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Tamimi A, Sheikhzadeh F, Ezabadi SG, Islampanah M, Parhiz P, Fathabadi A, Poudineh M, Khanjani Z, Pourmontaseri H, Orandi S, Mehrabani R, Rahmanian M, Deravi N. Post-LASIK dry eye disease: A comprehensive review of management and current treatment options. Front Med (Lausanne) 2023; 10:1057685. [PMID: 37113611 PMCID: PMC10126282 DOI: 10.3389/fmed.2023.1057685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is a unique corneal stromal laser ablation method that uses an excimer laser to reach beneath corneal dome-shaped tissues. In contrast, surface ablation methods, such as photorefractive keratectomy, include removing epithelium and cutting off the Bowman's layer and the stromal tissue of the anterior corneal surface. Dry eye disease (DED) is the most common complication after LASIK. DED is a typical multi-factor disorder of the tear function and ocular surface that occurs when the eyes fail to produce efficient or adequate volumes of tears to moisturize the eyes. DED influences quality of life and visual perception, as symptoms often interfere with daily activities such as reading, writing, or using video display monitors. Generally, DED brings about discomfort, symptoms of visual disturbance, focal or global tear film instability with possible harm to the ocular surface, the increased osmolarity of the tear film, and subacute inflammation of the ocular surface. Almost all patients develop a degree of dryness in the postoperative period. Detection of preoperative DED and committed examination and treatment in the preoperative period, and continuing treatments postoperatively lead to rapid healing, fewer complications, and improved visual outcomes. To improve patient comfort and surgical outcomes, early treatment is required. Therefore, in this study, we aim to comprehensively review studies on the management and current treatment options for post-LASIK DED.
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Affiliation(s)
- Atena Tamimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sajjad Ghane Ezabadi
- Students’ Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Peyman Parhiz
- Student Research Committee, Zahedan Medical Sciences Branch, Islamic Azad University, Zahedan, Iran
| | - Amirhossein Fathabadi
- Student Research Committee, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zahra Khanjani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Shirin Orandi
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Mehrabani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Rahmanian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Niloofar Deravi,
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Sharma B, Soni D, Saxena H, Stevenson LJ, Karkhur S, Takkar B, Vajpayee RB. Impact of corneal refractive surgery on the precorneal tear film. Indian J Ophthalmol 2020; 68:2804-2812. [PMID: 33229655 PMCID: PMC7856956 DOI: 10.4103/ijo.ijo_2296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/28/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Corneal refractive surgeries are one of the commonly performed procedures for correction of refractive errors. Tear film abnormality is the most common postoperative complication of corneal refractive surgeries. Consequently, these procedures represent a clinically significant cause of dry eye disease. The mechanisms which lead to dry eye disease include corneal sensory nerve dysfunction, ocular surface desiccation, glandular apoptosis and ocular surface inflammation. Although transient tear film abnormalities occur in almost all patients following surgery, patients with pre-existing dry eye symptoms or dry eye disease are at significant risk of developing more severe or long-term ocular surface disease. As such, careful patient selection and preoperative evaluation is essential to ensuring successful surgical outcomes. This is particularly important with LASIK which has the strongest association with dry eye disease. Appropriate surface lubrication and anti-inflammatory therapy remains the cornerstone treatment. Timely and effective management is important to facilitate visual rehabilitation and reduce the risk of secondary complications. In this review we describe the causes, pathophysiology, risk factors, manifestations, and management of tear film dysfunction and dry eye disease following corneal refractive surgery.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Louis J Stevenson
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rasik B Vajpayee
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
- Cornea Unit, Vision Eye Institute, Melbourne, Victoria, Australia
- Cornea and Cataract Surgery Unit, University of Melbourne, Melbourne, Victoria, Australia
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3
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Ghosh T, Maity N, Sur VP, Konar A, Hazra S. Mitigating fibrosis-An impediment to corneal re-innervation following lamellar flap surgery. Exp Eye Res 2020; 194:108009. [PMID: 32205135 DOI: 10.1016/j.exer.2020.108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/20/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
