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Goblet cell study marks a change in approach to dry eye following LASIK

ByJorge L. Alió del Barrio, MD, PhD

ByAhmed Galal, MD

ByJosé L. Rodríguez-Prats, MD

ByAlejandra E. Rodríguez, MD

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Jorge L. Alió

The April 2006 issue of Ocular Surgery News Europe/Asia-Pacific Edition featured an article on goblet cell changes following LASIK (“Goblet cell changes may be linked to dry eye after LASIK”). I would like to take a moment to discuss the importance of these findings as they apply to our thinking in regard to dry eye following LASIK.

All LASIK techniques are known to decrease the normal amount of lubrication in the eye. The destruction of the corneal nerves is the most popular theory as the cause of post-LASIK dry eye syndrome, but the findings of the authors indicate that there is a significant transient decrease in the population of conjunctival goblet cells after LASIK, which contributes to the appearance of the ocular surface syndrome following LASIK.

This decrease in the goblet cell population depends on the method used to create the flap. The techniques using manual microkeratomes or femtosecond laser to create the corneal flap cause a large decrease in goblet cell population, while other techniques of surface ablation (epi-LASIK, LASEK, PRK) produce minimal or no decrease in the goblet cell count after surgery.

These differences can be explained by the type of suction ring used and suction time necessary to obtain the flap.

Although the mean period that the suction ring is applied is five times longer with femtosecond laser than the manual microkeratome, the degree of damage is similar in both techniques.

Epi-LASIK, LASEK and PRK may induce dry eye symptoms, but LASIK and femtosecond LASIK seem to be more frequently associated with dry eyes. When epi-LASIK or LASEK are performed, the postoperative decrease in the goblet cell population is low, about 10%, whereas in stromal ablation techniques (manual microkeratome or femtosecond laser), the decrease in the goblet cell count reaches 40% to 50%.

When PRK is performed, the population of conjunctival goblet cells does not change, probably due to the fact that the suction ring is not necessary for the surgery and no pressure of any type is applied.

Although, to date, we had only contemplated the nerve-cut theory, these results on the decrease of goblet cell population after refractive surgery from the research team at Vissum, Instituto Oftalmólogico of Alicante, contribute to the understanding and management of post-LASIK dry eye syndrome.

For more information:

• Prof. Jorge L. Alió, MD, PhD, can be reached at Vissum, Instituto Oftalmológico de Alicante, Avda de Denia, s/n, 03016 Alicante, Spain; +34-965-150-025; fax: +34-965-151-501; e-mail: jlalio@vissum.com.