Ocular surface management of photorefractive keratectomy and laser in situ keratomileusis.

Abstract

To examine the effects of keratorefractive surgery and ocular surface management on goblet cell density, dry eye symptom incidence, and spherical equivalent refraction. We performed a retrospective analysis of four myopia groups: Untreated controls (n = 53); PRK (n = 51); LASIK without ocular surface management (n = 56); LASIK with ocular surface management (n = 140). 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 punctal plugs were used on indication. Assessments were conducted before and up to 12 months after surgery (right eyes only in patients with both eyes operated, and in the left or right eye in patients with one eye operated). Surgery caused a significant reduction in goblet cell density, with the greatest reduction in the LASIK without ocular surface management group. No significant differences were detected in dry eye symptoms or spherical equivalent refraction between PRK and LASIK without ocular surface management. Ocular surface management significantly minimized LASIK-induced decreases in goblet cell density and was associated with significantly less myopic outcomes at months 1 to 3 and 6 to 9 after LASIK. After surgery (1 to 3 mo), dry eye symptoms were significantly lower in the LASIK with ocular surface management group. In all groups, significant inverse correlations existed between goblet cell density and dry eye symptoms. Ocular surface management minimized the negative impact of LASIK on goblet cell density and reduced dry eye symptoms. Without ocular surface management, goblet cell density and dry eye symptoms after LASIK were similar to or worse than after PRK.