Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA.
Ocul Surf. 2021 Jan;19:275-281. doi: 10.1016/j.jtos.2020.10.004. Epub 2020 Oct 21.
Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain.
Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest.
43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009).
Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK.
NCT02701764.
手术引起的疼痛处理和自主功能差异与慢性疼痛的发展有关。本研究旨在评估疼痛和自主神经指标是否可预测 LASIK 术后慢性干眼症 (DE) 症状的严重程度，因为越来越多的证据表明 DE 症状可能是持续性术后眼部疼痛的表现。
对前瞻性随机临床试验进行二次分析。患者接受普瑞巴林或安慰剂治疗。由于在六个月时未发现治疗分配对 DE 症状有显著差异，因此所有参与者均归入本分析组。在 LASIK 之前，对受试者进行了诱发疼痛敏感性评估（利用定量感觉测试）、自主神经指标以及 DE 和眼部疼痛症状评估（通过验证性问卷）。LASIK 后评估 DE 和眼部疼痛，手术 6 个月后采用干眼问卷 5 项（DEQ5）评分作为主要观察指标。
43 名患者被随机分配至普瑞巴林组（n=21）或安慰剂组（n=22）。42 名患者完成了 6 个月的随访。几项基线自主神经指标与 6 个月术后 DEQ5 评分相关，包括较低的收缩压（r=-0.37，p=0.02）和舒张压（r=-0.32，p=0.04）。6 个月时的眼部疼痛也与血压呈负相关（r=-0.31，p=0.047）。术后持续疼痛感觉的存在是 6 个月时慢性 DE 症状的显著预测因素（平均 DEQ5 评分：8.0±1.9 与 5.0±5.0，p=0.009）。
术前测量的副交感神经活动亢进和疼痛敏感性延长可预测 LASIK 后 6 个月时 DE 症状的严重程度。
NCT02701764。
