June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Tear Neuromediator and Corneal Denervation following Small Incision Lenticule Extraction (SMILE)
Author Affiliations & Notes
  • Yu-Chi Liu
    Singapore Eye Research Institute, Singapore, Singapore
  • Molly Tzu-Yu Lin
    Singapore Eye Research Institute, Singapore, Singapore
  • Jodhbir S Mehta
    Singapore National Eye Centre, Singapore, Singapore, Singapore
  • Footnotes
    Commercial Relationships   Yu-Chi Liu, None; Molly Tzu-Yu Lin, None; Jodhbir Mehta, None
  • Footnotes
    Support  This work was supported by the HREF grant, Singapore National Eye Centre, Singapore (R1568/67/2018)
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 956. doi:
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    • Get Citation

      Yu-Chi Liu, Molly Tzu-Yu Lin, Jodhbir S Mehta; Tear Neuromediator and Corneal Denervation following Small Incision Lenticule Extraction (SMILE). Invest. Ophthalmol. Vis. Sci. 2021;62(8):956.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To investigate the changes in tear neuromediators and corneal subbasal nerve plexus following small incision lenticule extraction (SMILE).

Methods : Thirty patients were included for tear neuromediator analysis (40 eyes) and corneal nerve analysis using in-vivo confocal microscopy scans (20 eyes). Tear analysis included substance P (SP), calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF) concentrations.

Results : Corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), and corneal nerve branch density (CNBD) decreased significantly postoperatively, then gradually increased from 3 months onward, but did not recover to the baseline levels at 12 months. Tear SP and CGRP levels remained stable over 12 months. Tear NGF levels demonstrated a small peak at 1 week, before decreasing significantly compared to preoperative levels at 6 months (P=0.03) and 12 months (P<0.01). The 1-month reduction in CNFL, tear SP and CGRP concentrations were significantly correlated with the spherical equivalent (SE) corrected (r= 0.71 for CNFL; r= -0.33 ~ -0.52 at different time points for SP and CGRP, respectively, all P<0.05). The high myopia group (corrected SE greater than -6.0 diopters), compared to the low-moderate myopia group, had significantly greater decrease in CNFD, and significantly higher tear SP concentrations at 1 week, 1 month and 6 months, as well as significantly higher tear CGRP concentrations at 1 and 6 months.

Conclusions : Our results provide new insight into the neuro-biological responses and their potential implications in corneal nerve damage and recovery after SMILE. High myopic treatment was associated with greater corneal denervation and neuroinflammation.

This is a 2021 ARVO Annual Meeting abstract.


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