{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:24:46Z","timestamp":1791491086652,"version":"4.3.4"},"reference-count":38,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"Singapore National Medical Research Council","doi-asserted-by":"crossref","award":["MOH-CSAINV21jun-0001"],"award-info":[{"award-number":["MOH-CSAINV21jun-0001"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,1,10]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>To identify the risk factors for neuropathic corneal pain (NCP) following corneal refractive surgery and to report its clinical manifestations, imaging and proteomic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 1\u2009year prospective cohort study included 100 eyes that underwent small incision lenticule extraction (SMILE) or laser-assisted in situ keratomileusis (LASIK). Ocular surface assessments, in-vivo confocal microscopy scans, tear neuromediators and proteomics analyses were performed. NCP was assessed using the ocular pain assessment survey. Univariate and multivariate analyses were conducted to identify the risk factors associated with postoperative NCP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of NCP was 13.3% and 10.5% after SMILE and LASIK, respectively (p=0.70). In SMILE, preoperative manifest refractive spherical equivalent (MRSE) and spherical power (both p=0.02) were significantly higher in the NCP compared with the non-NCP group. In LASIK, NCP eyes had a significantly lower corneal nerve fibre length (CNFL) (p=0.02), lower nerve fractal dimension (p=0.003), higher nerve fibre width (p=0.04) and larger neuroma area (p=0.04) than non-NCP eyes. In SMILE, higher preoperative MRSE was a significant risk factor for postoperative NCP (95%\u2009CI: 0.48\u20141.96, p=0.04). An MRSE greater than \u22128.0 diopter was 9.57 times more likely to develop postoperative NCP (OR=9.57, p=0.002). In LASIK, lower preoperative corneal nerve fibre density (95%\u2009CI:0.13\u20141.11, p=0.05) and CNFL (95%\u2009CI:0.09\u20141.25, p=0.05) were significant risk factors for postoperative NCP. Significant increases in tear nerve growth factor, calcitonin gene-related peptide, Frizzled class receptor 7 and nucleoside-diphosphate kinase three were observed in postoperative NCP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The reported characteristics and risk factors would identify patients susceptible to NCP after corneal refractive surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2024-325996","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T13:23:19Z","timestamp":1738156999000},"page":"747-755","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Neuropathic corneal pain following refractive surgery: risk factors, clinical manifestations, imaging and proteomic characteristics"],"prefix":"10.1136","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7611-3664","authenticated-orcid":false,"given":"Calesta Hui Yi","family":"Teo","sequence":"first","affiliation":[{"name":"National University of Singapore Yong Loo Lin School of Medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Liu","sequence":"additional","affiliation":[{"name":"Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0275-4850","authenticated-orcid":false,"given":"Isabelle Xin Yu","family":"Lee","sequence":"additional","affiliation":[{"name":"Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly Tzu-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengyi","family":"Liu","sequence":"additional","affiliation":[{"name":"University of Cambridge Girton College, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charmaine Jan Li","family":"Toh","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siew Kwan","family":"Koh","sequence":"additional","affiliation":[{"name":"Ocular Proteomic Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da Qian","family":"Lu","sequence":"additional","affiliation":[{"name":"Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3511-5620","authenticated-orcid":false,"given":"Thomas Chuen","family":"Lam","sequence":"additional","affiliation":[{"name":"Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong"},{"name":"Department of Applied Biology and Chemical Technology; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Applied Biology and Chemical Technology; Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, Hong Kong"},{"name":"Department of Ophthalmology, NUS Yong Loo Lin School of Medicine, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3986-6552","authenticated-orcid":false,"given":"Louis","family":"Tong","sequence":"additional","affiliation":[{"name":"Cornea & External Eye Disease, Singapore National Eye Centre, Singapore"},{"name":"Ocular Surface Research Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodhbir S","family":"Mehta","sequence":"additional","affiliation":[{"name":"Cornea & External Eye Disease, Singapore National Eye Centre, Singapore"},{"name":"Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5408-0382","authenticated-orcid":false,"given":"Yu-Chi","family":"Liu","sequence":"additional","affiliation":[{"name":"Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore"},{"name":"Cornea & External Eye Disease, Singapore National Eye Centre, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"2025071523150920000_109.7.747.