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The influence of the suction ring in goblet cell density and efficiency after refractive surgery: 6 month follow-up

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Session Details

Session Title: Presented Poster Session: Refractive Surgery Complications

Session Date/Time: Monday 07/09/2015 | 09:30-11:00

Paper Time: 09:30

Venue: Poster Village: Pod 3

First Author: : A.Rodero Serrano SPAIN

Co Author(s): :    G. Carracedo   J. Sanchez Pina   A. Martin-Gil   A. Salazar   M. Teus   J. Pintor

Abstract Details


Recent studies have suggested that a decrease in Goblet cell density due to the suction ring could be one of the causes of dry eye after Laser assisted in Situ Keratomileusis (LASIK). A new technique for the analysis of impression cytology by laser confocal microscopy allows 3D imaging that can analyze cell density, cell layer thickness (CLT) and mucin cloud height (MCH). The aim of this study was to evaluate the Goblet cell density and efficiency before and after LASIK and photorefractive keratectomy (PRK) during 6 month follow up. Symptoms of dry eye, tear volume and stability also were assessed.


The study was performed in Clínica Novovisión (Madrid, Spain) and samples collected were analyzed in Department of Biochemistry and Molecular Biology IV of Universidad Complutense de Madrid (Madrid, Spain).


Thirty one eyes of thirty one patients were enrolled in this prospective study. 15 patients (35.0±7.12 years old) underwent LASIK and 16 patients PRK (31.08±7.20 years old). Tear volume with Schirmer test, tear stability with tear break up time (BUT), symptomatology with Ocular Surface Disease Index (OSDI) and impression cytology of the bulbar conjunctiva (using the EyePrim device) were performed before and one day, one month and six months after surgery. All impression cytology samples were preserved in 96% ethanol and processed for laser confocal microscope observations. Cell density, MCH and CLT were evaluated.


There were no significant changes in either BUT and tear volume after both surgeries at any visit. However, the OSDI scores were increased 7 days after surgery in both procedures, remaining increased only in the PRK one month later (p<0.05), returning to baseline values in both groups at the 6 month visit. We found a significant decrease in the Goblet cell density in both groups at 7 and at 30 days post-op, especially in the PRK group (p<0.05), returning to basal values after 6 months. MCH and CLT were increased at all post-op visits in both groups (p<0.05).


A dysfunction of Goblet cells behavior appeared after refractive surgery, decreasing their density and, at the same time, increasing the production of mucins and the Goblet cell thickness, possibly as a compensatory reaction. The suction ring is used during LASIK, but it is not used in PRK. Therefore, the results found in this study suggest that the suction ring is not the responsible of the Goblet cell loss seen after surgery.

Financial Interest:


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