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Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye

  • Refractive Surgery
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Abstract

Purpose

The most likely etiology of post-LASIK dry eye is corneal nerve damage; however, no direct relationship between post-LASIK dry eye symptoms and nerve damage has been established, and limited information is available about the relationship between dry eye signs and corneal reinnervation after LASIK. Tear neuropeptides (SP and CGRP) are important in the maintenance of corneal nerve health, but the impact of LASIK has not yet been studied. This study evaluated changes in nerve morphology, tear neuropeptide, and dry eye, so as to establish the relationship between reinnervation and dry eye and to assess the role of tear neuropeptides in reinnervation post-LASIK.

Methods

Twenty non-dry eye volunteers who had undergone bilateral myopic-LASIK completed this study. Corneal nerve morphology (density, width, interconnections, and tortuosity), SP and CGRP concentration, and dry eye were monitored over time prior to, 1 day, 1 week, 1, 3, and 6 months post-LASIK.

Results

Dry eye symptoms and tear function, except for osmolarity (P = 0.003), remained unchanged post-LASIK. Corneal nerve morphology decreased immediately, and did not return to preoperative levels by 6 months post-LASIK (P < 0.001). Increased tear SP concentration was observed 3 months post-LASIK (P < 0.001). Associations between reinnervation as measured by increased density and lower tear SP (P = 0.03), and between increased density and decreased dry eye symptoms (P = 0.01) were found post-LASIK.

Conclusion

An inverse relationship between reinnervation post-LASIK and dry eye symptoms was found, confirming that post-LASIK dry eye is a neuropathic disease. This study is the first to demonstrate an association between tear SP and post-LASIK reinnervation, suggesting that strategies for manipulating neuropeptide concentration to improve reinnervation may improve ocular comfort post-LASIK.

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Acknowledgments

Support for the tear osmolarity testcards by TearLab Corporation is acknowledged. The authors thank Dr Wei Chen for the instrument support (TearLab) in China. We would like to thank staff in the refractive surgery outpatient unit in Wenzhou Eye Hospital for assistance with data collection, and are grateful for the lab support from Zhou’s team in the School of Ophthalmology and Optometry, Wenzhou Medical University. In addition, we would like to thank Dr Ren Chen for his kind contribution.

Conflict of interest disclosures

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Financial support

This study was supported by the University of New South Wales and Wenzhou Medical University. CC received a scholarship from the Australian Government through the International Postgraduate Research Scholarship scheme. SZ received a scholarship from Government Supported Student Award from China. SH received grant supports from Key Technological Innovation Team, Wenzhou China (Refractive surgery new technologies and new product, C20120009-02) and National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2012BAI08B05). The sponsor or funding organization had no role in the design or conduct of this research.

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Authors and Affiliations

  1. School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, 2052, Australia

    Cecilia Chao, Fiona Stapleton, Xiangtian Zhou & Blanka Golebiowski

  2. College of Optometry, State University of New York, New York, NY, 10036, USA

    Cecilia Chao

  3. School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China

    Xiangtian Zhou & Shi Zhou

  4. Refractive Surgery Center, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China

    Shihao Chen

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  1. Cecilia Chao
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  2. Fiona Stapleton
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  3. Xiangtian Zhou
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  4. Shihao Chen
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  5. Shi Zhou
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  6. Blanka Golebiowski
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Correspondence to Blanka Golebiowski.

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Chao, C., Stapleton, F., Zhou, X. et al. Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye. Graefes Arch Clin Exp Ophthalmol 253, 2029–2039 (2015). https://doi.org/10.1007/s00417-015-3120-1

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