Ocular surface management of photorefractive keratectomy and laser in situ keratomileusis

Abstract

THE AUTHORS PERFORMED A RETROSPECTIVE ANALYSIS of the effects photorefractive keratectomy (PRK) and in-situ keratomileusis (LASIK) with and without ocular surface management on the incidence of dry eye symptoms and goblet cell density. Ocular surface management involved the routine use of non-preserved artificial tears and other lubricants before, during, and after surgery. Lid hygiene procedures, topical anti-inflammatory agents, and punctual plugs were used on indication. Study groups included untreated controls (n = 53), PKP without ocular surface management (n = 51), LASIK without ocular surface management (n = 56), and LASIK with ocular surface management (n = 140). Assessments were conducted before and up to 12 months after surgery. Initially, the incidence of dry eye symptoms was significantly higher in the PRK group than in both LASIK groups. At 12 months, the incidence of dry eye symptoms were less in the PRK group than in both LASIK groups, although this difference was not statistically significant. Compared to the untreated control group, both PRK and LASIK caused a highly significant overall reduction in goblet cell density. Significant relationships between the incidence of dry eye symptoms and goblet cell density were found consistently in each group. Compared to PRK, LASIK without ocular surface management resulted in significantly lower goblet cell density overall at 1 to 3 months (P = 0.003) and 9 to 12 months (P = 0.02). Ocular surface management minimized the LASIK-induced decrease in goblet cell density compared to the LASIK group without ocular surface management. At each time point, goblet cell density was significantly higher in the LASIK with ocular surface management. The authors conclude that ocular surface management reduces the negative impact of goblet cell loss and dry eye symptoms after LASIK.—Michael D. Wagoner