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In vivo confocal microscopy and tear cytokine analysis in post-LASIK ectasia
  1. Natasha Kishore Pahuja1,
  2. Rohit Shetty1,
  3. Rashmi Deshmukh1,
  4. Anupam Sharma2,
  5. Rudy M M A Nuijts3,
  6. Vishal Jhanji4,5,
  7. Swaminathan Sethu2,
  8. Arkasubhra Ghosh2,6
  1. 1 Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
  2. 2 Narayana Nethralaya Foundation, GROW Research Laboratory, Bangalore, India
  3. 3 Cornea Clinic, Department of Ophthalmology, Maastricht University Medical Centre, Maastricht, The Netherlands
  4. 4 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
  5. 5 UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, USA
  6. 6 Singapore Eye Research Institute, Singapore
  1. Correspondence to Dr Swaminathan Sethu, Narayana Nethralaya Foundation, GROW Research Laboratory, #258/A Hosur Road, Narayana Health City, Bangalore, KA 560099, India; swaminathansethu{at}


Aim Corneal keratectasia is one of the complications associated with laser in situ keratomileusis (LASIK) that results in vision impairment. The pathogenesis of post-LASIK ectasia (PLE) remains underexplored. We report the tear cytokine profile and in vivo confocal microscopy (IVCM) findings in eyes with PLE.

Methods This retrospective study included age-matched 7 (14 eyes) post-LASIK controls (PLCs) and 6 (12 eyes) PLE subjects. Corneal topography was used to categorise the subjects into PLC and PLE groups. Ocular Surface Disease Index (OSDI) scores obtained were based on standard questionnaire and IVCM images were used to determine corneal dendritic cells density (DCD) and sub-basal nerve plexus morphology. Inflammatory cytokines/chemokines in the tears were quantified using flow cytometry based cytometric bead array.

Results Pentacam-based scores, OSDI scores and corneal DCD were significantly (p<0.05) higher in patients with PLE compared with PLC. Discomfort-related subscale of OSDI score exhibited a positive correlation with total corneal DCD in the PLE cohort. The fold difference of chemokine (C-C motif) ligand/monocyte chemotactic protein-1 (CCL2/MCP1) (3.4±0.6) was found to be significantly (p<0.05) higher in the PLE cohorts and a positive correlation between CCL2/MCP1 levels and total corneal DCD was also observed in the PLE cohort.

Conclusion The current study found a significant difference in the tear film cytokine profile between normal and PLE eyes. Presence of increased corneal dendritic cells and altered tear cytokines suggests an ongoing inflammatory response in PLE.

  • Post-LASIK ectasia
  • corneal dendritic cell density
  • OSDI
  • inflammation

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  • Contributors Study concept and design (RS, AG, VJ, SS, RMMAN). Data collection (NKP, RD, AS). Analysis and interpretation of data (RS, AG, SS). Writing the manuscript (AG, SS). Critical revision of the manuscript (RS, AG, SS). All of the authors were involved in the finalisation of the manuscript.

  • Funding This work was supported by Narayana Nethralaya Foundation, Bangalore, India.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of Narayana Nethralaya Eye Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.