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 Post subject: Goblet cell damage after LASIK
PostPosted: Tue May 09, 2006 12:01 pm 
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OCULAR SURGERY NEWS EUROPE/ASIA-PACIFIC EDITION April 2006

Goblet cell changes may be linked to dry eye after LASIK

Researchers are exploring microkeratomes and suction rings and the damage they may cause to conjunctival goblet cells.

Jared Schultz

Excerpts:

?If the nerve is recovering between 3 and 6 months, we should have a full histopathology of the conjunctival surface at the corneal surface again after 6 months,? Dr. Galal said during a telephone interview with Ocular Surgery News. ?So why are the patients still having dry eye after 6 months??


"Dr. Galal said that 6 months after surgery, there was goblet cell reduction of up to 40% to 50%, a statistically significant difference from preop."


Read the entire article at: http://www.osnsupersite.com

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PostPosted: Sat Jan 27, 2007 2:04 am 
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http://www.ophmanagement.com/article.aspx?article=86738
Ophthalmology Management
December, 2006

Quote:
Examination of patients following LASIK has revealed other important factors that can potentially lead to chronic dry eye, including loss of goblet cells and reduction in tear production. Conjunctival goblet cells play an important role in tear film quality, by secreting mucins which have gel-like properties that increase tear viscosity. Many surgeons feel that goblet cell density initially drops following LASIK due to damage from the microkeratome suction ring. However, Julie Albietz, M.D., has reported that there is a significant, progressive loss of goblet cells following LASIK (Figure).8 In one study, Dr. Albietz found that patients without pre-existing dry eye who underwent LASIK had a 27% reduction in goblet cell density at 1 year, while patients with pre-existing dry eye had a 71% reduction in goblet cells.

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 Post subject:
PostPosted: Fri May 18, 2007 3:31 am 
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Location: Studio City, CA
Is there a scan or something to measure or view Goblet cells in patients?
I wonder if I can go get a "scan" or something.
They don't have to dissect me, do they? :shock:


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 Post subject: No dissection required
PostPosted: Sat Jun 30, 2007 5:42 pm 
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Hi RaginFro -
We've already been dissected - or at least transected. Not even a LASIK surgeon would dissect you further... because there's no MONEY in it for them! Ba-da-bing! :wink:

Seriously, there are tests to assess the composition of your tears. I think that's how they figure out that you have a goblet cell problem - the goblet cells make the mucus and they can tell if you're mucin-deficient.

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 Post subject:
PostPosted: Sun Jul 01, 2007 1:46 am 
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Effect of Suction Ring Application During LASIK on Goblet Cell Density

Journal of Refractive Surgery Vol. 23 No. 6 June 2007

Jose Luis Rodriguez-Prats, MD, PhD; Islam M. Hamdi, FRCS, MD; Alejandra E. Rodriguez, BSc; Ahmed Galal, MD, PhD; Jorge L. Alio, MD, PhD

PURPOSE
To study the effect of LASIK surgery on conjunctival goblet cells as one of the proposed mechanisms for dry eye occurring after LASIK.

METHODS
This prospective study included 22 eyes (11 patients) that underwent LASIK for the correction of myopia. Three pairs of samples were taken from the bulbar conjunctiva of each eye. The first pair was taken preoperatively before application of the suction ring. The second and third pairs were taken from the same sites at 1 week and 1 month consecutively. The first site was at 12 o?clock and the second at the inferotemporal quadrant between 7 and 8 o?clock. Time of suction was recorded.

RESULTS
Preoperatively, mean goblet cell density was 424?105 cells/mm2 (range: 284 to 630 cells/mm2). All postoperative samples showed a statistically significant decrease in goblet cell count: 216?81 cells/mm2 (range: 40 to 325 cells/mm2) at 1 week and 218?99 cells/mm2 (range: 50 to 396 cells/mm2) at 1 month. Other parameters of conjunctival impression cytology were normal. The difference between the samples in the inferior conjunctiva preoperatively and 1 week postoperatively was greater than that of the superior conjunctiva. Recovery rate in both sites was similar and the damage did not correlate with the duration of suction.

