currently is the most frequently used antiproliferative drug to enhance the outcome of surgery in humans. No severe toxic effects to the ciliary epithelium were seen in suramin treated eyes. CONCLUSIONS: This study demonstrates for the first time the efficiency of a substance that broadly inhibits the action of growth factors on target cells in the setting of ocular wound healing. In this in vivo model, suramin has been shown to be highly effective in preventing scarring and in having fewer toxic side effects than usually used antimetabolites. These results therefore may suggest a new approach to the surgical treatment of glaucoma.     

Malingering behavior in private medical practice

OBJECTIVE: This study investigated the influence of the fetal environment on the healing characteristics of adult skin. SUMMARY BACKGROUND DATA: The remarkable ability of the fetus to heal without scarring is poorly understood. The unique qualities of fetal wound healing may be caused by the fetal environment, the fetal tissues, or a combination of both. There are numerous differences between the prenatal and postnatal environments that may play a role in the unique fetal response to injury. METHODS: Full-thickness adult sheep skin was transplanted onto the backs of 60-day-gestation fetal lambs (term, 145 days of gestation). The adult skin grafts were thus perfused by fetal blood and bathed in amniotic fluid. Previous work has demonstrated that, before midgestation, fetal lambs do not reject allogenic skin grafts. Forty days later (100 days of gestation), incisional wounds were made on both the adult skin graft and the adjacent fetal skin. The wounds were harvested 14 days postwounding and analyzed by both light microscopy and immunohistochemical testing using antibodies to collagen types I, III, and VI. RESULTS: The wounds in the adult skin grafts healed with scar formation. This observation contrasts strongly with the scarless healing of the incisional fetal skin wounds. CONCLUSIONS: This study suggests that scarless fetal skin healing properties are intrinsic to fetal skin and are not primarily the result of the fetal environment.     

Comparative results of combined procedures for glaucoma and cataract: II. Limbus-based versus fornix-based conjunctival flaps

BACKGROUND AND OBJECTIVE: One of the variables to be considered in a combined procedure for glaucoma and cataract is the type of conjunctival flap to be used. The objective of this study was to compare the effects of limbus-based and fornix-based conjunctival flaps on postoperative long-term intraocular pressure (IOP) control and visual acuity after combined trabeculectomy with phacoemulsification. PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 189 patients (215 eyes) who underwent combined trabeculectomy with phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and intraoperative mitomycin-C administration and who had a minimum follow-up of 12 months. The results of the limbus-based (151 eyes) versus fornix-based (64 eyes) conjunctival incisions used in these combined procedures were compared. RESULTS: In the limbus-based conjunctival flap group, 146 eyes (97%) achieved an IOP of less than 20 mm Hg, with or without medication; 62 eyes (97%) of the fornix-based conjunctival flap group (P > .05) achieved this result. A visual acuity of 20/40 or better was noted in 106 eyes (70%) in the limbus-based conjunctival flap group and in 45 eyes (70%) in the fornix-based conjunctival flap group (P > .05) at the last examination. Early wound leakage was observed more frequently in the fornix-based conjunctival flap group (8% vs 1%) (P = .014); however, it was not a serious clinical problem, as only 1 eye required surgical repair. Posterior capsular opacification was found more often in the limbus-based conjunctival flap group (25% vs 14%) (P = .072) and required more frequent laser capsulotomy (22% vs 9%) (P = 0.03). CONCLUSION: Limbus-based and fornix-based conjunctival flaps appear to be comparable with respect to postoperative IOP control and visual acuity after a combined trabeculectomy with phacoemulsification and posterior chamber IOL implantation in cases supplemented by intraoperative mitomycin-C.     

Acute and chronic animal models for excessive dermal scarring: quantitative studies

Excessive scarring in the form of keloids and hypertrophic scars continues to be a clinical problem for some patients. The lack of an animal model for such scarring has been an obstacle to studying the cellular and molecular biology of these entities. Previous observations made by the authors that some surgical scars in the rabbit ear remain raised for months after wounding prompted us to investigate whether the rabbit ear might provide a model by which to study excessive dermal scarring. After establishing the model in preliminary study, 40 excisional wounds, 6 mm in diameter, were created over the ventral surface of rabbit ears. Elevated scars were treated with either intralesional triamcinolone acetonide or saline at day 16 postwounding. On day 22, 25 scar wounds were used for thorough histomorphometric analysis, 15 wounds were eliminated prior to analysis because of invagination of epithelial tissue, which made analysis difficult. Total area of scar and Hypertrophic Index, a ratio comparing scar prominence with the thickness of adjacent unwounded tissue, were measured for 25 (62 percent) of the resulting scars. Both total area of scar and Hypertrophic Index were found to be significantly decreased in the steroid-treated group (p < 0.02 and < 0.03, respectively). In a chronic form of this model, in which larger excisions were taken, an excessive accumulation of both new collagen and cartilage over 9 months was observed. An animal model for excessive dermal scarring that allows quantitation of scar formation and, at an early stage, can be modulated in a predictable way with intralesional corticosteroid treatment is presented. This model may parallel hypertrophic scarring in humans and thus might provide a tool by which to study its pathophysiology and objectively evaluate therapeutic modalities.     

