Posters

Management of post-laser in situ keratomileusis (LASIK) dry eye with LipiFlow®

Poster Details

First Author: G.Petzold GERMANY

Co Author(s):    R. Bedi              

Abstract Details

Purpose:

Evaporative dry eye syndrome is considered to be the most common post-LASIK complication. Corneal nerve damage in the process of flap creation with resultant loss of corneal sensation appears to be a significant contributing factor. As a result of reduced blinking rate (associated with loss of corneal sensation), a state of low delivery of lipids in to the tear film is produced. Consequently, there is a decrease in lipid layer thickness which leads to the development of post-LASIK evaporative dry eye. The purpose of this case report is to present a case of post-LASIK dry eye with severe dry eye symptoms that was successfully treated using LipiFlow® device.

Setting:

Eye Diagnostic Center, Kulmbach, Germany

Methods:

A 43-year-old female had undergone LASIK four years back. Since then, she had discomfort, irritation, foreign body sensation, dryness and severe pain in both eyes with significant negative impact on her daily activities. The treatment included instillation of methyl hydroxypropyl cellulose (Artelac 3.2 mg/ml eye drops, Bausch & Lomb Pharmaceuticals, Rochester, NY) every 15 minutes (up to 64 times a day) during waking hours and carbomer 0.2% gel (Artelac nighttime gel 0.2%, Bausch & Lomb Pharmaceuticals, Rochester, NY) at night. The patient was evaluated for corneal staining, meibomian gland function, lipid layer thickness and tear break-up time (TBUT). The patient symptom scores were recorded with the standard patient evaluation of eye dryness (SPEED) questionnaire. The best corrected visual acuity (CDVA) was 0.63 (decimal) in right eye and 0.8 (decimal) in left eye. Eight meibomian glands were yielding any secretion in right eye and 10 in left. The TBUT was < 5 sec in both eyes and SPEED score was 20. Average lipid layer thickness, using LipiView® Ocular Surface Interferometer was 33 ± 5 interferometric color unit (ICU) in right eye and 31 ± 5 ICU in left. As such, a diagnosis of post-LASIK evaporative dry eye was made.

Results:

Both eyes of the patient were treated with single simultaneous 12-minute LipiFlow® treatment. Treatment was tolerated very well with no report of discomfort during the insertion or removal of the device, or during the treatment. The patient was followed-up at 1, 6 and 18 months after the treatment. At post-treatment 1 month, the lipid layer thickness increased to 50 ± 8 ICU in right eye and 45 ± 4 in left eye. SPEED score improved to 7 and TBUT rose to 10 and 15 seconds in right and left eyes respectively. The number of meibomian glands yielding secretions was 13 in the right eye and 14 in the left. The need of lubricants reduced to only 5 times a day. The improvement was maintained at post-treatment 18 months with lipid layer thickness of 77 ± 5 ICU and 70 ± 2 ICU, TBUT of 8 and 15 seconds in the right and left eyes respectively, CDVA of 1 (decimal) both eyes and SPEED score of 12. Overall, the patient was very satisfied with the symptom relief at 18 months follow-up visit (needing lubricants only 4-5 times a day). As such, there was no need for retreatment.

Conclusions:

The single 12 minute LipiFlow® treatment was effective in substantially reducing this particular patient's post-LASIK evaporative dry eye symptoms. The reduction in symptoms was maintained up to 18 months of the treatment, which indicate the overall success of the treatment approach. The primary function of LipiFlow® is to treat obstructive meibomian gland dysfunction associated dry eye. While significant reduction in frequency and severity of dry eye signs has been demonstrated at 1, 9 and 12 months after a single 12-minute LipiFlow® treatment, the findings of the current case suggest that the LipiFlow® may potentially help treat post-LASIK evaporative dry eye as well. Future studies with larger dataset are needed to validate the results of this case report. FINANCIAL INTEREST: One of more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented