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Home > Archive > Lasik Eyes Surgery > December 2005 > LASIK nerve damage symptoms persist at 16 months
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LASIK nerve damage symptoms persist at 16 months
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| LASIK nerve damage symptoms persist at 16 months
http://www.ncbi.nlm.nih.gov/entrez/...rch&DB=3Dpubmed
Ophthalmology. 2001 Jul;108(7):1230-5
Effects of laser in situ keratomileusis on tear production, clearance,
and the ocular surface.
Battat L, Macri A, Dursun D, Pflugfelder SC.
Bascom Palmer Eye Institute, university of Miami School of Medicine,
Miami, Florida, USA.
Excerpts from the full text:
=B7 Corneal sensation remained reduced 16 months after LASIK
=B7 Conjunctival sensation remained reduced 16 months after LASIK
=B7 Tear clearance remained reduced 16 months after LASIK.
ABSTRACT
PURPOSE: To evaluate components of the integrated ocular
surface/lacrimal gland unit in a series of patients before and after
undergoing bilateral laser in situ keratomileusis (LASIK).
DESIGN: Prospective, noncomparative case series. PARTICIPANTS:
Forty-eight eyes of 14 men and 34 women (age range, 26-54; mean, 39.2
years) who underwent bilateral LASIK for myopia or myopic astigmatism.
METHODS: LASIK was performed using a VISX Star Excimer Laser (Santa
Clara, CA). Patients completed a questionnaire containing 11 questions
that evaluated the character and severity of ocular irritation
symptoms. Snellen visual acuity, tear fluorescein clearance, corneal
fluorescein staining, aqueous tear production by the Schirmer 1 test,
and corneal and conjunctival sensitivity were measured in each eye.
Corneal surface regularity (SRI) was evaluated with the Tomey TMS-1
(Tomey, Cambridge, MA) topography instrument. Each randomly chosen eye
was evaluated 1 to 2 days (T0) before LASIK and 7 days (T1), 1 (T2), 2
(T3), 6 (T4), 12 (T5), and 16 (T6) months postoperatively. A Wilcoxon
test, two-tailed paired t test, Friedman test, or analysis of variance
were used for statistical comparisons.
MAIN OUTCOME MEASURES: Components of the integrated ocular
surface/lacrimal gland unit. RESULTS: Both corneal and conjunctival
sensitivity were noted to be significantly decreased from preoperative
levels at 1week, 1 month, 12 months, and 16 months postoperatively (P <
0=2E0002 at each time point). Symptom severity scores were significantly
increased at 1 week, 12 months, and 16 months postoperatively (P <
0=2E007 at all time points). The mean Schirmer 1 test scores were 24 +/-
14 mm preoperatively, and they decreased to 18 +/- 14 mm by 1 month
postoperatively (P < 0.001). Tear fluorescein clearance showed a linear
increase postoperatively and was significantly greater than baseline (P
< 0.001) at each time point. There was a significant increase in
punctate corneal fluorescein staining at 1 week postoperatively (P <
0=2E0001), but staining returned to baseline by 12 months. There was a
statistically significant increase in SRI 1 week postoperatively (P <
0=2E007) with return to baseline levels by 6 months.
CONCLUSIONS: Sensory denervation of the ocular surface after bilateral
LASIK disrupts ocular surface tear dynamics and causes irritation
symptoms. Patients undergoing LASIK should be informed of these risks.
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| Glenn - USAEyes.org 2005-12-26, 6:02 pm |
| This study ends with 16 months postop information, but a recent study
and subsequent follow-up by the Mayo clinic shows that sub-basal nerve
generation does not return to normal levels until about three years
postop for PRK and about five years postop for LASIK.
What is more important, of course, is symptoms that cause patient
discomfort or vision degradation after the normal six-month healing
period. The incidence of this type of complication is less than 3%
because sensitivity returns to functional levels much earlier than
full nerve regeneration.
It is interesting to find that some patients who have LASIK induced
temporary dry eyes do not consider it to be a problem or LASIK to have
been a failure. It seems they consider using over the counter
lubricating eye drops a few times a day a satisfactory trade off from
glasses and contacts.
This is important information for everyone considering refractive
surgery to consider. Surgery is not perfect and there is always the
possibility of a poor outcome. If something like eye drops a few times
a day would make the patient consider the surgery a "failure", then it
would probably be best to not have refractive surgery at all.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Trulytelling@yahoo.com 2005-12-27, 1:04 am |
| Glenn, these patients are using drops because they have nerve damage
from an elective procedure. Likely they were not told that persistent,
perhaps permanent nerve damage was part and parcel of corneal
refractive surgical procedures.
How can you say that symptoms of dry eye are less than 3% at 6 months
when the peer-reviewd article posted above states "Symptom severity
scores were significantly
increased at 1 week, 12 months, and 16 months postoperatively (P <
0.007 at all time points)."
The Mayo Clinic longitudinal study did not include PRK patients, and
nothing has been published since the 3 year study showing nerves were
decreased over 40% at the 3 year mark. You keep talking about data
you're not showing Glenn. Provide a reference if you expect to be
believed.
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