2-Iminothiazolidine-4-carboxylic acid produces hippocampal CA1 lesions independent of seizure excitation and glutamate receptor activation

Impaired wound healing is a common complication of diabetes mellitus. The underlying pathophysiology of diabetes-impaired healing is poorly understood. In the present study we have compared cell proliferation rates, apoptosis (programmed cell death), the myofibroblast marker alpha-smooth muscle actin and procollagen I mRNA expression, between diabetic and control mice. Full-thickness skin wounds were made in non-obese diabetic (NOD) mice and C57B6 controls. NOD mice showed a marked retardation of wound healing at both 7 and 14 days after wounding. Comparison of cell proliferation rates 7 days after wounding, using 5-bromo-2'-deoxy-Uridine incorporation, showed higher rates of cell proliferation in controls (88.1 +/- 12.8) than in NOD wounds (52.1 +/- 9.9, p < 0.02, n = 4). Immunohistochemical detection of alpha-smooth muscle actin, showed a later onset in diabetic wounds, suggesting that wound contraction may be delayed in the diabetic animals. In situ hybridisation for alpha 1 (I) procollagen mRNA expression, showed reduced procollagen I expression in the diabetic wounds when compared with controls. Lastly, there appeared to be higher levels of apoptosis in diabetic wounds, shown by the terminal transferase mediated UTP nick end-labelling technique. Apoptotic cells were rare in control wounds confirming previous studies, which showed that apoptosis occurs late in normal wound healing as the wound matures into scar tissue. In conclusion, we hypothesize that reduced cell proliferation, retarded onset of the myofibroblast phenotype, reduced procollagen I mRNA expression and aberrant control of apoptotic cell death may contribute to impaired wound healing seen in this diabetic model.     

Reconstruction of the constricted orbital cavity in patients with artificial anophthalmy

In cases, in which not only the globe of the eye, but the whole conjunctival sack is missing and the eyelids are due to scarring attached either to the orbital tissues and/or to each other, it is not possible to insert a prosthesis. This is a major aesthetic defect. The cavity that allows artificial eye insertion can be formed by surgery. One of the best methods is the orbital cavity reconstruction developed and suggested by the Hungarian István Csapody. He constructed two instruments to perform the operation: a butterfly shaped marker to prepare skin graft with proper size and shape, and an adjustable cone formed spacer to keep the reconstructed socket open during the healing process. We use free autologous split skin graft to line the cavity. If the shapes of the eyelids are intact, and the color of the prosthesis matches the fellow eye and it fits perfectly, then the postoperative cosmetic result can be excellent.     

Reproducible model of a bacterial conjunctivitis

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topic we have developed a model of bacterial conjunctivitis in the rabbit eye. Instillation of a suspension of Haemophilus influenzae, Staphylococcus epidermidis or Staphylococcus aureus into the cul-de-sac did not result in any effect. Thus, standardized techniques of conjunctival incision were used additionally. A follow-up was done for a period of 2 weeks (degree of conjunctival hyperemia, microbiology). Radial incision of the conjunctiva with injection of an S. aureus suspension (50 microliters of ATCC 29213; 1.35 x 10(8) cells) was done mimicking a branch injury. This resulted in a purulent conjunctivitis over a period of 1 week and disappeared within 14 days. The swabs were negative on day 7. This is the first model establishing a reproducible purulent conjunctivitis in the rabbit. Using this model antimicrobial substances may be tested under standardized conditions.     

Tenascin-C expression in normal, inflamed, and scarred human corneas

AIMS/BACKGROUND: In adult tissues the expression of tenascin-cytotactin (TN-C), an extracellular matrix glycoprotein, is limited to tumours and regions of continuous renewal. It is also transiently expressed in cutaneous and corneal wound healing. There are limited data regarding its expression in inflammation and scarring of the adult human cornea. In this study, TN-C expression patterns in normal, inflamed, and scarred human corneas have been examined. METHODS: Penetrating keratoplasty specimens were selected from cases of herpes simplex keratitis, herpes zoster ophthalmicus, rheumatoid arthritis ulceration, bacterial keratitis, rosacea keratitis, interstitial keratitis, and previous surgery so as to encompass varying degrees of active and chronic inflammation and scarring. TN-C in these and in normal corneas was immunodetected using TN2, a monoclonal antibody to human TN-C. RESULTS: There was no TN2 immunopositivity in normal corneas except at the corneoscleral interface. In pathological corneas, TN2 immunopositivity was localised in and around regions of active inflammation, fibrosis, and neovascularisation. TN2 positivity was less in acute inflammation than in active chronic inflammation. Mature, avascular scar tissue and epithelial downgrowth were TN2 negative. CONCLUSION: These results indicate that in the adult human cornea, TN-C expression is induced in regions of inflammation, fibrosis, and neovascularisation, but that expression is absent in mature, avascular scar tissue. This suggests a role for this glycoprotein in inflammation, healing, and extracellular matrix reorganisation of the cornea.     

Inhibition of cathepsin B by its propeptide: use of overlapping peptides to identify a critical segment

OBJECTIVE: The study was designed to investigate the corneal changes at various times after epikeratophakia performed on rabbit cornea. METHODS: The process of epithelial repair, or interlayer healing, the changes of endothelial cells and Langerhans cells (LC) in corneal epithelium were observed at different intervals after surgery by using histochemistry technique. RESULTS: The epithelial repair of the graft was completed by 4-12 postoperative days. The repopulation of keratocytes was seen firstly at peripheral and superior part of the lenticule at 7-14 postoperative days and completed to normal by postoperative 2 months. No changes were observed in the endothelial cells. The proliferation of LC was observed in the limbal epithelium at day 3, reached the peak by day 14 and recovered to normal at month 2 postoperatively. CONCLUSION: Epikeratophakia is available and safe, The proliferation of LC might result from wound healing not from immune rejection.