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Comparison of Goblet Cell Density after Femtosecond Laser and Mechanical Microkeratome in LASIK

¹From the Vissum—Instituto Oftalmologico de Alicante, Alicante, Spain; the ²Magrabi Eye and Ear Center, KSA/Ain Shams University, Cairo, Egypt; the ³Research Institute of Ophthalmology, Cairo, Egypt; and ⁴Pathology and Surgery Department, Miguel Hernandez University, Alicante, Spain.

PURPOSE. To study the effect of the LASIK procedure performed with a femtosecond laser and a manual microkeratome on the conjunctival goblet cell and epithelial cell populations.

METHODS. In this prospective, nonrandomized, masked study, 64 eyes undergoing LASIK were included: 30 with the Moria M2 (M2) microkeratome and 34 with the IntraLase femtosecond laser (IL). The preoperative spherical equivalent was –2.0 ± 3.8 D in the M2 group and –3.1± 3.1 D in the IL group. The time that the suction ring was applied on the eye was registered, and goblet cell density (GCD), epithelial cell morphology, and inflammatory cells were evaluated by conjunctival impression cytology, before and after the surgery.

RESULTS. All the patients in both groups showed a decrease in GCD after LASIK (P < 0.001) that recovered after 6 months. At 1 week, 1 month, and 3 months, GCD was lower with IL than with M2 (P < 0.019, P < 0.001, and P < 0.024, respectively). The mean period that the suction ring was applied was longer in the IL than in the M2 group (P < 0.001). There was a high correlation between the decrease in GCD and the suction time (R = 0.8), and the preoperative spherical equivalent (R 0.4).

CONCLUSIONS. Impression cytology showed a greater reduction in goblet cell populations after IL than after M2, probably because of the length of time that the suction ring exerted pressure on the conjunctiva. These changes in the goblet cells may contribute to the development of the ocular surface syndrome after LASIK procedures.