Restoration of corneal sensitivity is of utmost importance to maintain corneal homeostasis following any injury or insult, for which, both corneal nerve regeneration and re-innervation are essential. Fibrosis poses a major impediment for re-innervation. We have in this study evaluated the influence of various nerve growth factors and corneal fibrosis on corneal nerve regeneration and reinnervation following lamellar flap surgery (LFS) and its modulation using antifibrotic drug pirfenidone. To achieve this, trigeminal ganglion cells were treated with pirfenidone, NGF, and NT-3 to evaluate their effect on trigeminal cell neurite growth. Following LFS, the gene expression of nerve growth factors NGF, BDNF and NT-3, Gap 43, Nogo-A and profibrotic factors Tenascin C, TGF-beta 1 were evaluated with and without pirfenidone. Wound fibrosis and corneal nerve regeneration using pirfenidone following LFS were evaluated by staining whole corneal mounts with α SMA and β tubulin 3. Safety of NGF and pirfenidone topical drops in normal unoperated cornea and its efficacy in enhancing corneal healing was evaluated following LFS. Our study shows, pirfenidone did not influence trigeminal cell neurite elongation; NGF and NT-3 significantly enhanced trigeminal cell neurite elongation. NT-3 also significantly increased neurite branching. There was significant increase in the gene expression of NGF, BDNF, NT-3, Gap- 43, TGF beta-1, Tenascin C, Nogo-A genes in the operated cornea compared to normal cornea, treatment of operated corneas with pirfenidone prevented the increased expression of these genes except Gap 43 which remained unchanged. The treatment of operated eyes with combination of NGF and pirfenidone positively influenced corneal healing compared to treatment with NGF alone, and had no adverse influence on the cornea. Pirfenidone appreciably reduced corneal fibrosis which aided in re-innervation. Both NGF and NT3 positively influence trigeminal neurite elongation. NGF and pirfenidone have complementary influence on corneal wound healing.
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Affiliation(s)
- Tanushri Ghosh
- Dept of Veterinary Surgery & Radiology, West Bengal University of Animal & Fishery Sciences, 37& 68 Khudiram Bose Sarani, Kolkata, 700037, India
| | - Namrata Maity
- Dept of Veterinary Surgery & Radiology, West Bengal University of Animal & Fishery Sciences, 37& 68 Khudiram Bose Sarani, Kolkata, 700037, India
| | | | | | - Sarbani Hazra
- Dept of Veterinary Surgery & Radiology, West Bengal University of Animal & Fishery Sciences, 37& 68 Khudiram Bose Sarani, Kolkata, 700037, India.
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Bandeira F, Yam GHF, Liu YC, Devarajan K, Mehta JS. Three-Dimensional Neurite Characterization of Small Incision Lenticule Extraction Derived Lenticules. Invest Ophthalmol Vis Sci 2020; 60:4408-4415. [PMID: 31639827 DOI: 10.1167/iovs.19-27566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We study the density and excitatory response of neurites, and Schwann cells (SCs) in fresh and cryopreserved stromal lenticules derived from small incision lenticule extraction (SMILE). Methods Human stromal lenticules (n = 23) were immunostained for β III-tubulin and imaged using spinning disk confocal laser microscopy, followed by three-dimensional reconstruction, to reveal neurite distribution. The lenticule neurite density (LND) was assessed using a validated neurite tracing and length measurement method with NeuronJ. LND was compared among groups of different lenticule thickness (71-165 μm) obtained from -3 to >-6 diopters (D) corrections. SCs were identified by marker expression and the laser effect on SC-neurite interaction was examined under transmission electron microscopy (TEM). Fresh porcine SMILE-lenticules (n = 18) were used for LND comparison among storage conditions and functional excitatory calcium response assay. Results Using a validated neurite length measurement method, we found an inverse correlation of LND with lenticule thickness. Higher LND was found in thinner lenticules obtained from lower power of correction (r = -0.8925, P < 0.0001), whereas total lenticule neurite lengths did not alter significantly with regards to lenticule thickness. SCs were identified by GAP43 and p75NTR expression and were closely associated with lenticule neurites under TEM. In porcine lenticules, LND and excitatory calcium response were reduced after cold and cryogenic storage, when compared to fresh lenticules. Conclusions The stromal neurites showed variations in density related to SMILE lenticule thickness and cryopreservation. With the presence of SC support and excitatory response, these neurite residues could retain minimal functionality that might serve as a potential advantage in the event of lenticule implantation.
