ESCRS - POREF034 - Dry Eye Disease Before And After Clear (Corneal Lenticule Extraction For Advanced Refractive Correction)

Dry Eye Disease Before And After Clear (Corneal Lenticule Extraction For Advanced Refractive Correction)

Published 2026 - 44th Congress of the ESCRS

Reference: POREF034 | Type: Case Report | DOI: 10.82333/s2f0-rk19

Authors: Dr Nazokat Mukhamedova* 1 , A/Prof. Azamat Yusupov 2

1Ophtalmology,Saif-Optima ,Tashkent,Uzbekistan, 2Ophtalmology,Republican Specialized Scientific-Practical Medical Center of Eye Microsurgery,Tashkent,Uzbekistan

Purpose

To describe ocular surface optimisation and postoperative dry eye status in a contact-lens–intolerant patient with dry eye disease (DED) undergoing Corneal Lenticule Extraction for Advanced Refractive Correction (CLEAR).

Setting

SAIF-OPTIMA Eye Clinic, Tashkent, Uzbekistan.

Report of case

A 23-year-old female with 5-year soft contact lens wear presented with lens intolerance, burning, foreign-body sensation, and redness. Refraction: OD −4.00/−4.00×10, OS −4.50/−2.00×165. Diagnosis: bilateral high myopia, compound myopic astigmatism, hypoxic keratopathy, and DED.
Baseline ocular surface: NIBUT 4.5/4.4 s (OD/OS); interferometry – lipid layer ≈15 nm (open meshwork, grade A); meibography – meibomian gland loss area (%) lower lid 0/0, upper lid 0/10; TMH 0.19/0.21 mm; corneal epithelial mapping.
The ocular surface was optimised with contact lens discontinuation, preservative-free lubricants, a cationic emulsion at night, and a short course of preservative-free topical corticosteroid. After treatment, symptoms and objective metrics improved. Post-optimisation: NIBUT 8.4/8.0 s; lipid layer ≈30 nm (close meshwork, grade B); TMH 0.25/0.20 mm.
Femtosecond CLEAR (flapless lenticule extraction via small incision) was performed. At follow-up, the patient was emmetropic (OD +0.50/−0.50×10) with no significant dry eye symptoms. Post-CLEAR: NIBUT 8.7/9.0 s; TMH 0.19/0.24 mm. Optical quality improved: MTF average height from 0.239 to 0.611, total HOA from 0.171 to 0.062 μm. No clinically relevant postoperative dry eye was observed.

Conclusion/Take home message

Long-term contact lens wearers should be screened for hypoxic keratopathy and DED using objective tear-film and corneal epithelial assessments. Preoperative ocular surface optimisation can improve both symptoms and objective metrics. In this case, CLEAR achieved effective refractive correction with favourable early postoperative ocular surface comfort and optical quality, consistent with the nerve-sparing profile of flapless small-incision lenticule extraction.