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THE ROLE OF SUBBASAL NERVE PLEXUS IN THE PATHOGENESIS
OF NEUROPATHIC EYE PAIN AFTER KERATOREFRACTIVE
SURGERY
Zakirkhodjaev R.A.
DSc, associate professor of the department of ophthalmology, Tashkent state
medical university, Tashkent, Uzbekistan
Azimova G.A.
Expert ophthalmologist of the military medical commission of the medical
department of the Tashkent city main department of internal affairs, Tashkent,
Uzbekistan
https://doi.org/10.5281/zenodo.15847549
Relevance. Refractive surgery (in particular, LASIK) is widely used to
correct ametropia and usually gives good visual results. However, some patients
develop chronic dry eye syndrome (DES), which in some cases is accompanied
by severe eye pain unrelated to the severity of clinical signs. Current data
indicate the development of neuropathic eye pain (NEP) in such patients,
associated with damage to the corneal nerves and central sensitization.
Diagnosis and treatment of NEP require a specific approach, but in routine
ophthalmological practice this pathology often remains underestimated.
Objective of the study. Comprehensive assessment of clinical, sensory and
morphological signs of neuropathic eye pain in patients with chronic dry eye
syndrome after LASIK surgery.
Materials and methods. From September 2024 to May 2025, a prospective
clinical study is being conducted at the Ziyobahsh Multidisciplinary Private
Clinic, which currently includes 35 people (70 eyes). Patients are divided into
three groups. Group I - 10 patients with a high degree of myopia and symptoms
of dry eye syndrome (DES), Group II - 10 patients with a high degree of myopia
combined with DES and signs of neuropathic eye pain and a control group - 15
practically healthy volunteers without ophthalmological complaints. The
average age of the subjects was 29.3 ± 5.2 years (range from 21 to 40 years).
Gender ratio: 20 women (57.1%) and 15 men (42.9%). All participants
underwent a comprehensive ophthalmological examination and in vivo confocal
microscopy.
Results. The study included 35 people (70 eyes), divided into three groups.
The average age was 29.3±5.2 years, women - 57.1%, men - 42.9%. All patients
in the main groups underwent LASIK and had a high degree of myopia (≥6.0 D).
Patients in group I (painless dry eye syndrome) had moderate complaints of
dryness (OSDI - 42.5±6.3), decreased tear production (Schirmer test - 6.2±2.1
mm) and TBUT (5.1±1.4 sec). Confocal microscopy showed preserved density of
subbasal nerve fibers (1255±115 waves/mm²), microneuromas and dendritic
cells were not detected. In group II (DES+neuropathic pain), along with dryness
(OSDI - 46.8±5.7), severe complaints of pain were observed. The test with
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anesthetic was positive in 8 out of 10 patients. According to confocal
microscopy, a decrease in the density of nerve fibers (985±130 waves/mm²),
the presence of microneuromas (in 70% of cases) and an increase in the number
of dendritic cells were revealed. In participants of the control group (n=15), the
density of nerve fibers was 1340±105 waves/mm², pathological changes were
not detected. The obtained data confirm the presence of morphological signs of
neuropathy in patients with a pain component after LASIK and emphasize the
diagnostic value of in vivo confocal microscopy.
Conclusions. Patients with neuropathic ocular pain after LASIK have
characteristic morphological changes in the subbasal corneal nerve plexus:
decreased nerve fiber density, the presence of microneuromas, and an increase
in the number of dendritic cells. The topical anesthetic test in combination with
in vivo confocal microscopy is an effective tool for the early diagnosis of
neuropathic pain, allowing it to be differentiated from classic dry eye syndrome.
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