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Affiliation(s)
- Francisco Bandeira
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Federal University of São Paulo, Sao Paulo, Brazil.,São Gonçalo Eye Hospital, Rio de Janeiro, Brazil
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Experimental Microscopy Platform, Singapore Eye Research Institute, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Singapore National Eye Centre, Singapore
| | - Kavya Devarajan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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Dry Eye Post-Laser-Assisted In Situ Keratomileusis: Major Review and Latest Updates. J Ophthalmol 2018; 2018:4903831. [PMID: 29619255 PMCID: PMC5829349 DOI: 10.1155/2018/4903831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/12/2017] [Indexed: 11/18/2022] Open
Abstract
Dry eye is one of the most common complications occurring after laser-assisted in situ keratomileusis (LASIK), with virtually all patients experiencing some degree of postoperative dry eye symptoms. Enhanced understanding of the pathophysiology and mechanism of dry eye development in addition to preoperative screening of patients who are prone to dry eye is essential for better patient satisfaction and for improving short-term visual outcome postoperatively. This article reviews the latest studies published on LASIK-associated dry eye, including epidemiology, pathophysiology, risk factors, preoperative assessment, and management.
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Xie W. Recent advances in laser in situ keratomileusis-associated dry eye. Clin Exp Optom 2016; 99:107-12. [PMID: 27012690 DOI: 10.1111/cxo.12361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/07/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022] Open
Abstract
Dry eye is the most common complication after laser in situ keratomileusis (LASIK). The major cause of LASIK-associated dry eye is corneal nerve damage. Early identification and treatment of post-operative dry eye are essential to prevent further ocular surface damage. This article reviews the recent studies of LASIK-associated dry eye, including clinical features, aetiology, risk factors, evaluations and treatment. The applications of novel technologies in LASIK-associated dry eye evaluation like anterior segment spectral-domain optical coherence tomography (SD-OCT) and corneal confocal microscopy are also introduced in this review.
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Affiliation(s)
- Wenjia Xie
- Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Katz T, Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ. Flap-induced astigmatism in eyes with sphere myopia correction: Superior hinge using a rotating microkeratome versus nasal hinge using a linear microkeratome. J Cataract Refract Surg 2015; 41:1160-7. [PMID: 26189377 DOI: 10.1016/j.jcrs.2014.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare the effect of a rotating microkeratome (M2) and a linear microkeratome (SBK) on the change in the astigmatic component in eyes with preoperative plano refractive cylinder. SETTING University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. DESIGN Retrospective case series. METHODS An Allegretto excimer laser was used to perform laser ablation in myopic eyes of consecutive patients. The laser in situ keratomileusis (LASIK) procedure included mechanical flap preparation using a microkeratome, either a linear type with a single-use 90 μm head to create a nasal hinge or a rotating type with a single-use 90 μm head to create a superior hinge. The Alpins vector method was applied to describe the effects of LASIK on postoperative refractive cylinder. RESULTS The study evaluated 1045 eyes of 852 patients. Although the mean overall efficacy and safety indices indicate the procedure was highly precise, safe, and efficient, there were statistically significant differences in surgically induced astigmatism (SIA) between the microkeratomes (P = .002). The postoperative refractive cylinder (ie, SIA) was 0.75 diopter (D) or more in 116 eyes (11.1%), 44 (12.8%) of 344 linear cases and 72 (10.3%) of 701 rotating cases. Independent of the type of microkeratome used, the SIA was slightly higher in eyes treated first; the mean magnitude of the induced astigmatism was 0.35 D. CONCLUSIONS In approximately 10% of eyes with preoperative plano refractive myopia, the astigmatic component tended to be overcorrected. Nevertheless, independent of the type of microkeratome, the maximum mean magnitude of refractive cylinder documented was 0.35 D. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Toam Katz
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Frings
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany.
