Radial keratotomy offers a unique opportunity to study corneal wound healing because the corneas are normal, the fine knife blades disrupt adjacent tissue minimally, no
sutures are used, there is minimal
inflammation, and few postoperative drugs are administered. We studied corneal
wounds with a
slit-lamp microscope as they healed from two weeks to three years after
radial keratotomy in 84 eyes of 51 consecutive patients enrolled in the Prospective Evaluation of
Radial Keratotomy (PERK) Study. One day after surgery, the incisions were surrounded by
edema. At two weeks, a dense, gray, diffusely marginated opacity occupied 0.1 mm on both sides of the incision. At three months, the area adjacent to the incision was filled with discrete, fine, gray spicules that protruded at right angles from the incision. At six months, the gray cloudiness had completely disappeared, and the individual spicules were more prominent. By one year, the spicules were disappearing from the anterior portion of the incision and were concentrated primarily in the posterior part of the incisions. At two and three years, the incision
scar was fainter and the spicules had disappeared from all but the deep posterior part of the
wound. We believe that these spicules correspond to the reorganization of the stroma along the edges of the corneal incision. The persistence of the spicules suggests that wound healing in
radial keratotomy may not be complete until two years or more after surgery.