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The structural and functional corneal reinnervation mechanism at different regions after LASIK—an in vivo confocal microscopy study

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Abstract

Purpose

To determine the recovery of structural and functional corneal sensory nerves within the LASIK flap in order to provide insight to more proximal corneal reinnervation and symptoms post-LASIK.

Methods

Twenty participants underwent femtosecond LASIK with a superior flap hinge. Ocular Comfort Index in Chinese (OCI-C), Cochet-Bonnet esthesiometry, and in vivo confocal microscopy were conducted before surgery and 1 week, 1-, 3-, and 6-months post-LASIK to measure symptoms, corneal sensitivity, nerve fiber density, width, and the number of interconnections within the flap (central and mid-temporal regions), and next to the superior flap hinge. Linear mixed models were used to compare differences between corneal regions at each time point post-LASIK and changes over time post-LASIK. Spearman’s correlation tests were used to examine the associations between variables post-LASIK.

Results

The least reduction in sensitivity (P < 0.03) and in nerve fiber density (P < 0.02) was found near the flap hinge compared to other regions, but no regional differences were found in nerve fiber width and interconnections. Nerve fiber density and the number of interconnections at all regions within the flap recovered over time (P < 0.02). The recovery of corneal sensitivity and nerve fiber width was only seen at the central and temporal regions (P < 0.04). No association was found between sensitivity and nerve parameters, but a higher OCI-C score was associated with a lower nerve fiber density near the hinge (r =  − 0.43, P = 0.003) over time post-LASIK.

Conclusion

Corneal sensitivity and density are preserved in the hinge, but this preservation of the corneal nerve damage does not affect the nerve morphology.

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References

  1. Perez-Santonja JJ, Sakla HF, Cardona C, Chipont E, Alio JL (1999) Corneal sensitivity after photorefractive keratectomy and laser in situ keratomileusis for low myopia. Am J Ophthalmol 127:497–504

    Article  CAS  Google Scholar 

  2. Lee BH, McLaren JW, Erie JC, Hodge DO, Bourne WM (2002) Reinnervation in the cornea after lasik. Invest Ophthalmol Vis Sci 43:3660–3664

    PubMed  Google Scholar 

  3. Muller LJ, Vrensen GF, Pels L, Cardozo BN, Willekens B (1997) Architecture of human corneal nerves. Invest Ophthalmol Vis Sci 38:985–994

    PubMed  CAS  Google Scholar 

  4. Muller LJ, Marfurt CF, Kruse F, Tervo TM (2003) Corneal nerves: structure, contents and function. Exp Eye Res 76:521–542

    Article  CAS  Google Scholar 

  5. Patel SV, McLaren JW, Kittleson KM, Bourne WM (2010) Subbasal nerve density and corneal sensitivity after laser in situ keratomileusis: femtosecond laser vs mechanical microkeratome. Arch ophthalmol 128:1413–1419

    Article  Google Scholar 

  6. Darwish T, Brahma A, O’Donnell C, Efron N (2007) Subbasal nerve fiber regeneration after lasik and lasek assessed by noncontact esthesiometry and in vivo confocal microscopy: Prospective study. J Cataract Refract Surg 33:1515–1521

    Article  Google Scholar 

  7. Chao C, Stapleton F, Zhou X et al (2015) Structural and functional changes in corneal innervation after laser in situ keratomileusis and their relationship with dry eye signs and symptoms. Graefe’s Arch Clin Exp Ophthalmol 253:2029–2039

    Article  Google Scholar 

  8. Donnenfeld ED, Ehrenhaus M, Solomon R et al (2004) Effect of hinge width on corneal sensation and dry eye after laser in situ keratomileusis. J Cataract Refract Surg 30:790–797

    Article  Google Scholar 

  9. Donnenfeld ED, Solomon K, Perry HD et al (2003) The effect of hinge position on corneal sensation and dry eye after lasik. Ophthalmology 110:1023–1029; discussion 1029–1030

  10. Chao C, Golebiowski B, Stapleton F (2014) The role of corneal innervation in lasik-induced neuropathic dry eye. Ocul Surf 12:32–45

    Article  Google Scholar 

  11. Konomi K, Chen LL, Tarko RS et al (2008) Preoperative characteristics and a potential mechanism of chronic dry eye after lasik. Invest Ophthalmol Vis Sci 49:168–174

    Article  Google Scholar 

  12. Perez-Gomez I, Efron N (2003) Change to corneal morphology after refractive surgery (myopic laser in situ keratomileusis) as viewed with a confocal microscope. Optom Vis Sci 80:690–697

    Article  Google Scholar 

  13. Chuck RS, Quiros PA, Perez AC, McDonnell PJ (2000) Corneal sensation after laser in situ keratomileusis. J Cataract Refract Surg 26:337–339

    Article  CAS  Google Scholar 

  14. Savini G, Barboni P, Zanini M, Tseng SC (2004) Ocular surface changes in laser in situ keratomileusis-induced neurotrophic epitheliopathy. J Refract Surg 20:803–809

