Dry eye symptoms in keratoconus patients before and after femtosecond laser-assisted corneal transplantation
First Author: H.Sitnik BELARUS
To evaluate and compare the symptoms of dry eye in keratoconus patients before and after femtosecond laser-assisted corneal transplantation.
Setting. Chair of ophthalmology of Belarusian Medical Academy of Post-graduate Education
87 patients with advanced keratoconus were included in the study (90 eyes, 59 men, 28 women, mean age 32.7 ± 5.6 y.o.). Follow up varied from 12 to 24 months. Tear break up time (TBUT), Schirmer test (ST) without anesthesia, corneal staining, thorough survey of the eyelids, were performed before and after corneal transplantation in all cases. Ocular surface disease index (OSDI) were evaluated before and after keratoplasty. 1st group consisted 44 patients (45 eyes) operated with the use of femtosecond laser: 21 DALK, 24 PKP. In 2nd group manual keratoplasty was performed in all cases: 20, DALK, 24 PKP.
Dry eye diagnosed in 84.5% before operation: mild – 23.7%, moderate – 56.6%, severe – 19.7%. Chronic blepharitis revealed in 63.3% preoperatively, in 31.6% worsened postop. Dry eye worsened on 3-12 months postoperatively in 91.1%. ST improved on 6 months postoperatively: 8.7 ± 2.8 mm, on 12 months – 10.0 ± 2.6 mm, on 18 months – 12.4 ± 2.6 mm. The difference revealed between the groups after 12 months: ST was 11.9 ± 2.2 mm in 1st and 9.7 ± 2.7 mm in 2nd group, TBUT was 7.9 ± 1.2 sec and 8.7 ± 1.1 sec, OSDI 29.45 ± 4.65, and 38.8 ± 4.78.
The study revealed high rate (84.5%) and relevance of dry eye syndrome in advanced keratoconus patients before operation and it worsening after corneal transplantation (91.1%). Delayered epithelization and persistent erosion of corneal transplant were found in patients with severe dry eye. Worsening of blepharitis diagnosed in 31,6% that require thorough repeated medical treatment. Differences between the groups revealed in corneal transplant epithelization and ocular surface restoration within 12-18 months postoperatively, that proved the advantages of femtosecond laser-assisted corneal transplantation.