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The effect of 2% rebamipide ophthalmic solution on early dry eye after SMILE surgery: a retrospective study
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Jin Hyoung Kim, Mu Yan Kim, Young A Kwon, Sung Wook Park, Sung Won Byun, Seong Woo Lee, Sung Hyup Lim
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Received September 23, 2025 Accepted October 10, 2025 Published online October 22, 2025
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DOI: https://doi.org/10.63375/icrs.25.013
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 Abstract
- Purpose
The aim of this study was to investigate the effect of rebamipide 2% ophthalmic solution on early dry eye following small incision lenticule extraction (SMILE) surgery by analyzing dry eye indicators before and after the procedure.
Methods
In this retrospective study, an initial sample of 372 SMILE surgery patients were divided into a rebamipide group (artificial tears and 2% rebamipide) and a control group (artificial tears only). Changes in dry eye indicators, including the Ocular Surface Disease Index (OSDI), corneal fluorescein staining (CFS) score, tear meniscus height (TMH), tear break-up time (TBUT), and dry eye classification, were analyzed at 2 and 4 weeks postoperatively in comparison with the preoperative baseline.
Results
In total, 250 patients (250 eyes) were selected: 135 in the rebamipide group and 115 in the control group. Preoperative characteristics such as gender, age, spherical equivalent refraction, ablation depth, and optical zone size showed no significant differences between the two groups. Both groups demonstrated a significant increase in OSDI and CFS scores at 2 weeks postoperatively, followed by a decrease at 4 weeks, with no significant differences between groups. TMH increased significantly in the rebamipide group at 2 and 4 weeks (P=0.043, P=0.004), but showed no significant change in control group or intergroup difference. No significant difference was found in the first TBUT between the two groups at any time point, but the average TBUT significantly and rapidly increased from 2 to 4 weeks postoperatively in the rebamipide group (P=0.001). The dry eye classification was significantly lower in the rebamipide group at 4 weeks postoperatively (P=0.014).
Conclusion
The use of rebamipide 2% ophthalmic solution immediately after SMILE surgery is expected to be helpful in treating early postoperative dry eye, as it increased TMH and TBUT starting from 2 weeks postoperatively.
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