Changes in Corneal Sensation, Tear Film Stability and Ocular Surface after Advanced Surface Ablation

Hee Lee Byeong; Joo Kim Eun; Hyun Kim Jee; Ja Lee Gwang; Won Lee Kyoo; Jeung Park Young

doi:10.3341/jkos.2013.54.3.408

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Byeong, Eun, Jee, Gwang, Kyoo, and Young: Changes in Corneal Sensation, Tear Film Stability and Ocular Surface after Advanced Surface Ablation

Original Article

J Korean Ophthalmol Soc 2007;54(3):408-415.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.3.408

Changes in Corneal Sensation, Tear Film Stability and Ocular Surface after Advanced Surface Ablation

Hee Lee Byeong, MD, Joo Kim Eun, MD, Hyun Kim Jee, MD, Ja Lee Gwang, MD, Won Lee Kyoo, MD, PhD, Jeung Park Young, MD, PhD

Cheil Eye Hospital, Daegu, Korea

Address reprint requests to Young Jeung Park, MD, PhD Cheil Eye Hospital #1 Ayang-ro, Dong-gu, Daegu 701-820, Korea Tel: 82-53-959-1751, Fax: 82-53-959-1758, E-mail: eyepark9@dreamwiz.com

Received 26 July 2006 Accepted 8 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the changes in tearfilm, corneal sensation and ocular surface after advanced surface ablation.

Methods

Tearfilm break-up time (BUT), Schirmer test without local anesthesia, fluorescein staining, corneal sensitivity test, ocular surface disease index (OSDI), and conjunctival impression cytology were evaluated in 50 eyes of 25 patients who underwent advanced surface ablation preoperatively and postoperatively at 2 weeks and at 1, 2, 3, and 6 months. Each value was compared to the preoperative value.

Results

OSDI diminished by 2 weeks postoperatively, and corneal sensation diminished by 1 month postoperatively (p < 0.05). There were significant decreases in BUT by 2 weeks to 1 month postoperatively as well as decreases in the Schirmer test by 2 to 3 months postoperatively (p < 0.05). Fluorescein staining increased at 2 weeks postoperatively (p <0.05). Goblet cells decreased substantially by 1 month postoperatively and conjunctival squamous metaplasia increased significantly by 2 months postoperatively (p < 0.05).

Conclusions

Advanced surface ablation may affect tearfilm, corneal sensation and ocular surface up to 3 months postoperatively. Early treatment of dry eye syndrome following advanced surface ablation should strongly be considered.

Keywords: Advanced surface ablation, Dry eye, Impression cytology

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Figure 1.

Impression cytological finding of goblet cell density before and after advanced surface ablation. Photograph exhibits a sharp reduction in goblet cells at 2 weeks post-op, then shows a gradual recovery returning to a pre-op level at between 2-3 months post-op. The increase in goblet cell number continues to 6 months post-op (PAS-H&E, ×100).

Figure 2.

Impression cytological finding of squamous metaplasia before and after advanced surface ablation. The photograph shows that epithelial metaplasia grade worsens drastically at two weeks post-op, maximizing at 4 weeks post-op. Then it improves gradu-ally, returning to the pre-op level at 3 months post-op, yet to improve further all the way up to 6 months post-op (PAS-H&E, ×400).

Table 1.

Demographic features of patients

	Advanced surface ablation
Number of eyes (patients)	50 (25)
Sex (M/F)	6/19
Mean age of patients (year)	25.80 ± 5.25 (19-39)
CL history (year)	4.81 ± 5.36 (0-20)
Preoperative SE (diopter)	-4.80 ± 1.64 (-1.75~-8.5)
Preoperative pachymetry (μm)	543.7 ± 30.2 (484-608)
Ablation depth (μm)	82.39 ± 22.04 (41-127)
Ablation diameter (mm)	6.54 ± 0.30 (6.0-7.2)

Values are presented as mean ± SD (range)

Table 2.

Clinical parameters before and after

Parameter	Pre-op	Postoperative
2 weeks	1 month	2 months	3 months	6 months
BUT (seconds)	6.56 ± 3.14	4.60 ± 2.89^*	4.92 ± 2.60^*	5.88 ± 2.60	6.24 ± 2.93	6.76 ± 2.09
Schirmer I (mm)	13.6 ± 12.25	11.28 ± 9.24	10.88 ± 8.14	9.16 ± 7.59^*	8.32 ± 9.32^*	9.60 ± 5.35
Corneal fluorescein staining	0.72 ± 1.21	1.6 ± 1.22^*	0.48 ± 0.65	0.48 ± 0.71	0.36 ± 0.76	0.44 ± 0.77
Corneal sensation (mm)	56.00 ± 4.30	50.00 ± 5.20^*	52.00 ± 5.20^*	56.80 ± 2.84	57.20 ± 3.84	59.00 ± 2.04
OSDI	29.16 ± 22.71	36.86 ± 13.79^*	27.53 ± 13.77	25.01 ± 13.13	21.25 ± 10.65	20.84 ± 12.42

Values are presented as mean ± SD.

BUT = tear break-up time; OSDI = ocular surface disease index.

^* Significantly worse than the preoperative value (p < 0.05, Wilcoxon signed-rank test).

Table 3.

The changes in conjunctival impression cytology before and after advanced surface ablation

Parameter	Pre-op	Postoperative
2 weeks	1 month	2 months	3 months	6 months
Conjunctival epithelial metaplasia	0.72 ± 0.74	1.74 ± 0.56^*	1.82 ± 0.54^*	1.23 ± 0.65^*	0.96 ± 0.69	0.51 ± 0.49
Goblet cell count (cells/mm²)	301.6 ± 205.6	102.7 ± 75.1^*	181.0 ± 178.0^*	274.1 ± 148.1	353.3 ± 224.1	464.5 ± 251.0
Snake‐like chromatin (%)	32	32	44	40	52	32

Values are presented as mean ± SD.

^* Significantly worse than the preoperative value (p < 0.05, Wilcoxon signed-rank test).

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