title: Signs and Symptoms of Dry Eye in Keratoconus Patients Before and After Intrastromal Corneal Rings Surgery.
abstract: Based on the relationship between keratoconus and dry eye, the aim of this study was to evaluate changes in signs and symptoms of dry eye in keratoconus patients before and after intrastromal corneal ring surgery.
  
  
  
  Fifteen keratoconus patients were enrolled in Fundación Jiménez-Díaz of Madrid and University Clinic of Optometry of the Universidad Complutense de Madrid (Madrid, Spain). Tear break up time (TBUT), Schirmer test without anesthesia, corneal staining, diadenosine tetraphosphate (Ap4A) concentration, and ocular surface disease index (OSDI) were evaluated. Impression cytology combined with laser confocal microscopy was performed to evaluate goblet cell density, mucin cloud height (MCH), and cell layer thickness (CLT). All measurements were performed before (pre) surgery, 1 month (post) and 6 months after surgery (post6m).
  
  
  
  We found no statistical differences in time in Schirmer test, TBUT, and corneal staining. OSDI scores were 44.96  ±  8.65, 26.30 ± 6.79, and 19.31 ± 4.28 for (pre), (post), and (post6m) surgery, respectively (p < 0.001). Impression cytology showed a decrease in cell density at (post6m) compared with presurgery (47.36 ± 35.15 cells/mm2and 84.88 ± 32.08 cells/mm2, respectively, p = 0.04). At post6m, the MCH increased compared with presurgery values (13.97 ± 4.26 µm and 6.77 ± 2.51 µm, respectively, p < 0.001). There was a statistically significant increase in CLT in time. Ap4A tear concentrations were lower post6m than presurgery (1.02  ±  0.65 and 2.56   ± 1.10  µM, respectively, p < 0.001).
  
  
  
  Intrastromal corneal ring surgery induces changes improving dry eye symptoms but no changes were found in signs of dry eye after surgery in keratoconus patients except for the MCH that increases drastically. More studies are needed to clarify the reason of its improvement.
authors.affiliation: a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Carracedo
authors.affiliation: a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Recchioni
authors.affiliation: b Department of Ophthalmology , Fundación Jimenez Diaz , Madrid , Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Alejandre-Alba
authors.affiliation: c Department of Biochemistry and Molecular Biology IV , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Martin-Gil
authors.affiliation: a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Batres
authors.affiliation: b Department of Ophthalmology , Fundación Jimenez Diaz , Madrid , Spain.
authors.forename: Ignacio Jimenez-Alfaro
authors.initials: IJ
authors.lastname: Morote
authors.affiliation: c Department of Biochemistry and Molecular Biology IV , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Pintor
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003319:Corneal Stroma / Q000601:surgery*; D015226:Dinucleoside Phosphates / Q000378:metabolism; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D020397:Goblet Cells / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D018613:Microscopy, Confocal; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D013666:Tears / Q000737:chemistry; D055815:Young Adult
chemical_list: D015226:Dinucleoside Phosphates; C020733:diadenosine tetraphosphate
keywords: 3D impression cytology; ICRS; dinucleotide; dry eye; keratoconus