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)33209-4"},{"key":"2025071523150920000_109.7.747.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-0124(12)70224-0"},{"key":"2025071523150920000_109.7.747.3","doi-asserted-by":"crossref","unstructured":"Chin JY , Tong L , Liu C , et al . Quality of Life and Symptomatology in Neuropathic Corneal Pain in Comparison With Dry Eye Syndrome. Cornea 2022. doi:10.1097\/ICO.0000000000003674","DOI":"10.1097\/ICO.0000000000003674"},{"key":"2025071523150920000_109.7.747.4","unstructured":"Moshirfar M , Benstead EE , Sorrentino PM , et al . Ocular neuropathic pain. Treasure Island (FL), 2022."},{"key":"2025071523150920000_109.7.747.5","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines9101424"},{"key":"2025071523150920000_109.7.747.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2022.07.010"},{"key":"2025071523150920000_109.7.747.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2022.109057"},{"key":"2025071523150920000_109.7.747.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.01.053"},{"key":"2025071523150920000_109.7.747.9","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10070493"},{"key":"2025071523150920000_109.7.747.10","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.289435"},{"key":"2025071523150920000_109.7.747.11","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1078660"},{"key":"2025071523150920000_109.7.747.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2020.06.008"},{"key":"2025071523150920000_109.7.747.13","doi-asserted-by":"publisher","DOI":"10.2337\/db22-0611"},{"key":"2025071523150920000_109.7.747.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jare.2020.11.001"},{"key":"2025071523150920000_109.7.747.15","doi-asserted-by":"publisher","DOI":"10.21315\/mjms2018.25.4.12"},{"key":"2025071523150920000_109.7.747.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2019-314799"},{"key":"2025071523150920000_109.7.747.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2023.02.016"},{"key":"2025071523150920000_109.7.747.18","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-021-00358-x"},{"key":"2025071523150920000_109.7.747.19","doi-asserted-by":"publisher","DOI":"10.2147\/OPTH.S262060"},{"key":"2025071523150920000_109.7.747.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2016.12.001"},{"key":"2025071523150920000_109.7.747.21","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20200730-01"},{"key":"2025071523150920000_109.7.747.22","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20210423-01"},{"key":"2025071523150920000_109.7.747.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jare.2021.09.004"},{"key":"2025071523150920000_109.7.747.24","first-page":"3660","article-title":"Reinnervation in the cornea after LASIK","volume":"43","author":"Lee","year":"2002","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2025071523150920000_109.7.747.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0014-4835(03)00050-2"},{"key":"2025071523150920000_109.7.747.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2019.01.009"},{"key":"2025071523150920000_109.7.747.27","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.375308"},{"key":"2025071523150920000_109.7.747.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2020.07.004"},{"key":"2025071523150920000_109.7.747.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2022.09.020"},{"key":"2025071523150920000_109.7.747.30","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410360221"},{"key":"2025071523150920000_109.7.747.31","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.00928"},{"key":"2025071523150920000_109.7.747.32","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.308666"},{"key":"2025071523150920000_109.7.747.33","doi-asserted-by":"publisher","DOI":"10.1186\/gb-2004-5-7-234"},{"key":"2025071523150920000_109.7.747.34","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000366"},{"key":"2025071523150920000_109.7.747.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.neures.2013.12.002"},{"key":"2025071523150920000_109.7.747.36","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1818629116"},{"key":"2025071523150920000_109.7.747.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2023.110230"},{"key":"2025071523150920000_109.7.747.38","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-022-00629-1"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2024-325996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T06:15:55Z","timestamp":1752646555000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2024-325996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,6,23]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bjo-2024-325996"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2024-325996","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}