Abstract: The epithelial cell has the ability tore-establish itself. After corneal laser surgery, the epithelium remodels to obtain a smooth anterior corneal surface and reveals a non-uniform distribution across the entire cornea. The epithelial remodeling is related to the attempted refractive error correction and can be influenced by the surgical procedure and ocular surface condition. It plays a role in postoperative refractive regression. Understanding the changes in corneal epithelial thickness helps to improve the accuracy of refractive surgery. This article reviews the measurements of corneal epithelial thickness and postoperative epithelial remodeling.
Reinstein DZ, Archer TJ, Gobbe M. Rate of change of curvature of the corneal stromal surface drives epithelial compensatory changes and remodeling. J Refract Surg, 2014, 30(12): 799-802. DOI: 10.3928/1081597X-20141113-02.
Silverman RH, Urs R, RoyChoudhury A, et al. Epithelial remodeling as basis for machine-based identification of keratoconus. Invest Ophthalmol Vis Sci, 2014, 55(3): 1580- 1587. DOI: 10.1167/iovs.13-12578.
[4]
Hong J, Qian T, Yang Y, et al. Corneal epithelial thickness map in long-term soft contact lenses wearers. Optom Vis Sci, 2014, 91(12): 1455-1461. DOI: 10.1097/OPX.0000000000000410.
[5]
Atia R, Jouve L, Sandali O, et al. Early epithelial remodeling after standard and iontophoresis-assisted corneal cross-linking as evaluated by spectral-domain optical coherence tomography. J Refract Surg, 2018, 34(8): 551-558. DOI: 10.3928/1081597X- 20180702-01.
[6]
Reinstein DZ, Archer TJ, Gobbe M, et al. Epithelial thickness after hyperopic LASIK: Three-dimensional display with Artemis very high-frequency digital ultrasound. J Refract Surg, 2010, 26(8): 555-564. DOI: 10.3928/1081597X-20091105-02.
[7]
Chen X, Stojanovic A, Liu Y, et al. Postoperative changes in corneal epithelial and stromal thickness profiles after photorefractive keratectomy in treatment of myopia. J Refract Surg, 2015, 31(7): 446-453. DOI: 10.3928/1081597X-20150623- 02.
[8]
Luft N, Ring MH, Dirisamer M, et al. Corneal epithelial remodeling induced by small incision lenticule extraction (SMILE). Invest Ophthalmol Vis Sci, 2016, 57(9): 176-183. DOI: 10.1167/iovs.15-18879.
[9]
Ryu IH, Kim BJ, Lee JH, et al. Comparison of corneal epithelial remodeling after femtosecond laser-assisted LASIK and small incision lenticule extraction (SMILE). J Refract Surg, 2017, 33(4): 250-256. DOI: 10.3928/1081597X-20170111-01.
[10]
Fan L, Xiong L, Zhang B, et al. Longitudinal and regional nonuniform remodeling of corneal epithelium after topographyguided FS-LASIK. J Refract Surg, 2019, 35(2): 88-95. DOI: 10.3928/1081597X-20190104-01.
[11]
Tang M, Li Y, Huang D. Corneal epithelial remodeling after LASIK measured by fourier-domain optical coherence tomography. J Ophthalmol, 2015, 2015(6): 860313-860315. DOI: 10.1155/2015/860313.
[12]
Salomão MQ, Hofling-Lima AL, Lopes BT, et al. Role of the corneal epithelium measurements in keratorefractive surgery. Curr Opin Ophthalmol, 2017, 28(4): 326-336. DOI: 10.1097/ ICU.0000000000000379.
[13]
Hodden BA, Payor S, Mertz GW. Changes in thickness in the corneal layers. Am J Optom, 1979, 56: 821.
[14]
Møller-Pedersen T, Vogel M, Li HF, et al. Quantification of stromal thinning, epithelial thickness, and corneal haze after photorefractive keratectomy using in vivo confocal microscopy. Ophthalmology, 1997, 104(3): 360-368. DOI: 10.1016/s0161- 6420(97)30307-8.
[15]
Reinstein DZ, Silverman RH, Coleman DJ. High-frequency ultrasound measurement of the thickness of the corneal epithelium. Refract Corneal Surg, 1993, 9(5): 385-387.
[16]
Reinstein DZ, Archer TJ, Gobbe M. Change in epithelial thickness profile 24 hours and longitudinally for 1 year after myopic LASIK: Three-dimensional display with Artemis very high-frequency digital ultrasound. J Refract Surg, 2012, 28(3): 195-201. DOI: 10.3928/1081597X-20120127-02.
[17]
Reinstein DZ, Yap TE, Archer TJ, et al. Comparison of corneal epithelial thickness measurement between fourier-domain OCT and very high-frequency digital ultrasound. J Refract Surg, 2015, 31(7): 438-445. DOI: 10.3928/1081597X-20150623-01.
[18]
Hashmani N, Hashmani S, Saad CM. Wide corneal epithelial mapping using an optical coherence tomography. Invest Ophthalmol Vis Sci, 2018, 59(3): 1652-1658. DOI: 10.1167/ iovs.17-23717.
[19]
Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography. Science, 1991, 254(5035): 1178-1181. DOI: 10.1126/science.1957169.
[20]
Ma JX, Wang L, Weikert MP, et al. Evaluation of the repeatability and reproducibility of corneal epithelial thickness mapping for a 9-mm zone using optical coherence tomography. Cornea, 2019, 38(1): 67-73. DOI: 10.1097/ICO.0000000000001806.
