Comparison of dry-eye disease severity after laser in situ keratomileusis and laser-assisted subepithelial keratectomy

Laser Suite, Mater Private Hospital, Dublin, Ireland.
Journal of Cataract and Refractive Surgery (Impact Factor: 2.72). 06/2012; 38(6):1058-64. DOI: 10.1016/j.jcrs.2012.01.028
Source: PubMed


To evaluate the effects of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) on dry-eye disease markers including tear osmolarity, Schirmer testing, and the ocular surface disease index (OSDI).
Laser Suite, Mater Private Hospital, Dublin, Ireland.
Prospective controlled cross-sectional observation study.
In a single center, consecutive eyes that had LASIK or LASEK had dry-eye disease markers assessed preoperatively and 3, 6, and 12 months postoperatively.
In LASIK eyes (n = 50), the mean tear osmolarity was significantly elevated (by 2.8%) at 12 months (P=.009, Student t test). The mean Schirmer test values were not significantly altered postoperatively in either group. The mean OSDI was maximum in LASIK eyes at 3 months (mean follow-up 7.2 months ± 8.2 [SD]) and in LASEK eyes (n = 35) preoperatively (mean follow-up 9.1 ± 9.7 months).
There were no significant differences in dry-eye disease markers or tear osmolarity between LASIK and LASEK patients at any stage after surgery up to 1 year. Although tear osmolarity remains one of the highest predictive tests of dry eye, it is complementary with other diagnostic criteria in the context of dry eye after refractive surgery.

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Available from: Ian Dooley, Oct 01, 2015
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    ABSTRACT: Almost half the patients who undergo laser in situ keratomileusis (LASIK) experience dry eye following the procedure. However, the etiology of LASIK-induced dry eye is unclear. The purpose of this review is to examine and summarize the current evidence for the etiology of LASIK-induced dry eye, with a focus on ocular surface sensitivity and corneal innervation. Evidence suggests that the alteration of corneal nerves after LASIK is the most likely cause of the subjective symptoms of LASIK-induced dry eye, even though corneal sensitivity and the clinical indicators of dry eye return to apparently normal values within a year due to the partial recovery of the corneal nerve plexus. The hypothesis is explored that dry eye symptoms following LASIK may result from abnormal sensation due to LASIK-induced corneal neuropathy. Other factors such as alterations in conjunctival goblet cell density might also contribute to the symptoms and signs of LASIK-induced dry eye. Inter-relationships between nerve morphology, tear neuropeptide levels and dry eye require further investigation. A better understanding of this phenomenon may result in improved management of post-LASIK dry eye.
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