Neurotrophic keratopathy and refractive surgery

Abstract

Purpose of reviewCorneal nerve function is an important consideration for the refractive surgeon. In patients without a history of neuropathy, refractive surgery can lead to destruction of corneal nerves and may predispose to keratopathy. The purpose of this review is to provide an update on the effect of refractive surgery on corneal nerve function and the potential for an increased risk of neurotrophic keratopathy development. Recent findingsRecent studies have reinforced that refractive surgery can cause anatomical and functional changes in corneal nerve function. Among the most commonly performed refractive surgery procedures are Laser Assisted In-situ Keratomileusis, Photorefractive Keratectomy, and Small Incision Lenticule Extraction. Due to differences in technique, these procedures can have varying effects on corneal nerve structure. Using in vivo confocal microscopy, postrefractive patients were found to have decreased total nerve density when compared with controls in the immediate postoperative period. In some studies, patients have been shown to undergo re-innervation and regain significant amounts of nerve function. The majority of studies have found that despite decreased nerve cell density, long-term outcomes of refractive surgery patients are generally favorable. However, loss of corneal nerve function can lead to a variety of serious effects ranging from dry eye disease, corneal hypoesthesia/anesthesia, neuropathic pain, to neurotrophic keratopathy and ulceration in the rare cases. SummaryNeurotrophic keratopathy is a rare occurrence after keratorefractive surgery and is largely due to damage to corneal nerves. Proper patient selection and counseling are essential to decrease the risk of development of this devastating complication.

Tear Proteins Altered in Patients with Persistent Eye Pain after Refractive Surgery: Biomarker Candidate Discovery

“…There are some limitations in this study, including the relatively short duration of postsurgical follow-up. Cross-sectional studies have reported the onset of persistent ocular symptoms to range from immediately following surgery to as long as several years later . As the present study continues, we plan to analyze reports from participants after longer postoperative periods.…”

“…Crosssectional studies have reported the onset of persistent ocular symptoms to range from immediately following surgery to as long as several years later. 54 As the present study continues, we plan to analyze reports from participants after longer postoperative periods. Another limitation is the modest sample size; however, the relatively low incidence of persistent pain and the prospective nature of the study limited the number of qualified participants.…”

Diagnostic potential of NRG1 in benign nerve sheath tumors and its influence on the PI3K-Akt signaling and tumor immunity

“…In certain cases, the complete removal of a tumor without causing harm to vital nerves or adjacent structures necessitates the use of highly sophisticated surgical techniques [ 3 ]. Damage to important nerves or structures during surgery can result in postoperative functional impairments or complications [ 4 ]. Although the BNST is considered benign, it is still important to acknowledge the possibility of local recurrence, necessitating close follow-up [ 5 ].…”

Combination therapy with 3% diquafosol tetrasodium ophthalmic solution and sodium hyaluronate: an effective therapy for patients with dry eye after femtosecond laser-assisted in situ keratomileusis

“…The pathophysiology mechanism of post FS-LASIK dry eye is mainly associated with damage to corneal nerve fibers and ocular surface tissues ( 1 ). Most dry eye symptoms disappear within 6–9 months after surgery as corneal nerve regenerates ( 2 , 3 ). However, we should be aware that patients may still suffer from dry eye in the recovery period.…”