Abstract
Purpose :
To identify the risk factors for neuropathic corneal pain (NCP) followingrefractive surgery, and to report its clinical manifestations, imaging and proteomiccharacteristics.
Methods :
100 eyes underwent small incision lenticule extraction (SMILE) or laserassistedin situ keratomileuses (LASIK). Ocular surface assessments, in-vivo confocalmicroscopy scans, tear neuromediators and proteomics analysis were performed. NCPwas assessed using the Ocular Pain Assessment Survey. Univariate and multivariateanalyses were conducted to identify the risk factors associated with postoperativeNCP.
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 NCPcompared to non-NCP group. In LASIK, NCP eyes had a significantly lower cornealnerve fiber length (CNFL) (p=0.02), lower nerve fractal dimension (p=0.003), highernerve fiber width (p=0.04), and larger neuroma area (p=0.04) than non-NCP eyes. InSMILE, 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 were 9.57 timesmore likely to develop postoperative NCP (OR=9.57, p=0.002). In LASIK, lowerpreoperative corneal nerve fiber 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. Significantincrease in tear nerve growth factor, calcitonin gene-related peptide, Frizzled classreceptor 7, and nucleoside-diphosphate kinase 3 were observed in postoperative NCP (Figure 1, Figure 2).
Conclusions :
The characteristics and risk factors reported would identify patientssusceptible to NCP after refractive surgery.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.