Comparison of Tear Cytokines and Clinical Outcomes Between Off-flap and On-flap Epi-LASIK With Mitomycin C
ABSTRACT To compare tear cytokines and clinical outcomes between off-flap and on-flap epi-LASIK eyes and explore the possible mechanism for the clinical differences.
This double-masked, randomized study enrolled 18 myopic patients who underwent off-flap epi-LASIK with mitomycin C (MMC) in 1 eye and on-flap epi-LASIK with MMC in the contralateral eye. Tears were collected from each eye preoperatively and 2 hours, 1 day, and 5 days postoperatively. Concentrations of multiple tear cytokines were measured by a multiplex immunobead assay. Uncorrected distance visual acuity (UDVA), refraction, haze scores, pain scores, and percentage of corneal epithelial healing were evaluated.
Compared with the on-flap group, the off-flap group had outcomes of better UDVA and higher percentages of epithelial healing at 5 days after surgery (P<.001) and lower levels of haze at 1 month after surgery (P=.049). Preoperatively, no significant differences were noted in the release rate of all tear cytokines between groups. At 2 hours postoperatively, the release rate of tear basic fibroblast growth factor (bFGF), platelet-derived growth factor-BB (PDGF-BB), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNF-α) in the off-flap group were significantly lower than those in the on-flap group (P=.011, .017, .048, and .041, respectively).
Off-flap epi-LASIK with MMC offers faster corneal epithelial healing and visual recovery, and temporary less haze than on-flap epi-LASIK with MMC. The lower tear levels of bFGF, PDGF-BB, IL-8, and TNF-α in the offflap group 2 hours after surgery may suggest a possible mechanism for the clinical differences.
Article: December consultation #2Journal of Cataract and Refractive Surgery 11/2014; DOI:10.1016/j.jcrs.2014.10.004 · 2.75 Impact Factor
Article: December consultation #3Journal of Cataract and Refractive Surgery 11/2014; DOI:10.1016/j.jcrs.2014.10.005 · 2.75 Impact Factor
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ABSTRACT: Dry eye is the most common post-operative complication in patients who undergo laser-assisted in situ keratomileusis and other photorefractive procedures. Epidemiological studies have found that almost all patients experience some form of dry-eye-related discomfort in the post-operative period. This review seeks primarily to identify patient factors, which predispose to this complication, as well as outline the possible interventions clinicians can consider to avoid, prevent and treat this complication. Numerous pre-, intra- and post-operative guidelines are provided. The ideal method of post-laser-assisted in situ keratomileusis dry eye prevention is a meticulous peri-operative management plan, as opposed to post-operative management alone. Newer modalities of photorefractive surgery may have differing effects on the ocular surface.Expert Review of Ophthalmology 01/2014; 8(6). DOI:10.1586/17469899.2013.851602