Incidence and management of symptomatic dry eye related to LASIK for myopia, with topical cyclosporine A

Purpose: To evaluate the incidence of transient dry eye associated with LASIK for myopia and the efficacy of topical cyclosporine A administration. Methods: Group A was formed from 145 (82 female, 63 male) eyes that developed clinically significant dry eye within 1 month post-LASIK and were subjected to cyclosporine A treatment. A "non-symptomatic for dry eye" and age- and gender-matched group (group B) was formed from the same pool of patients to serve as control. Schirmer's, tear film break-up time (TBUT) and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. Central corneal epithelial thickness (CET) and topographic epithelial thickness variability (TVT) were evaluated as quantitative dry eye objective markers. Subjective patient survey was also assessed. Results: Mean age was 39.7 +/- 6.2 years for the female and 47.67 +/- 9.5 years for the male patients, in group A. Schirmer's test mean preoperative value was 8.4 +/- 3.1 mm; and 4.5 +/- 3.6 mm at 1 month post-LASIK. Statistically significant decrease from 1 month post-LASIK baseline was found at 12 months (8.2 +/- 2.1 mm; P=0.02). Mean preoperative TBUT value was 7.5 +/- 2.5 seconds, 6.5 +/- 3.1 seconds at 1 month postoperatively, and 7.6 +/- 2.0 seconds at 12 months postoperatively, statistically significant to baseline (P=0.04). Preoperatively, CET was 52.37 +/- 3.40 mu m and TTV was 1.24 +/- 0.57 mu m, 59.87 +/- 3.89 mu m, and 2.74 +/- 0.57 mu m at 1 month post-LASIK respectively and at 12 months, 55.42 +/- 2.75 mu m and 1.39 +/- 0.96 mu m. The differences in CET between 12 months post-LASIK vs baseline were statistically significant (P=0.007). The mean preoperative OSDI scores were 11.47 +/- 9.97 for group A and 11.79 +/- 10.31 for group B (P=0.782), which changed to 23.03 +/- 10.17 and 15.13 +/- 9.49 at 12 months postoperatively (P<0.05), respectively. Following commencement of cyclosporine A treatment in group A, statistically significant improvement was noted, greater than the one in group B, in all metrics at the 12-month examination in comparison to the 1-month baseline. Conclusion: Topical cyclosporine A treatment is an effective alternative in the management of LASIK for myopia-related transient dry eye. Optical coherence tomography epithelial mapping may provide an objective benchmark in diagnosing and monitoring this significant disorder and its correlation with visual symptoms.