CONCLUSIONS
The application of the microkeratome suction ring induced changes in the perilimbic conjunctiva. These changes contribute to the pathology of dry eye. Goblet cell count remains affected at 1 month postoperatively. [J Refract Surg. 2007;23:559-562.]

From the full text:

Quote:
Dry eye is a sign and symptom that occurs after LASIK.2 Many etiologies of pathogenesis have been suggested for this phenomenon. Among these are damage to the corneal nerve plexus,3 toxicity of topical medication, and damage to goblet cells at the site of the suction ring application.4 The suction ring provides a vacuum that reaches up to 765 mmHg on the external ocular wall and raises the intraocular pressure to 65 mmHg as measured by an external tonometer; however, in porcine eyes this was found to reach approximately 99 mmHg.5 This pressure is needed to maintain a tight grip on the globe so as to facilitate a smooth and perfect pass of the microkeratome blade and thus create an uneventful flap.


Quote:
Mean suction time of the microkeratome was 22.48.0 seconds (range: 13 to 50 seconds).


Quote:
Goblet cell density at 1 month after surgery is shown in Table 1. The mean nucleus/cytoplasm ratio was 0.320.08 (range: 0.25 to 0.50). Regarding the inflammatory cells, 20% of samples showed mild cells, 70% showed moderate cells, and 10% showed severe cells.


Quote:
Dry eye syndrome after LASIK usually is related to nerve plexus damage.3 Other mechanisms, such as toxicity from topical drugs and goblet cell damage from suction ring, have also been suggested.4


Quote:
Cytological samples taken a few minutes before the LASIK procedures showed normal conjunctivae. One month postoperatively, goblet cell density showed a significant decrease superiorly and inferotemporally without alteration of other parameters (Fig 3).


Quote:
At 1 month, goblet cell density showed a slight improvement (see Fig 3); however, it was not significant. Other parameters remained normal, suggesting that goblet cell density requires more than 1 month to recover after trauma from the suction ring.


Quote:
Another study by Albietz et al4 showed that this goblet cell decrease continues up to 1 year with a slow rate of recovery. Although not mentioned in previous literature or directly studied in this research, the damage limited to goblet cells might be related to the more fragile nature of this type of cell. Being a secretory cell, it has a less stable cell membrane, which degranulates with vacuum pressure.

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 Post subject:
PostPosted: Sun Jul 01, 2007 5:34 am 
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METHODS - excerpt:
Quote:
Three pairs of samples were taken from the bulbar conjunctiva of each eye.


Uh... that thing about not dissecting you to check your goblet cell density? Looks like these docs did do some dissecting and took actual tissue samples to count goblet cell densities.

The results are more shocking than the methods.

Wow, LASIK is just bad, bad, bad...

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We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. -Plato


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 Post subject:
PostPosted: Sun Jul 01, 2007 4:29 pm 
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Does anyone know which MD's in the southeast region or even in the country do confocal microscopy analysis on the surface of the eye?

It sounds like they have to scrape off some stuff from your eye to do the analysis, but I'm not sure about that.


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 Post subject: Confocal analysis is just 'looking'
PostPosted: Sun Jul 01, 2007 7:00 pm 
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I was shocked to hear that they took tissue samples to measure goblet cell density! For confocal microscopy examinations of your corneal nerves they can just 'look'.

I don't know where the closest center for a confocal exam for you would be but I can try to look into it. Stay away from Duke! :roll:


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 Post subject:
PostPosted: Sun Jul 01, 2007 7:10 pm 
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What I would do if I were trying to locate a doctor for confocal microscopy is I would do a search on www.pubmed.gov, and in the search feature I would type in "confocal microscopy lasik", or "confocal microscopy eye", etc. Click on the abstracts that are returned, and look at the authors and where they're from. Of course this is not going to provide a complete list, but it's a start.

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