SCAR TISSUE ORIENTATION IN UNSUTURED AND SUTURED CORNEAL WOUND-HEALING

Aims-This study aimed to evaluate stromal wound heating morphology in short term unsutured compared with sutured corneal wounds, to define r egional variation in healing within radial keratotomy wounds. Methods- Stromal scar tissue orientation (fibroblast and collagen fibre orienta tion) was analysed in unsutured and adjacent sutured keratotomy wounds in monkeys, 2 to 9 weeks after surgery, using light and transmission electron microscopy. Results-At 2 to 4 weeks, scar tissue orientation was transverse to the wound edge in unsutured wounds, but sagittal in sutured wounds. At 5 to 9 weeks, a re-orientation of scar tissue sagit tal to the wound was seen in the unsutured wounds, proceeding from the posterior to anterior wound regions. In sutured wounds, a scar tissue reorientation transverse to the wound was seen, proceeding from the a nterior wound region in a posterior direction. Conclusions-Within the same cornea, sutured and unsutured wounds showed opposite patterns of healing. Sutured wounds initially healed more slowly, but obtained pse udolamellar continuity over time. In contrast, healing of unsutured wo unds was characterised by an early approximation towards lamellar repa ir that was followed by an ineffective re-organisation of the scar. Th is latter pattern of healing, that may be associated with a variable w eakening of the wound, may relate to the clinical findings of unpredic tability and/or progression of refractive effect following radial kera totomy.