Early Changes in Ocular Surface and Tear Inflammatory Mediators after Small-Incision Lenticule Extraction and Femtosecond Laser-Assisted Laser In Situ Keratomileusis

Abstract

PurposeTo characterize the early ocular-surface changes or tear inflammatory-mediators levels following small-incision lenticule extraction (ReLEx smile) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).MethodsForty-seven myopic subjects were recruited for this prospective study. Fifteen underwent ReLEx smile and thirty-two underwent FS-LASIK. Corneal fluorescein (FL) staining, tear break-up time (TBUT), Schirmer I test (SIT), ocular surface disease index (OSDI) and central corneal sensitivity were evaluated in all participants. Tears were collected and analyzed for interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nerve growth factor (NGF) and intercellular adhesion molecule-1 (ICAM-1) levels using multiplex magnetic beads. All measurements were preformed preoperatively and 1 day, 1 week, 1 month and 3 months postoperatively.ResultsFL scores in ReLEx smile group were lower than those of FS-LASIK group 1 week postoperatively (P = 0.010). Compared to the FS-LASIK group, longer TBUT were observed in ReLEx smile group 1 month (P = 0.029) and 3 months (P = 0.045) postoperatively. No significant differences were found in tear secretion for the two groups (P>0.05). OSDI scores were higher in FS-LASIK group 1 month after surgery (P = 0.020). Higher central corneal sensitivity was observed in ReLEx smile group 1 week, 1 month and 3 months (P<0.05) postoperatively. Compared to FS-LASIK group, lower and faster recovery of IL-6 and NGF levels in tears was observed in ReLEx smile group postoperatively (P<0.05). Tears TNF-α and ICAM-1 concentrations were not significantly different between the two groups at any follow-up time (P>0.05). Moreover, IL-6 and NGF levels correlated with ocular surface changes after ReLEx smile or FS-LASIK.ConclusionsIn the early postoperative period, ReLEx smile results in milder ocular surface changes than FS-LASIK. Furthermore, the tear inflammatory mediators IL-6 and NGF may play a crucial role in the ocular surface healing process following ReLEx smile and FS-LASIK.

Anterior chamber interleukin 1β, interleukin 6 and prostaglandin E2in patients undergoing femtosecond laser-assisted cataract surgery

“…Significant elevation of IL-6 has been found in ocular fluids derived from patients with refractory/chronic uveitis. Gao and colleagues25 reported elevated IL-6 following femtosecond laser-assisted laser in situ keratomileusis and refractive lenticule extraction. One study suggested that IL-6 was involved in promoting corneal wound healing 26.…”

Small-incision lenticule extraction

“…39,81,82 Postoperative corneal sensitivity in small-incision lenticule extraction-treated eyes appears to be superior to that in femtosecond laser-assisted LASIK eyes as well. 83,84 The interrelation of corneal denervation and development of dry eye 85 has prompted investigation of dry-eye symptoms associated with small-incision lenticule extraction. Despite improved corneal sensation relative to LASIK, small-incision lenticule extraction does not appear to significantly decrease postoperative dry-eye symptoms.…”

Change in choroidal thickness and the relationship with accommodation following myopic excimer laser surgery

“…In previous studies, the safety, efficacy, and predictability of these treatments have been assessed by the change of visual function 8,9 and ocular anterior segment. 9,10 However, the change of ocular poster segment, especially choroid has rarely been evaluated following refractory surgery.…”