Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy

Objective: To evaluate tear production, corneal topography, accuracy of ref ractive correction, and best spectacle-corrected visual acuity in eyes that had moderate to severe rose bengal staining develop on the flap compared w ith eyes with little or no staining on the flap, the first few months after laser in situ keratomileusis (LASIK). None of the eyes in this study had s ignificant preoperative dry eye disease. Design: Retrospective case control study. Participants: Individual eyes of 19 consecutive patients with moderate to s evere punctate epithelial erosions and rose bengal staining on the flap 1 t o 3 months after LASIK were compared with eyes of 19 concurrent patients wh o did not have punctate epithelial erosions or more than trace staining on the flap develop. Methods: Nonparametric statistical analyses were used to compare tear secre tion, corneal topographic irregularity, spherical equivalent, and visual ac uity 3 and 6 months after surgery. Some eyes in both groups also had analys is of tear secretion 1 month after surgery. Main Outcome Measures: Schirmer's test without anesthesia, the topographic corneal irregularity measurement (CIM), the difference between attempted an d achieved spherical equivalent, and the loss of best spectacle-corrected v isual acuity. Results: There was no difference in tear production 1, 3, or 6 months after LASIK in patients who had punctate epithelial erosions and rose bengal sta ining on the flap develop and those who did not. There was no significant d ifference in the CIM or mean accuracy of the refractive correction in the t wo groups, but some patients had a transient decrease in best spectacle-cor rected visual acuity. Flap rose bengal staining resolved by 6 months after LASIK in most affected patients. Conclusions: LASIK-induced rose bengal staining in patients without preexis ting dry eye is likely neurotrophic epitheliopathy, because there is no dif ference in mean tear production between patients who have significant punct ate epithelial erosions and rose bengal staining develop on the flap and th ose who do not. The signs and symptoms of LASIK-induced (presumed) neurotro phic epitheliopathy tend to resolve approximately 6 months after surgery. T his disorder tends to be more common and severe in patients with pre-existi ng dry eye disease. Ophthalmology 2001;108:1082-1087 (C) 2001 by the Americ an Academy of Ophthalmology.