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Publications

Journal Article Epublish 1 citation

PubMed: 39880672 DOI: 10.1136/bjo-2024-325996

Neuropathic corneal pain following refractive surgery: risk factors, clinical manifestations, imaging and proteomic characteristics.

Br J Ophthalmol 109(7):747-755

Authors: Calesta Hui Yi Teo, Chang Liu, Isabelle Xin Yu Lee, Molly Tzu-Yu Lin, Fengyi Liu, Charmaine Jan Li Toh, Siew Kwan Koh, Da Qian Lu, Thomas Chuen Lam, Lei Zhou, Louis Tong, Jodhbir S Mehta, Yu-Chi Liu

Affiliations

  • National University of Singapore Yong Loo Lin School of Medicine, Singapore.
  • Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.
  • University of Cambridge Girton College, Cambridge, UK.
  • Lee Kong Chian School of Medicine, Singapore.
  • Ocular Proteomic Group, Singapore Eye Research Institute, Singapore.
  • Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
  • Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong. Department of Applied Biology and Chemical Technology; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
  • Department of Applied Biology and Chemical Technology; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong. Department of Ophthalmology, NUS Yong Loo Lin School of Medicine, Singapore.
  • Cornea & External Eye Disease, Singapore National Eye Centre, Singapore.
  • Ocular Surface Research Group, Singapore Eye Research Institute, Singapore.
  • Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore.
  • Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.

Abstract

BACKGROUND/AIMS

To identify the risk factors for neuropathic corneal pain (NCP) following corneal refractive surgery and to report its clinical manifestations, imaging and proteomic characteristics.

METHODS

This 1 year prospective cohort study included 100 eyes that underwent small incision lenticule extraction (SMILE) or laser-assisted in situ keratomileusis (LASIK). Ocular surface assessments, in-vivo confocal microscopy scans, tear neuromediators and proteomics analyses were performed. NCP was assessed using the ocular pain assessment survey. Univariate and multivariate analyses were conducted to identify the risk factors associated with postoperative NCP.

RESULTS

The incidence of NCP was 13.3% and 10.5% after SMILE and LASIK, respectively (p=0.70). In SMILE, preoperative manifest refractive spherical equivalent (MRSE) and spherical power (both p=0.02) were significantly higher in the NCP compared with the non-NCP group. In LASIK, NCP eyes had a significantly lower corneal nerve fibre length (CNFL) (p=0.02), lower nerve fractal dimension (p=0.003), higher nerve fibre width (p=0.04) and larger neuroma area (p=0.04) than non-NCP eyes. In SMILE, higher preoperative MRSE was a significant risk factor for postoperative NCP (95% CI: 0.48-1.96, p=0.04). An MRSE greater than -8.0 diopter was 9.57 times more likely to develop postoperative NCP (OR=9.57, p=0.002). In LASIK, lower preoperative corneal nerve fibre density (95% CI:0.13-1.11, p=0.05) and CNFL (95% CI:0.09-1.25, p=0.05) were significant risk factors for postoperative NCP. Significant increases in tear nerve growth factor, calcitonin gene-related peptide, Frizzled class receptor 7 and nucleoside-diphosphate kinase three were observed in postoperative NCP.

CONCLUSIONS

The reported characteristics and risk factors would identify patients susceptible to NCP after corneal refractive surgery.

MeSH

Eye, Tears, Ophthalmology, Pain, Risk Factors, Refractive Surgical Procedures