Comparing Dry Eye Disease After Small Incision Lenticule Extraction and Laser Subepithelial Keratomileusis

Abstract

Purpose: To compare dry eye disease parameters between small incision lenticule extraction (SMILE) and laser subepithelial keratomileusis (LASEK). Methods: This prospective, nonrandomized study included 39 eyes of 39 patients who underwent SMILE (n = 19) and LASEK (n = 20). Dry eye disease parameters included Ocular Surface Disease Index (OSDI), tear breakup time, Schirmer I test (SIT) value, corneal esthesiometry result, tear meniscus area, meibomian gland evaluation result, lipid layer thickness, and blink rate. Evaluations were performed before surgery and at 1 and 6 months after surgery. Results: Compared with the LASEK group, the SMILE group showed lower corneal esthesiometry values at 1 month and higher OSDI scores and lower SIT values at 6 months after surgery. The SMILE group showed significantly higher OSDI scores at 1 and 6 months after surgery than before, but significantly lower OSDI scores at 6 months than at 1 month after surgery. Both groups showed significantly decreased corneal sensitivity at 1 month after surgery, which increased to the preoperative level 6 months after surgery. The change in OSDI scores at 1 month after surgery positively correlated with changes in the total and partial blink rates, whereas the change in corneal sensitivity at 1 month after surgery negatively correlated with the total and partial blink rates. Conclusions: Both SMILE and LASEK groups showed temporary decreases in corneal sensitivity, which recovered to baseline levels. Although subjective symptoms worsened after SMILE, SIT values improved after LASEK. Compared with SMILE, LASEK yielded better results regarding subjective symptoms, tear production, and corneal sensitivity.

Effects of warm compress on tear film, blink pattern and Meibomian gland function in dry eyes after corneal refractive surgery

“…However, at more than 2 years after surgery, we observed no significant difference between surgeries except PBF. Similarly, Chung B, et al also reported that the decrease in corneal sensitivity recovered to baseline level at 6 months after both SMILE and LASEK [38]. Accordingly, we presumed that the long-term difference between SMILE and LASEK might be slight, which need to be further investigated.…”

“…In that case, WC may be more beneficial for the SMILE group. Moreover, although SMILE and LASEK are both flapless corneal refractive surgeries with only superficial corneal ablation, the former had worse recovery of corneal sensitivity following surgery, besides, association among the blinking rate, TFLLT, and corneal sensitivity was also noticed [38]. Therefore, the varying degree of postoperative corneal sensitivity recovery may partly explain the different change of TFLLT and blink pattern following SMILE and LASEK.…”

Changes in ocular surface and Meibomian gland after penetrating Keratoplasty

“…Functional changes of meibomian glands after surgery have been previously reported in surgeries other than PKP [32][33][34][35][36]. Unavoidable trauma from cataract surgery may induce ocular inflammation [37].…”

The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery

“…Neither femtosecond LASIK nor SMILE patients, however, displayed a significant change in meiboscore at one month. In a similarly designed study, Chung et al [29 ▪ ] found that patients who underwent SMILE or LASEK surgery had decreased meibomian gland expressibility after 6 months. The SMILE group also had worsened meibum quality.…”