Effect of 3% Diquafosol Sodium on Dry Eye After Femtosecond Laser-Assisted In Situ Keratomileusis and Small Incision Lenticule Extraction Surgery in High-Myopic Eyes

Purpose:To evaluate the effect of 3% diquafosol sodium eye drop on dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) in high-myopic eyes.Methods:Eighty-one cases with high myopia (162 eyes) who received FS-LASIK or SMILE were divided into four groups by surgical design and tear film stability: D-FS-LASIK (5s <breakup time [BUT] <10s) and D-SMILE (5s <BUT <10s) were treated with 3% diquafosol sodium and 0.3% sodium hyaluronate eye drops, C-FS-LASIK and C-SMILE (BUT >= 10s) treated with 0.3% sodium hyaluronate. Follow-up points were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Schirmer I test, BUT, fluorescein staining, and objective optical quality were measured, and questionnaires were acquired.Results:The D-SMILE group showed increase in BUT postoperatively (1m: P=0.006, 3m: P=0.004), whereas C-FS-LASIK (1m: P=0.012) and C-SMILE (1m: P=0.036) groups showed decrease in BUT. Higher Delta BUT were observed in D-FS-LASIK (1m: P=0.027) and D-SMILE (1m: P=0.001, 3m: P=0.012) postoperatively. The D-FS-LASIK group showed less decrease than C-FS-LASIK group in Schirmer I. The D-SMILE group showed increase in Schirmer I, whereas C-SMILE showed decrease in 3 months. Delta OSDI was lower in D-SMILE group than in C-SMILE group (1m: P=0.026, 3m: P=0.035). Fatigue was severer in D-SMILE group than in C-SMILE group preoperatively (P=0.019), although there was no significant difference postoperatively. Objective scattering index (1m: P=0.002, 3m: P=0.021) and tear film objective scattering index (1m: P=0.005, 3m: P=0.010) were lower in D-FS-LASIK group than in C-FS-LASIK group postoperatively. The D-FS-LASIK group showed better VA20% (P=0.036) and VA9% (P=0.027) than the C-FS-LASIK group 1 month postoperatively.Conclusions:3% Diquafosol sodium eye drop was effective for SMILE and FS-LASIK-related dry eye in high-myopic eyes. It is necessary to focus on perioperative anti-dry eye management and especially pay attention to the eyes with risk factors, including unstable tear film, high myopia, and FS-LASIK surgery.