| | - Gisbert Richard
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Steinberg
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Vasyl Druchkiv
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan J Linke
- From the Department of Ophthalmology (Katz, Richard, Steinberg, Druchkiv, Linke), University Medical Centre Hamburg-Eppendorf, Hamburg, and the Department of Ophthalmology (Frings), University Hospital Erlangen-Nuremberg, Erlangen, Germany
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Lin SJ, Su CC, Chang DCK, Hsi B, Hu FR, Lee SH, Wang IJ. Autologous serum therapy in recalcitrant laser-assisted in situ keratomileusis-induced neurotrophic epitheliopathy. Taiwan J Ophthalmol 2015; 5:109-113. [PMID: 29018680 PMCID: PMC5602705 DOI: 10.1016/j.tjo.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 11/06/2022] Open
Abstract
Background/Purpose: To evaluate the efficacy of autologous serum eye drops for patients with recalcitrant laser-assisted in situ keratomileusis (LASIK)-induced neurotrophic epitheliopathy (LINE) unresponsive to conventional treatment, and to determine the possible predisposing risk factors of these patients. Methods: We enrolled 10 consecutive patients (20 eyes) undergoing femtosecond-assisted myopic LASIK surgery presenting with recalcitrant LINE for > 1 year. Another 340 patients (713 eyes) receiving femtosecond-assisted myopic LASIK without recalcitrant LINE were set as controls. Possible risk factors associated with recalcitrant LINE were investigated. Twenty percent autologous serum treatment was prescribed to 20 eyes. The efficacy of autologous serum was assessed with ocular surface conditions, tear function, and the change of best-corrected visual acuity. Results: Age older than 30 years [odds ratio (OR) = 7.74; 95% confidence interval (CI), 1.74–34.50], flap thickness < 110 μm (OR = 3.47; 95% CI, 1.22–9.73), and a flap diameter < 8.5 mm (OR = 5.38; 95% CI, 1.95–14.85) pose higher risks in femtosecond laser-assisted myopic LASIK. All eyes (100%) achieved remission after autologous serum treatment. The visual acuity before treatment was 0.49 ± 0.41 in LogMAR, and the visual acuity after treatment was 0.14 ± 0.22 in LogMAR. Time to achieve remission was 8.26 ± 11.87 weeks. Mean relapse-free survival after discontinuing autologous serum was 47 weeks. Conclusion: Risk factors of recalcitrant LINE in femtosecond laser-assisted myopic LASIK were identified as older age, a thinner flap (<110 μm), and a small flap diameter (<8.5 mm). Autologous serum eye drops can effectively improve corneal surface conditions and postoperative visual acuity.
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Affiliation(s)
- Shan-Jiun Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Brian Hsi
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shwu-Huey Lee
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
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Levitt AE, Galor A, Weiss JS, Felix ER, Martin ER, Patin DJ, Sarantopoulos KD, Levitt RC. Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders. Mol Pain 2015; 11:21. [PMID: 25896684 PMCID: PMC4411662 DOI: 10.1186/s12990-015-0020-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022] Open
Abstract
Laser in-situ keratomileusis (LASIK) is a commonly performed surgical procedure used to correct refractive error. LASIK surgery involves cutting a corneal flap and ablating the stroma underneath, with known damage to corneal nerves. Despite this, the epidemiology of persistent pain and other long-term outcomes after LASIK surgery are not well understood. Available data suggest that approximately 20-55% of patients report persistent eye symptoms (generally regarded as at least 6 months post-operation) after LASIK surgery. While it was initially believed that these symptoms were caused by ocular surface dryness, and referred to as “dry eye,” it is now increasingly understood that corneal nerve damage produced by LASIK surgery resembles the pathologic neuroplasticity associated with other forms of persistent post-operative pain. In susceptible patients, these neuropathological changes, including peripheral sensitization, central sensitization, and altered descending modulation, may underlie certain persistent dry eye symptoms after LASIK surgery. This review will focus on the known epidemiology of symptoms after LASIK and discuss mechanisms of persistent post-op pain due to nerve injury that may be relevant to these patients. Potential preventative and treatment options based on approaches used for other forms of persistent post-op pain and their application to LASIK patients are also discussed. Finally, the concept of genetic susceptibility to post-LASIK ocular surface pain is presented.
