Abstract:Objective: To compare the differences in postoperative tear inflammatory mediator levels and ocular surface health recovery between transepithelial photorefractive keratectomy with smart pulse technology (SPT-TPRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Methods: Patients undergoing corneal refractive surgery at the Department of Ophthalmology, The First Affiliated Hospital of Henan Medical University, from July 2024 to February 2025 were enrolled and divided into an SPT-TPRK group (30 patients, 60 eyes) and an FS-LASIK group (30 patients, 60 eyes) based on the surgical procedure. Tear samples were collected preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), matrix metalloproteinase-9 (MMP-9), intercellular cell adhesion molecule-1 (ICAM-1), and nerve growth factor (NGF) were measured using enzyme-linked immunosorbent assay. Tear film break-up time (BUT) and ocular surface disease index (OSDI) questionnaire were also assessed. Results: At 1 week postoperatively, tear levels of TNF-α, IL-1β, IL-6, MMP-9, and ICAM-1 in the SPT-TPRK group were significantly higher than those in the FS-LASIK group (all P < 0.05). However, these levels decreased rapidly from 1 month postoperatively and were lower in the SPT-TPRK group than in the FS-LASIK group at 3 and 6 months postoperatively. NGF concentrations in the FS-LASIK group were significantly higher than those in the SPT-TPRK group at all postoperative time points (all P < 0.05) and declined more slowly. At 1 week postoperatively, BUT was significantly lower and OSDI scores significantly higher in the SPT-TPRK group compared to the FS-LASIK group (both P < 0.05). From 1 month postoperatively onwards, no statistically significant differences were observed in BUT or OSDI scores between the two groups (all P > 0.05). Correlation analysis revealed that all inflammatory mediator levels were significantly negatively correlated with BUT and significantly positively correlated with OSDI scores (all P < 0.05). Conclusion: Both SPT-TPRK and FS-LASIK induce elevated inflammatory mediator levels and decreased ocular surface function postoperatively. SPT-TPRK is associated with a more intense but rapidly resolving early inflammatory response, whereas FS-LASIK results in a more pronounced and persistently elevated NGF response. Postoperative tear film stability and subjective discomfort in patients undergoing SPT-TPRK and FS-LASIK are closely correlated with inflammatory mediator levels.