[21]
Sella R, Zangwill LM, Weinreb RN, et al. Repeatability and reproducibility of corneal epithelial thickness mapping with spectral domain optical coherence tomography in normal and diseased cornea eyes. Am J Ophthalmol, 2019, 197: 88-97. DOI: 10.1016/j.ajo.2018.09.008.
[22]
Wang J, Fonn D, Simpson TL, et al. Precorneal and pre- and postlens tear film thickness measured indirectly with optical coherence tomography. Invest Ophthalmol Vis Sci, 2003, 44(6): 2524-2528. DOI: 10.1167/iovs.02-0731.
[23]
Werkmeister RM, Alex A, Kaya S, et al. Measurement of tear film thickness using ultrahigh-resolution optical coherence tomography. Invest Ophthalmol Vis Sci, 2013, 54(8): 5578- 5583. DOI: 10.1167/iovs.13-11920.
[24]
Dua HS, Shanmuganathan VA, Powell-Richards AO, et al. Limbal epithelial crypts: A novel anatomical structure and a putative limbal stem cell niche. Br J Ophthalmol, 2005, 89(5): 529-532. DOI: 10.1136/bjo.2004.049742.
[25]
Kanellopoulos AJ, Asimellis G. Longitudinal postoperative lasik epithelial thickness profile changes in correlation with degree of myopia correction. J Refract Surg, 2014, 30(3): 166-171. DOI: 10.3928/1081597X-20140219-01.
Lohmann CP, Patmore A, Reischl U, et al. The importance of the corneal epithelium in excimer-laser photorefractive keratectomy. Ger J Ophthalmol, 1996, 5(6): 368-372.
[31]
Lohmann CP, Reischl U, Marshall J. Regression and epithelial hyperplasia after myopic photorefractive keratectomy in a human cornea. J Cataract Refract Surg, 1999, 25(5): 712-715. DOI: 10.1016/s0886-3350(99)00014-0.
[32]
Ivarsen A, Fledelius W, Hjortdal JØ. Three-year changes in epithelial and stromal thickness after PRK or LASIK for high myopia. Invest Ophthalmol Vis Sci, 2009, 50(5): 2061-2066. DOI: 10.1167/iovs.08-2853.
[33]
Chayet AS, Assil KK, Montes M, et al. Regression and its mechanisms after laser in situ keratomileusis in moderate and high myopia. Ophthalmology, 1998, 105(7): 1194-1199. DOI: 10.1016/S0161-6420(98)97020-8.
[34]
Pan Q, Gu YS, Wang J, et al. Differences between regressive eyes and non-regressive eyes after LASIK for myopia in the time course of corneal changes assessed with the Orbscan. Ophthalmologica, 2004, 218(2): 96-101. DOI: 10.1159/ 000076143.
[35]
Moshirfar M, Desautels JD, Walker BD, et al. Mechanisms of optical regression following corneal laser refractive surgery: Epithelial and stromal responses. Med Hypothesis Discov Innov Ophthalmol, 2018, 7(1): 1-9.
[36]
Cho Y, Hieda O, Wakimasu K, et al. Multiple linear regression analysis of the impact of corneal epithelial thickness on refractive error post corneal refractive surgery. Am J Ophthalmol, 2019, 207: 326-332. DOI: 10.1016/j.ajo.2019.05. 016.
[37]
Ganesh S, Brar S, Relekar KJ. Epithelial thickness profile changes following small incision refractive lenticule extraction (SMILE) for myopia and myopic astigmatism. J Refract Surg, 2016, 32(7): 473-482. DOI: 10.3928/1081597X-20160512-01.
[38]
Reinstein DZ, Srivannaboon S, Gobbe M, et al. Epithelial thickness profile changes induced by myopic LASIK as measured by Artemis very high-frequency digital ultrasound. J Refract Surg, 2009, 25(5): 444-450. DOI: 10.3928/1081597X- 20090422-07.
[39]
Kanellopoulos AJ. Comparison of corneal epithelial remodeling over 2 years in LASIK versus SMILE: A contralateral eye study. Cornea, 2019, 38(3): 290-296. DOI: 10.1097/ ICO.0000000000001821.
[40]
Vinciguerra P, Azzolini C, Vinciguerra R. Corneal curvature gradient determines corneal healing process and epithelial behavior. J Refract Surg, 2015, 31(4): 281-282. DOI: 10.3928/1081597X-20150319-08.
[41]
Wilson SE, Mohan RR, Hong JW, et al. The wound healing response after laser in situ keratomileusis and photorefractive keratectomy: elusive control of biological variability and effect on custom laser vision correction. Arch Ophthalmol, 2001, 119(6): 889-896. DOI: 10.1001/archopht.119.6.889.
[42]
Huang D, Tang M, Shekhar R. Mathematical model of corneal surface smoothing after laser refractive surgery. Am J Ophthalmol, 2003, 135(3): 267-278. DOI: 10.1016/s0002- 9394(02)01942-6.
[43]
Ljubimov AV, Saghizadeh M. Progress in corneal wound healing. Prog Retin Eye Res, 2015, 49: 17-45. DOI: 10.1016/ j.preteyeres.2015.07.002.
[44]
Suzuki K, Saito J, Yanai R, et al. Cell-matrix and cell-cell interactions during corneal epithelial wound healing. Prog Retin Eye Res, 2003, 22(2): 113-133. DOI: 10.1016/s1350- 9462(02)00042-3.