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Biomechanics and Wound Healing in the Cornea

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Variations in the biomechanical and wound healing properties of the cornea undermine the predictability and stability of refractive surgery and contribute to discrepancies between attempted and achieved visual outcomes after corneal refractive procedures. Furthermore, patients predisposed to biomechanical failure or abnormal wound healing can experience serious complications such as corneal ectasia or clinically significant corneal haze. In this review, we describe the cornea as a complex structural composite material with pronounced anisotropy and heterogeneity, summarize current understanding of major biomechanical and reparative pathways that contribute to the corneal response to laser vision correction, and review the role of these processes in postoperative complications such as ectasia and stromal fibrosis (scarring haze). Differences in the corneal response after photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE) are reviewed. Surgical and disease models that account for corneal geometric data, microstructural anatomy, material properties, and wound healing behavior have the potential to improve clinical outcomes and minimize complications but depend on the identification of preoperative predictors of biomechanical and wound healing responses in individual patients.

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Authors and Affiliations

  1. Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA

    Vinicius S. De Stefano

  2. Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    William J. Dupps Jr. & Steven E. Wilson

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  1. Vinicius S. De Stefano
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  2. William J. Dupps Jr.
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  3. Steven E. Wilson
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Correspondence to William J. Dupps Jr. .

Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Oregon Health & Science University Department of Ophthalmology, Portland, OR, USA

    Daniel Albert

  2. Massachusetts Eye and Ear, Boston, MA, USA

    Joan Miller

  3. Department of Ophthalmology, University of Illinois at Chicago Department of Ophthalmology, Chicago, IL, USA

    Dimitri Azar

  4. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  2. Division of Ophthalmology, Department of Pathology and Surgery, Universidad Miguel Hernandez, Alicante, Spain

    Jorge Alio

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De Stefano, V.S., Dupps, W.J., Wilson, S.E. (2021). Biomechanics and Wound Healing in the Cornea. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_224-1

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