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LASEK found successful for dry eye associated with soft contact lenses
Study found no significant differences in Schirmer test and tear breakup times before and after LASEK.
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Laser epithelial keratoplasty was found to be a safe and effective treatment for myopic patients with preoperative dry eye associated with extended soft contact lens use in a pilot study.
Although the study included only nine patients, “the results in this small population highlight the safety and efficacy of LASEK in treating myopia/myopic astigmatism in severe dry eyes associated with complicated soft contact lens wear,” said first author Ko-Hua Chen, MD, and colleagues.
“Indeed, the safety index and efficacy index of visual outcomes 1 year following LASEK are comparable with data derived from studies of larger populations,” the authors said.
With proper ocular surface management – discontinuance of soft contact lens wear, treating soft contact lens- associated keratoconjunctival disorders and vigorous dosage of preservative-free lubricants – patients with severe dry eye linked to complicated soft contact lens wearing may be good candidates for LASEK, the authors concluded.
The study was performed at Taipei Veterans General Hospital in Taiwan, where the authors said many patients undergo laser refractive surgery because of intolerance to contact lenses caused by dry eyes.
All nine patients (18 eyes) in the study were Chinese. Mean age in the study was 27.4 years with a range in age of 22 to 40 years. Patients suffered from dry eye and keratoconjunctivitis associated with long-term use of daily-wear soft contact lenses ranging from 4.5 to 20 years of wear.
The outcomes of the study, including epithelial wound healing, visual performance, dry-eye status, tear formation, recovery of corneal sensitivity and incidence of complications after LASEK, were published in the Journal of Cataract & Refractive Surgery.
Epithelial healing
During surgery, all epithelial flaps were easily detached intact and no flaps displayed a loss of integrity. All patients had their therapeutic bandage lens removed no later than postoperative day 4, with total corneal epithelial healing and without any vital staining.
With the exception of one eye, there was no subepithelial haze or corneal epitheliopathy evident at any follow-up exam. The 1-year follow-up exam showed a mean spherical equivalent of –0.79 D. No intraoperative complications occurred in any eye and corneal sensitivity recovered to preoperative levels within 1 month after LASEK.
Patients assessed their dry-eye symptoms using a questionnaire. They reported that symptoms improved mildly but significantly from 1 to 12 months after LASEK. The results of the Schirmer test with anesthesia were 0 mm at all follow-up exams.
For more information:
- Wen-Ming Hsu, MD, the corresponding author on this study, can be reached at the department of ophthalmology, Taipei Veterans General Hospital, 201, Shih-Pai Road, Section II, Taipei 11217, Taiwan; e-mail: khchen@vghtpe.gov.tw.
Reference:
- Chen KH, Hsu WM, et al. Laser-assisted subepithelial keratectomy for dry eye associated with soft contact lenses. J Cataract Refract Surg. 2005;31:2299-2305.
- Bob Kronemyer is an OSN Correspondent based in Elkhart, Ind.