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Affiliation(s)
- Alexandra E Levitt
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA.
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA. .,Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA.
| | - Jayne S Weiss
- Departments of Ophthalmology, Pathology and Pharmacology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans, LA, USA.
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA. .,Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Eden R Martin
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA. .,John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Dennis J Patin
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Konstantinos D Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Roy C Levitt
- Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA. .,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA. .,John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA. .,Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.
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Yip YWY, Yu MCY, Jhanji V. Randomized, contralateral eye study to evaluate the effect of standard and inverted side-cut angle on corneal biomechanical properties during femtosecond laser-assisted in situ keratomileusis. Acta Ophthalmol 2014; 92:e437-42. [PMID: 24667038 DOI: 10.1111/aos.12396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 02/22/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effect of side-cut angle profile on corneal biomechanical properties after femtosecond laser in situ keratomileusis (FS-LASIK). METHODS Ninety-six myopic eyes of 48 patients underwent FS-LASIK. One eye of each patient was randomized to flap creation with a side-cut angle of 115°. The fellow eye flap side-cut angle was adjusted to 70°. Mean absolute error of flap diameter and mean change in Goldmann-correlated intra-ocular pressure (IOPg), corneal-compensated IOP (IOPcc), corneal hysteresis (CH), corneal resistance factor (CRF), p1 area, p2 area, p1 area 1 and p2 area 1 were compared between both groups. RESULTS Overall, the mean IOPg and CRF showed significant reduction at the end of 1 and 3 months, as well as between 1 and 3 months postoperatively (p ≤ 0.03). The mean IOPcc and CH showed significant reduction (p < 0.001) at the end of 3 months postoperatively. The parameters p1 area, p2 area, p1 area 1 and p2 area 1 changed significantly at the end of 1 and 3 months postoperatively (p < 0.001). There was no significant difference between both groups with regards to the mean change of IOPg, IOPcc, CH, CRF, p1 area, and p1 area 1. In 115° group, the mean absolute error in flap diameter was greater compared with 70° group (p = 0.014). CONCLUSIONS The stability of IOP and corneal biomechanical properties were not enhanced in FS-LASIK flaps with an inverted side-cut angle. The size of corneal flap created with 70° side-cut angle was more accurate compared with 115° side-cut angle.
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Affiliation(s)
- Yolanda W. Y. Yip
- Department of Ophthalmology & Visual Sciences; The Chinese University of Hong Kong; Hong Kong Eye Hospital; Kowloon Hong Kong China
| | - Marco C. Y. Yu
- Department of Ophthalmology & Visual Sciences; The Chinese University of Hong Kong; Hong Kong Eye Hospital; Kowloon Hong Kong China
| | - Vishal Jhanji
- Department of Ophthalmology & Visual Sciences; The Chinese University of Hong Kong; Hong Kong Eye Hospital; Kowloon Hong Kong China
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11
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Li M, Zhou Z, Shen Y, Knorz MC, Gong L, Zhou X. Comparison of corneal sensation between small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK for myopia. J Refract Surg 2014; 30:94-100. [PMID: 24763474 DOI: 10.3928/1081597x-20140120-04] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the impact on corneal sensation after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (femto-LASIK) in patients with myopia. METHODS In this prospective, nonrandomized comparative study, 71 subjects were enrolled. Thirty-eight eyes of 38 patients underwent SMILE and 33 eyes of 33 patients underwent femto-LASIK. Corneal sensation was tested with Cochet-Bonnet esthesiometry in five corneal areas preoperatively and at 1 week and 1, 3, and 6 months postoperatively. Comparison of corneal sensation was performed for the SMILE and femto-LASIK groups. Additionally, the correlations were evaluated between the postoperative corneal sensation, preoperative spherical equivalent, and ablation depth. RESULTS All tested areas within the cap or flap demonstrated corneal hypoesthesia immediately after both surgeries. SMILE-treated eyes showed less compromised corneal sensation than femto-LASIK-treated eyes at all postoperative visits in the central, inferior, nasal, and temporal areas at the 1-week and 1-month visits. In the SMILE group, the inferior, nasal, and temporal quadrants recovered faster than other areas. In the femto-LASIK group, the sensation over the flap did not recover to preoperative levels by postoperative 6 months. There was no correlation between postoperative corneal sensation, preoperative spherical equivalent, and ablation depth in both groups. CONCLUSIONS The impairment of corneal sensation was less significant in the SMILE group than in the femto-LASIK group and was independent of preoperative spherical equivalent or ablation depth.
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Shaheen BS, Bakir M, Jain S. Corneal nerves in health and disease. Surv Ophthalmol 2014; 59:263-85. [PMID: 24461367 PMCID: PMC4004679 DOI: 10.1016/j.survophthal.2013.09.002] [Citation(s) in RCA: 305] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 08/23/2013] [Accepted: 09/03/2013] [Indexed: 12/14/2022]
Abstract
Corneal nerves are responsible for the sensations of touch, pain, and temperature and play an important role in the blink reflex, wound healing, and tear production and secretion. Corneal nerve dysfunction is a frequent feature of diseases that cause opacities and result in corneal blindness. Corneal opacities rank as the second most frequent cause of blindness. Technological advances in in vivo corneal nerve imaging, such as optical coherence tomography and confocal scanning, have generated new knowledge regarding the phenomenological events that occur during reinnervation of the cornea following disease, injury, or surgery. The recent availability of transgenic neurofluorescent murine models has stimulated the search for molecular modulators of corneal nerve regeneration. New evidence suggests that neuroregenerative and inflammatory pathways in the cornea are intertwined. Evidence-based treatment of neurotrophic corneal diseases includes using neuroregenerative (blood component-based and neurotrophic factors), neuroprotective, and ensconcing (bandage contact lens and amniotic membrane) strategies and avoiding anti-inflammatory therapies, such as cyclosporine and corticosteroids.
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Affiliation(s)
- Brittany Simmons Shaheen
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - May Bakir
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sandeep Jain
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
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The role of corneal innervation in LASIK-induced neuropathic dry eye. Ocul Surf 2013; 12:32-45. [PMID: 24439045 DOI: 10.1016/j.jtos.2013.09.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/13/2013] [Accepted: 09/14/2013] [Indexed: 11/22/2022]
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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Feng YF, Yu JG, Wang DD, Li JH, Huang JH, Shi JL, Ye T, Wang QM, Zhao YE. The effect of hinge location on corneal sensation and dry eye after LASIK: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2012; 251:357-66. [PMID: 22752222 DOI: 10.1007/s00417-012-2078-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis is to investigate the possible effect of hinge location on corneal sensation and dry eye syndrome after laser-assisted in situ keratomileusis (LASIK). METHODS A comprehensive literature search was conducted in the PubMed, EMBASE, and Cochrane Controlled Trials Register to identify potentially relevant randomized controlled trials (RCTs) of comparing the effects of horizontal-hinge flaps and vertical-hinge flaps on corneal sensation and dry eye after LASIK. Meta-analyses were performed for corneal sensation, tear break-up time (TBUT), Schirmer's I test and corneal fluorescein staining (CFS) at 1 week, 1, 3, and 6 months postoperatively. RESULTS Eight RCTs (657 eyes) investigating the effects of hinge location on the corneal sensation and dry eye syndrome after LASIK were identified. The results showed that the horizontal-hinge group causes less loss of sensation than the vertical-hinge group, and the difference was significant at 3-month postoperative (p = 0.01). The TBUT value was significantly larger and a lower percentage of patients with CFS in the horizontal-hinge group than in the vertical-hinge group at 1-month postoperative (p = 0.007 and p = 0.01, respectively) and 3-month (p = 0.03 and p = 0.009, respectively); Schirmer's I test values were also higher in the horizontal-hinge group, but the difference did not reach statistically significance at each postoperative period. CONCLUSIONS According to the available data, we suggest that hinge location may have some effect on corneal sensation and dry eye syndrome after LASIK at the early postoperative period. However, there was no significant difference between the groups at 6 months after surgery. Further well-organized, prospective, randomized studies involving more patients are warranted.
