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Indications for preoperative planning of excimer laser surgery

Poster Details

First Author: A.Zhemchugova RUSSIA

Co Author(s):    V. Kurenkov   E. Polununa           

Abstract Details



Purpose:

To evaluate the clinical status of the patients who are planned to undergo excimer laser surgeries and LASIK in particular for the availability of blepharoconjunctival form of dry eye syndrome and influence of lid therapy on the intensity of signs.

Setting:

Doctor Kurenkov clinic

Methods:

288 patients aged 18 to 57 including 162 women and 126 men were observed. In accordance with the study objectives and depending on the type of the conducted therapy two groups of patients who underwent LASIK surgery were differentiated: the first group includes 140 patients (280 eyes) who had lid therapy during 7 days before the surgery; the second (control) group includes 148 patients (296 eyes) without lid therapy. The method of lid therapy included as follows: 1. application of warm dressings that soften the meibomian gland obstruction; 2. self-massage of the lid margins to enable evacuation of discharge from the glandular ducts. All the patients complained of dryness, burning, discomfort in the eyes, etc. During biomicroscopy the condition of eyelids was evaluated in detail such as availability and intensity of hyperaemia, oedema, obstruction in the meibomian gland orifice. Intensity of subjective and objective symptoms was evaluated according to a points system: lack of signs - 0 points, mild - 1 point, moderate - 2 points, pronounced - 3 points, severe and very severe - 4 points. Besides, lacrimation tests (Schirmer's test, tear breakup time) and conjunctival inoculation were carried out.

Results:

It was defined that at baseline testing mean intensity of complaints of dryness, burning, discomfort in the eyes, etc. accounted for 1.4 points in the main group of patients. In 7 days following the lid therapy the index accounted for 0.7 reducing by 17.5%. The level of subjective complaints constituted 1.3 in the control group; in 7 days it accounted for 1.3 without any additional therapeutic manipulations demonstrating the lack of index dynamics. The mean intensity of biomicroscopic signs of blepharoconjunctival form of the dry eye syndrome accounted for 1.3 in the main group. In 7 days the index reduced by 20% and accounted for 0.5 following the lid therapy. Preoperative reduction of lacrimation in three mentioned tests cumulatively was noted in 45.7% of patients from the main group; normal level of lacrimation was found in 54.3% of patients. In the control group preoperative reduction of lacrimation was seen in 36.2% of cases. In the group of patients who underwent lid therapy before the surgery the level of lacrimation restored in 6 patients by the beginning of the surgery against the background of the conducted therapy accounting for 8.6%.

Conclusions:

In spite of the fact that it is a practically healthy patient who requests for excimer laser vision correction, signs of dysfunction of the meibomian glands and related complaints are found in detailed preoperative diagnostics and history taking (periodically occurring complaints typical of an instable tear film) which can serve as a risk factor for complications in the surgical setting. The conducted study revealed that following the course of eyelid therapy the intensity of complaints and biomicroscopic signs of meibomian gland dysfunction is reduced, and Schirmer's test values are increased alongside with the tear break-up time. This reduces risk of pathological processes related to the disturbance of the tear film stability. FINANCIAL INTEREST: NONE

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