Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Comparison of Ocular Surface Changes Following Laser-Assisted in Situ Keratomileusis and Photorefractive Keratectomy: Cross-Sectional Study
Lazer Yardımlı İn Situ Keratomileusis ve Fotorefraktif Keratektomi Sonrası Oküler Yüzey Değişikliklerinin Karşılaştırılması: Kesitsel Çalışma
Hasan KIZILTOPRAKa , Merve İNANÇ TEKİNb , Emine Rümeysa HEKİMOĞLUc , Kemal TEKİNb , Kemal ÖZÜLKENd , Dilara ÖZKOYUNCU KOCABAŞd
aDepartment of Ophthalmology, Adıyaman University Faculty of Medicine, Adıyaman, Türkiye
bClinic of Ophthalmology, Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Türkiye
cDepartment of Histology and Embryology, Bezmiâlem Vakıf University Faculty of Medicine, İstanbul, Türkiye
dDepartment of Ophthalmology, TOBB University of Economics and Technology Faculty of Medicine, Ankara, Türkiye
Turkiye Klinikleri J Ophthalmol. 2023;32(3):153-61
doi: 10.5336/ophthal.2022-95060
Article Language: EN
Full Text
ABSTRACT
 Objective: To compare the ocular surface changes following Femtosecond laser in situ keratomileusis (Femto-LASIK) and photorefractive keratectomy (PRK). Material and Methods: TThis prospective study included 74 eyes of 37 patients: 34 were in the Femto-LASIK group, and 40 were in the PRK group. Schirmer test, tear break-up time, and conjunctival impression cytology (CIC) were used to determine ocular surface changes before and 1 month, and 3 months after PRK or Femto-LASIK. Results: There were no significant differences between PRK and LASIK group in mean CIC scores in the first month (p > .05, for each). However, a significant difference observed at goblet cell density (GCD) at the third month between PRK and LASIK group (p =0.008). Comparing of the CIC scores between first month and the third month of PRK group showed significant improvements in the GCD and epithelial cell sheet (p =0.005, p =0.001, respectively). However, no significant changes occurred in the FemtoLASIK group between first month and the third month (p > .05, for each). Conclusion: We observed histopathological changes in the perilimbal conjunctiva in the PRK and LASIK groups at the first month after surgery. It was observed that these changes continued in the 3rd postoperative month. Although GCD improved significantly in the PRK group, it was still lower than preoperatively. We can say that these changes play a primary role in the pathogenesis of dry eye and even cause a more severe course of DED in LASIK patients.

Keywords: Conjunctival impression cytology; Femto-LASIK; PRK; Schirmer test; Tear break-up time
ÖZET
 Amaç: emtosaniye lazer in situ keratomileusis (Femto-LASIK) ve fotorefraktif keratektomi (PRK) sonrası oküler yüzey değişikliklerini karşılaştırmak. Gereç ve Yöntemler: Bu prospektif çalışmaya Femto-LASIK grubunda 34, PRK grubunda 40 olmak üzere toplam 37 hastanın 74 gözü dahil edildi. PRK veya Femto-LASIK öncesi, 1. ay ve 3. aydaki oküler yüzey değişikliklerini belirlemek için Schirmer testi, gözyaşı kırılma zamanı ve konjonktival impresyon sitolojisi (KİS) kullanıldı. Bulgular: PRK ve LASIK grubu arasında, ortalama KİS skorlarında birinci ayda anlamlı fark yoktu (her biri için p > .05). Ancak üçüncü aydaki goblet hücre dansitesinde (GHD) PRK ve LASIK grubu arasında anlamlı bir fark gözlendi (p =0.008). PRK grubunun birinci ay ile üçüncü ay arasındaki KİS skorlarının karşılaştırılması, GHD ve epitel hücre tabakasında anlamlı iyileşmeler gösterdi (sırasıyla p = 0.005, p = 0.001). Ancak Femto-LASIK grubunda birinci ay ile üçüncü ay arasında anlamlı bir değişiklik olmadı (her biri için p >.05). Sonuç: Ameliyat sonrası 1. ayda PRK ve LASIK gruplarında perilimbal konjonktivada histopatolojik değişiklikler gözlemledik. Ameliyat sonrası 3. ayda bu değişikliklerin devam ettiği görüldü. GHD, PRK grubunda önemli ölçüde iyileşmesine rağmen, yine de preoperatif dönemden daha düşüktü. Bu değişikliklerin kuru göz patogenezinde birincil rol oynadığı ve hatta LASIK hastalarında kuru göz hastalığının daha ağır seyretmesine neden olduğu söylenebilir.

Anahtar Kelimeler: Konjonktival impresyon sitolojisi; Femto-LASIK; PRK; Schirmer testi; gözyaşı kırılma zamanı
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