Ocular surface treatment before laser in situ keratomileusis in patients with severe dry eye

PURPOSE: To evaluate the efficacy and safety of laser in situ keratomileusis (LASIK) in patients with severe dry eye associated with Sjögren's syndrome. METHODS: Three patients (six eyes) with Sjögren's syndrome who underwent bilateral LASIK were retrospectively evaluated for visual outcome, intraoperative and postoperative complications, dry eye status (subjective symptoms and objective findings, Schirmer test, vital staining of the ocular surface), and outcome satisfaction by subjective questionnaire. All patients had negative reflex tearing and were treated with topical autologous serum and/or punctal occlusion prior to LASIK to improve the ocular surface. This treatment was continued postoperatively. RESULTS: Mean attempted correction of six eyes was -8.46 ± 1.55 D (range -7.00 to -10.63 D). One year after LASIK, mean uncorrected visual acuity was 1.07 (range 0.7 to 1.5),mean best spectacle-corrected visual acuity was 1.29 (range 1.2 to 1.5), and mean refraction was -0.19 ± 0.51 D (range -1.00 to +0.50 D). Tear production, rose bengal and fluorescein staining, and dry eye symptoms were not exacerbated after LASIK. No complications, such as intraoperative epithelial defect, diffuse lamellar keratitis, epithelial ingrowth, or recurrent erosion occurred. All three patients were satisfied with the outcome of their surgery. CONCLUSION: LASIK can be safely and effectively managed in patients with severe dry eye with reduced reflex tearing by preoperative and postoperative treatments consisting of a combination of artificial tears, topical autologous serum, and punctal occlusion. Careful assessment of preoperative and postoperative ocular surface status is mandatory in such patients.