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Affiliation(s)
- Yi-fan Feng
- The Affiliated Eye Hospital of Wenzhou Medical College, School of Optometry and Ophthalmology, Wenzhou Medical College, No. 270, Xueyuan Road, Wenzhou, Zhejiang Province, China
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Chen HJ, Xia YJ, Zhong YY, Song XL, Chen YG. Anterior Segment Optical Coherence Tomography Measurement of Flap Thickness After Myopic LASIK Using the Moria One Use-Plus Microkeratome. J Refract Surg 2010; 26:403-10. [DOI: 10.3928/1081597x-20090710-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 06/08/2009] [Indexed: 11/20/2022]
Affiliation(s)
- Hui-Jin Chen
- Peking University Third Hospital, Peking University Eye Center, Beijing, China
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Dry eyes and corneal sensation after laser in situ keratomileusis with femtosecond laser flap creation. J Cataract Refract Surg 2009; 35:2092-8. [DOI: 10.1016/j.jcrs.2009.07.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 07/04/2009] [Indexed: 11/21/2022]
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Ghaffariyeh A, Peyman A, Puyan S, Honarpisheh N, Bagheri B, Peyman M. Evaluation of transcutaneous electrical simulation to improve recovery from corneal hypoesthesia after LASIK. Graefes Arch Clin Exp Ophthalmol 2009; 247:1133-8. [DOI: 10.1007/s00417-009-1079-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/20/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022] Open
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LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment. J Refract Surg 2008; 24:396-407. [DOI: 10.3928/1081597x-20080401-14] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mian SI, Shtein RM, Nelson A, Musch DC. Effect of hinge position on corneal sensation and dry eye after laser in situ keratomileusis using a femtosecond laser. J Cataract Refract Surg 2007; 33:1190-4. [PMID: 17586374 DOI: 10.1016/j.jcrs.2007.03.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 03/17/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine whether hinge position has an effect on corneal sensation and dry-eye symptoms after myopic laser in situ keratomileusis (LASIK) performed with the IntraLase femtosecond laser (IntraLase Corp.). SETTING University-based academic practice, Ann Arbor, Michigan, USA. METHODS Sixty-six consecutive eyes of 33 patients were prospectively evaluated in a randomized contralateral-eye study to compare the difference between superior-hinge and temporal-hinge locations after bilateral myopic LASIK with the IntraLase femtosecond laser. Central Cochet-Bonnet esthesiometry, the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer test with anesthesia, tear breakup time (TBUT), corneal fluorescein, and conjunctival lissamine green staining were evaluated preoperatively as well as 1 week and 1, 3, 6, and 12 months after surgery. RESULTS Corneal sensation was reduced with both superior-hinged and temporal-hinged LASIK flaps 1 week and 1, 3, 6, and 12 months after surgery (P<.0001). There was no difference in corneal sensation between superior-hinged and temporal-hinged flaps at any time point. The OSDI score was increased in 22.6% of patients at 1 week and 21.9% at 1 month (P<.00001), and corneal fluorescein staining was increased in 18% at 1 week. There were no differences in the OSDI, Schirmer with anesthesia, TBUT, corneal fluorescein, or conjunctival lissamine green staining when preoperative values and hinge location were compared. CONCLUSIONS Mild dry-eye disease was present early after myopic LASIK with the IntraLase laser. Hinge position had no effect on central corneal sensation or dry-eye disease.
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Affiliation(s)
- Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan 48105, USA.
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Laser literature watch. Photomed Laser Surg 2005; 23:233-42. [PMID: 15910194 DOI: 10.1089/pho.2005.23.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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