Clinical analysis of dry eye after refractive surgery in army recruits in 2024

Dry eye is among the most prevalent complications following refractive surgery, significantly impacting the training and daily lives of recruits. While recent years we have witnessed some advancements in understanding the occurrence and progression of dry eye, the specific effects of refractive surgery on this condition remain unclear. This study aims to investigate the impact of refractive surgery on dry eye among 300 army recruits. A series of examinations specific to dry eye were conducted on the subjects using the OSDI questionnaire and the ocular surface comprehensive analyzer. The correlation between refractive surgery and dry eye was analyzed in conjunction with dry eye symptoms and related data. Additionally, optical coherence tomography (OCT) was employed to observe fundus changes in dry eye patients, comparing those with low to moderate myopia against patients with high myopia prior to surgery. The morphology of the meibomian glands in the upper eyelid was assessed using the Keratograph 5M ocular surface analyzer, where the area of meibomian gland loss was calculated and scored, facilitating an exploration of the relationship between meibomian gland loss and dry eye. Furthermore, the dry eye detection rates of Non-Invasive Break-Up Time (NIBUT), Lipid Layer Thickness Measurement (LTMH), and basal Schirmer secretion (SIT) were calculated, and the diagnostic differences among these three methods for dry eye were analyzed. According to the OSDI questionnaire, 117 (39%) patients opted for SMILE, 60 (20%) for F-LASIK, and 123 (41%) for LASIK. Among the recruits, 78 (26%) were diagnosed with dry eye following refractive surgery. Single factor and multiple logistic regression analyses indicated that LASIK may serve as an independent risk factor for the development of dry eye after refractive surgery. Furthermore, the incidence of leopard-pattern fundus was significantly higher in recruits with high myopia compared to those with low to moderate myopia. Keratograph5M assessments revealed that 52.6% of patients exhibited no meibomian gland loss; 45.5% had meibomian gland loss of less than 1/3; 1.9% experienced meibomian gland loss ranging from 1/3 to 2/3; and no patients had meibomian gland loss exceeding 2/3. These results suggest that there is no direct relationship between dry eye and meibomian gland loss following refractive surgery. Additionally, the dry eye detection rate using non-invasive tear break-up time (NIBUT) was 92.6%, while the detection rate for LTMH dry eye was 91.0%. The basal Schirmer test (SIT) yielded a dry eye detection rate of 78.2%, indicating that non-invasive tear assessment methods have a higher detection rate for dry eye. The incidence of dry eye among recruits following excimer laser corneal refractive surgery is significantly higher than that observed with other surgical methods, suggesting that it may represent an independent risk factor for dry eye post-refractive surgery. Consequently, we do not recommend the use of laser in situ keratomileusis for refractive surgery.