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(Investigative Ophthalmology and Visual Science. 2008;49:168-174.)
© 2008 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.07-0337
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Preoperative Characteristics and a Potential Mechanism of Chronic Dry Eye after LASIK

Keiko Konomi,1,2,3 Li-Li Chen,1,2,4 Rachel S. Tarko,1 Amy Scally,5 Debra A. Schaumberg,1,2,6 Dimitri Azar,1,2,7 and Darlene A. Dartt1,2

1From the Schepens Eye Research Institute, Boston, Massachusetts; the 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; the 5Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; and the 6Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, Massachusetts. 3Present affiliations: Department of Ophthalmology, Keio University School of medicine, Tokyo, Japan; 4Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan; 7Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois.

PURPOSE. To determine whether measurable preoperative characteristics predispose patients to chronic dry eye after laser in situ keratomileusis (LASIK).

METHODS. The study consisted of 24 eyes of 24 patients who underwent LASIK. Tear breakup time, Schirmer testing with and without anesthesia, rose bengal staining, central corneal sensitivity, nucleus-to-cytoplasmic ratio, and goblet cell density were evaluated 2 weeks before and 1 week, 3 months, and 9 months after surgery. Patients were classified into two outcome groups, the nondry-eye group (NDEG) and the chronic dry-eye group (CDEG), on the basis of dry eye status 9 months after surgery. The authors tested whether preoperative values of each parameter were associated with the development of chronic dry eye.

RESULTS. All parameters, except rose bengal staining, deteriorated significantly after surgery but returned to preoperative levels within 3 to 9 months. The CDEG had significantly lower preoperative Schirmer test values with and without anesthesia and were delayed in recovery after surgery in goblet cell density, rose bengal staining, Schirmer test values without anesthesia, and tear breakup time. Results of preoperative Schirmer tests without anesthesia positively correlated with tear breakup time 9 months after surgery.

CONCLUSIONS. Preoperative tear volume may affect recovery of the ocular surface after LASIK and may increase the risk for chronic dry eye.






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