Analysis of dry eye syndrome incidence and prognostic factors in 778 patients following refractive corneal surgery

OBJECTIVE: To investigate the incidence of dry eye syndrome following refractive corneal surgery and identify prognostic factors, thereby providing evidence-based guidance for precise clinical assessment and individualized management. METHODS: A retrospective cohort study was conducted including 778 patients (1598 eyes) aged 18-45 years who underwent refractive corneal surgery at our hospital between January and December 2020. Surgical procedures included LASIK, FS-LASIK, PRK, Smart transepithelial photorefractive keratectomy, and ICL implantation. Comprehensive preoperative ophthalmic examinations were performed, including assessment of dry eye-related parameters such as tear meniscus height and tear film break-up time (BUT). Subjective symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Dry eye symptoms were assessed at 2 months postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify independent risk factors for postoperative dry eye development. RESULTS: Among the 778 patients, 526 were male and 252 were female, with a mean age of 22.1 ± 5.2 years. The overall incidence of dry eye at 2 months postoperatively was 41.4% (662/1598 eyes). Ocular dryness was the most common symptom (78.5%), followed by foreign body sensation (65.3%) and photophobia (42.8%). Significant differences in dry eye incidence were observed among different surgical procedures (P = 0.012). Surface ablation procedures (PRK + Smart transepithelial PRK) demonstrated an incidence of 45.7%, significantly higher than lamellar procedures (LASIK + FS-LASIK) at 39.7% (P = 0.005). Univariate analysis revealed associations between postoperative dry eye and female gender, age 26-30 years, surface ablation procedures, preoperative tear meniscus height