    Article  Google Scholar 

  15. Nassaralla BA, McLeod SD, Nassaralla JJ Jr (2003) Effect of myopic lasik on human corneal sensitivity. Ophthalmology 110:497–502

    Article  Google Scholar 

  16. Linna TU, Vesaluoma MH, Perez-Santonja JJ et al (2000) Effect of myopic lasik on corneal sensitivity and morphology of subbasal nerves. Invest Ophthalmol Vis Sci 41:393–397

    PubMed  CAS  Google Scholar 

  17. Chao C, Golebiowski B, Cui Y, Stapleton F (2014) Development of a chinese version of the ocular comfort index. Invest Ophthalmol Vis Sci 55:3562–3571

    Article  Google Scholar 

  18. Chao C, Golebiowski B, Zhao X et al (2016) Long-term effects of lasik on corneal innervation and tear neuropeptides and the associations with dry eye. J Refract Surg 32:518–524

    Article  Google Scholar 

  19. Lum E, Golebiowski B, Swarbrick H (2017) Reduced corneal sensitivity and sub-basal nerve density in long-term orthokeratology lens wear. Eye Contact Lens 43:218–224

    Article  Google Scholar 

  20. Chao C, Stapleton F, Badarudin E, Golebiowski B (2015) Ocular surface sensitivity repeatability with cochet-bonnet esthesiometer. Optom Vis Sci 92:182–189

    Article  Google Scholar 

  21. Golebiowski B, Chao C, Stapleton F, Jalbert I (2017) Corneal nerve morphology, sensitivity, and tear neuropeptides in contact lens wear. Optom Vis Sci 94:534–542

    Article  Google Scholar 

  22. Golebiowski B, Papas E, Stapleton F (2011) Assessing the sensory function of the ocular surface: implications of use of a non-contact air jet aesthesiometer versus the cochet-bonnet aesthesiometer. Exp Eye Res 92:408–413

    Article  CAS  Google Scholar 

  23. Calvillo MP, McLaren JW, Hodge DO, Bourne WM (2004) Corneal reinnervation after lasik: prospective 3-year longitudinal study. Invest Ophthalmol Vis Sci 45:3991–3996

    Article  Google Scholar 

  24. Erie JC, McLaren JW, Hodge DO, Bourne WM (2005) Recovery of corneal subbasal nerve density after prk and lasik. Am J Ophthalmol 140:1059–1064

    Article  Google Scholar 

  25. Moilanen JA, Holopainen JM, Vesaluoma MH, Tervo TM (2008) Corneal recovery after lasik for high myopia: a 2-year prospective confocal microscopic study. Br J Ophthalmol 92:1397–1402

    Article  CAS  Google Scholar 

  26. Chao C, Lum E, Golebiowski B, Stapleton F (2020) Alteration of the pattern of regenerative corneal subbasal nerves after laser in-situ keratomileusis surgery. Ophthalmic Physiol Opt 40:577–583

    Article  Google Scholar 

  27. Nguyen QT, Sanes JR, Lichtman JW (2002) Pre-existing pathways promote precise projection patterns. Nat Neurosci 5:861–867

    Article  CAS  Google Scholar 

  28. Linna TU, Perez-Santonja JJ, Tervo KM et al (1998) Recovery of corneal nerve morphology following laser in situ keratomileusis. Exp Eye Res 66:755–763

    Article  CAS  Google Scholar 

  29. Borsook D, Rosenthal P (2011) Chronic (neuropathic) corneal pain and blepharospasm: Five case reports. Pain 152:2427–2431

    Article  Google Scholar 

  30. Patel SV, McLaren JW, Hodge DO, Bourne WM (2002) Confocal microscopy in vivo in corneas of long-term contact lens wearers. Invest Ophthalmol Vis Sci 43:995–1003

    PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by UNSW Sydney Australia and Wenzhou Medical University China. C.C. received an International Postgraduate Research Scholarship from the Australian government. Z.S. received a Chinese Government Supported Student Award.

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Authors and Affiliations

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

    Cecilia Chao, F. Stapleton & B. Golebiowski

  2. University of Houston College of Optometry, 4901 Calhoun Rd., Houston, TX, 77204-2020, USA

    Cecilia Chao

  3. Wenzhou Medical University, Wenzhou, China

    S. Zhou, S. Chen & X. Zhou

Authors
  1. Cecilia Chao
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  2. S. Zhou
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  3. F. Stapleton
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  4. S. Chen
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  5. X. Zhou
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  6. B. Golebiowski
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Corresponding author

Correspondence to Cecilia Chao.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Cecilia Chao shared as co-first author

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Chao, C., Zhou, S., Stapleton, F. et al. The structural and functional corneal reinnervation mechanism at different regions after LASIK—an in vivo confocal microscopy study. Graefes Arch Clin Exp Ophthalmol 260, 163–172 (2022). https://doi.org/10.1007/s00417-021-05381-z

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  • DOI: https://doi.org/10.1007/s00417-021-05381-z

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