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In Vivo Confocal Microscopy of Epithelial Inclusions From Aberrant Wound Healing After Astigmatic Keratotomy

Objective: To report confocal microscopic findings in vivo of delayed prominent epithelial inclusions at a gaped incision groove after astigmatic keratotomy (AK). Methods: Astigmatic keratotomy using paired arcuate incisions was performed on the right eye of a 59-year-old man who had a preoperative refraction of +2.50 DS, −7.00 DC × 80. The procedure and initial postoperative course were uneventful, and his refraction was OD +1.00 DS, −2.50 DC × 60 at 16 months. However, at 17 months postsurgery, tiny pearl-like lesions appeared along one of the incision grooves. In vivo confocal microscopy was performed to investigate these lesions. Results: Under confocal microscopy, clusters of epithelial inclusions inside the gaped incision groove corresponded to the pearl-like lesions observed clinically. A confluent layer of flat, regular and polygonal epithelial cells covered the wall of the groove. Activated keratocytes were observed adjacently. The number of keratocytes around the groove, however, did not appear to increase in comparison to normal corneal wound healing and scar formation. No foreign body, infective, or inflammatory signs were observed. Conclusions: Aberrant wound healing was identified in post-AK incisions, similar to post–radial keratotomy cases. Confocal microscopy is a useful tool to study the wound healing of AK incisions and to rule out foreign bodies or infective elements as illustrated by this case. To the best of our knowledge, this is the first reported in vivo confocal study of AK wound healing in humans.