Purpose: To examine the latest theories in understanding wound healing, primarily as it pertains to refractive surgery but also, briefly, incisional surgery and nonsurgical corneal conditions (iatrogenic injury and noninfectious corneal ulcers).
Recent findings: Corneal wound healing involves transformation of fibroblasts; intercellular signaling-for example between epithelial and stromal cells-from cytokines, neuropeptides, growth factors, and chemokines; action of matrix metalloproteinases; and protection of tissue from free radical damage. There may be a common wound healing pathway after different types of surgery and injury to the cornea-for example, the wound healing cascades after laser in situ keratomileusis and photorefractive keratectomy may be similar, and yet the effects on the cornea differ because of the extent of disruption to the basement membrane-but the outcomes may depend on small differences in the cascade.
Summary: Interest in the study of corneal wound healing has increased with the proliferation of keratorefractive surgery. Important contributions come from intercellular signaling, fibroblast transformation, remodeling of the extracellular matrix, and free radical scavengers. Despite these advances, a formalized, unified vision of the wound healing cascade remains elusive.