Non-Conservative Therapy in the Prevention of Subepithelial Fibroplasia after LASEK Hypermetropia Correction
https://doi.org/10.18008/1816-5095-2018-2-200-206
Abstract
The results of observation of patients who underwent vision eximerlaser correction by the LASEK method regarding medium degree of hyperopia were analyzed.
Purpose: to investigate the severity of the «dry eye» syndrome and corneal subepithelial fibroplasia in patients after laser correction of hyperopia by the LASEK method, and their prevention by reducing the preservative action on the eye surface.
Patients and methods. The study included 40 patients (76 eyes), aged 21–46 years (32.98 ± 1.79) who underwent LASEK surgery for moderate hyperopia (4.03 ± 0.38 D). Patients were divided into two groups: 1) control group (20 patients, 37 eyes) — postoperative therapy included the corneoprotector “Stilavit®” and the preparation of hyaluronic acid “Oksial®”, containing preservatives; 2) the study group (20 patients, 39 eyes) — postoperative therapy included the corneoprotector “Hilozar-comod®” and the artificial tear preparation “Hilo-comod®”, which did not contain reservatives. Ophthalmic examination included, in addition to standard diagnostic methods, the Norn test, the Schirmer test, the staining of the eye surface with lissamine green. In addition, a questionnaire was conducted on a modified OSDI questionnaire; there a section characterizing the quality of vision (section B) was removed.
Results. The analysis of the obtained data showed that in the study group there was less pronounced “dry eye” syndrome at 3,6,12 months after the operation. The maximum difference in the indicators of the “dry eye” syndrome between the groups was at 3 and 6 months of the postoperative period. When evaluating corneal subepithelial fibroplasia, maximum attention was paid to the frequency and the intensity index. It was shown a significant difference in the intensity of the haze between the study group and the control group by 26.1 % at 3 months, by 62.2 % at 6 months and by 65.3 % 12 months after the operation.
Conclusion. Nonconservative therapy with sodium hyaluronate and dexapanthenol in the early postoperative period and only sodium hydrolurate allows to reduce the severity of the dry eye syndrome after laser correction of hypermetropia and, as a result, to reduce the intensity of haze development by 65.3 %, and its frequency on 11,5 %.
About the Authors
S. A. KorotkikhRussian Federation
Repina str., 3, Ekaterinburg, 620028, Russia
MD, professor, head of the department of ophthalmology, chief ophthalmologist of the Ural federal district
A. E. Bogachev
Russian Federation
Repina str., 3, Ekaterinburg, 620028, Russia
assistant of the ophthalmology department, excimer laser surgeon of the medical clinic “Professorskaya plus”
A. S. Shamkin
Russian Federation
Repina str., 3, Ekaterinburg, 620028, Russia
assistant of the department of ophthalmology, excimer laser surgeon of the medical clinic “Professorskaya plus
References
1. Baudouin C., Messmer E.M., Aragona P., Geerling G., Akova Y.A., Benítez-del-Castillo J., Boboridis K.G., Merayo-Lloves J., Rolando M., Labetoulle M. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. The British Journal of Ophthalmolgy. 2016;100:300–6. DOI: 10.1136/bjophthalmol-2015-307415
2. Albietz J.M., Lenton L.M., Mclennan S.G. Effect of laser in situ keratomileusis for hyperopia on tear film and ocular surface. Journal of Refractive Surgery. 2002;18:113–23.
3. Toda I., Asano-Kato N., Komai-Hori Y., Tsubota K. Dry eye after laser in situ keratomileusis. American Journal of Ophthalmology. 2001;132:1–7.
4. Turu L., Alexandrescu C., Stana D., Tudosescu R. Dry eye disease after LASIK. Journal of Medicine and Life. 2012;22:82–4.
5. Chung S.H., Lee S.K. Cristol S.M., Lee E.S., Lee D.W., Seo K.Y., Kim E.K. Impact of short- term exposure of commercial eyedrops preserved with benzalkonium chloride on precorneal mucin. Molecular vision. 2006;12:415–21.
6. Kahook M.Y., Noecker R. Quantitative analysis of conjunctival goblet cells after chronic application of topical drops. Advances in therapy. 2008:25:743–751. DOI: 10.1007/s12325-008-0078-y
7. Pauly A., Meloni M., Brignole-Baudouin F., Warnet J.M., Baudouin C. Multiple endpoint analysis of the 3D-reconstituted corneal epithelium after treatment with benzalkonium chloride: early detection of toxic damage. Investigative Ophthalmology & Visual Science. 2009;50(4):1644–52. DOI: 10.1167/iovs.08-2992
8. Егоров В.В., Дутчин И.В., Посвалюк В.Д., Смолякова Г.П., Сорокин Е.Л. Роль и значение провоспалительных иммуноцитокинов в патогенезе субэпителиального флера роговицы при хирургической коррекции близорукости методом ФРК. Вестник Оренбургского государственного университета. 2004:140–143. [Egorov V.V., Dutchin I.V., Posvalyuk V.D., Smolyakova G.P., Sorokin E.L. The role and importance of proinflammatory immunocytokines in the pathogenesis of subepithelial corneal haze in the surgical correction of myopia by the PRK method. New technologies of eye microsurgery. Annals of Orenburg State University=Vestnik Orenburgskogo gosudarstvennogo universiteta. 2004:140–143. (In Russ.)]
9. Егоров В.В., Дутчин И.В., Смолякова Г.П., Сорокин Е.Л. Клинико-патогенетическая эффективность иммуномодуляции у пациентов с риском регенераторных нарушений после коррекции миопии методами ФРК и ЛАСИК. Рефракционная хирургия и офтальмология. 2007;3:18–24. [Egorov V.V., Dutchin I.V., Smolyakova G.P., Sorokin E.L. Clinico-pathogenetic efficacy of immunomodulation in patients with a risk of regeneration disorders after correction of myopia by the methods of PRK and LASIK. Refractive surgery and ophthalmology in Russia= Refraktsionnaya hirurgiya i ophthal`mologiya. 2007;3:18–24. (In Russ.)]
10. Bron A.J., Evans E.V., Smith J.A. Grading of corneal and conjunctival staining in the context of other eye dry tests. Сornea. 2003;2(7): 640–9.
11. Seiler T., Wollensak J. Myopic photorefractive keratectomy (PRK) with the excimer laser. One -year follow-up. Ophthalmology. 1991;98:1156–63.
12. Pallikaris I.G., Kalyvianaki M.I., Katsanevaki V.J., Ginis H.S. Epi-LASIK: preliminary clinical results of an alternative surface ablation procedure. Journal of Cataract and Refractive Surgery. 2005;31:879–85.
Review
For citations:
Korotkikh S.A., Bogachev A.E., Shamkin A.S. Non-Conservative Therapy in the Prevention of Subepithelial Fibroplasia after LASEK Hypermetropia Correction. Ophthalmology in Russia. 2018;15(2):200-206. (In Russ.) https://doi.org/10.18008/1816-5095-2018-2-200-206