Conjunctival Changes Induced by LASIK Suction Ring in a Rabbit Model

Shin, Sun Young; Lee, Yoon Jung

doi:10.1159/000096229

Cited by 25 publications

(10 citation statements)

References 36 publications

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“…One possible explanation is that changes in corneal curvature and smoothness may alter the friction between the cornea and lid, resulting in tear film instability. 37 Alternatively, the pressure exerted by the patient interface of the femtosecond laser may damage conjunctival goblet cells and reduce mucin secretion 38,39 (Fig. 3).…”

Section: Mechanisms Involved In Post-lasik Dry Eyementioning

confidence: 99%

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Dry Eye After LASIK

Toda

2018

Invest. Ophthalmol. Vis. Sci.

117

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Post-LASIK dry eye is the most common postoperative dry eye after ophthalmic surgeries. The clinical signs of post-LASIK dry eye include positive vital staining of the ocular surface, decreased tear breakup time and Schirmer test values, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs usually last for about 1 month after LASIK. A small number of patients continue to experience symptoms more than 1 year postoperatively. It has been suggested that the loss of corneal innervation caused by flapmaking is the major cause, affecting the corneal-lacrimal gland, corneal-blinking, and blinkingmeibomian gland reflexes, resulting in decreased aqueous and lipid tear secretion and mucin expression. A new type of corneal refractive surgery, SMILE, which has less impact on corneal nerves, induces less postoperative dry eye, supporting the association between corneal denervation and postoperative dry eye. As LASIK enhancement by flap-lifting induces fewer dry eye symptoms and signs than initial surgery, factors other than neurotrophic effects may be involved in the mechanisms of post-LASIK dry eye. Post-LASIK ocular surface pain is a type of postoperative chronic pain and discomfort, and is thought to be a different clinical entity from dry eye, possibly induced by abnormal reinnervation or neural sensitization of peripheral nerves and the central nervous system after LASIK. Treatments include tear supplements, anti-inflammatory agents, meibomian gland dysfunction management, ointment and eye patches, punctal plugs, and autologous serum eye drops. For patients with preoperative dry eye, careful patient selection, and preoperative ocular surface management are mandatory.

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Section: Mechanisms Involved In Post-lasik Dry Eyementioning

confidence: 99%

“…As mentioned earlier, transient elevation of pressure on the conjunctiva, induced by the suction ring of a femtosecond laser or a microkeratome at the initial LASIK, may cause damage to the conjunctival goblet cells and alter mucin expression. 38,39…”

Section: Dry Eye After Lasik Enhancementmentioning

confidence: 99%

Dry Eye After LASIK

Toda

2018

Invest. Ophthalmol. Vis. Sci.

117

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“…Loss of conjunctival goblet cells has also been identified after LASIK, likely due to direct damage from the suction device used during creation of the LASIK flap [17]. Damage to the goblet cells occurs with both microkeratome- and femtosecond laser-created flaps [18–20].…”

Section: Pathophysiologymentioning

confidence: 99%

Post-LASIK dry eye

Shtein¹

2011

Expert Review of Ophthalmology

106

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Laser-assisted in situ keratomileusis (LASIK) is a frequently performed corneal refractive surgery with excellent refractive outcomes. The most common complication of LASIK is dry eyes, with virtually all patients developing some degree of dryness in the immediate postoperative period. Identifying preoperative dry eyes, and conscientious attention and treatment in the perioperative time period, can lead to enhanced patient satisfaction and more accurate visual outcomes. Improved understanding of the development of dry eyes after LASIK will advance our understanding of the complex pathophysiology of dry eye disease.

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“…Because LASIK enhancement by flap lifting induces less dry eye symptoms and signs compared with the first surgery, 30 it is suggested that other factors rather than loss of neurotrophic effect may be involved in the mechanisms of post-LASIK dry eye. These include damage of goblet cells by microkeratome suction 31 and altered central corneal shape. FIGURE 9.…”

Section: Post-lasik Dry Eyementioning

confidence: 99%