不同制瓣方式对角膜屈光手术后泪膜稳定性的影响  

Effect of different styles of making valva on stability of tear film after corneal refractive operation

作　　者：胡明[1] 牟国营[2] 李招娜[1] 张亚丽[1] 徐健[1] 刘蕾[1] 

机构地区：[1]济南市第二人民医院眼科,山东省济南市250001 [2]济南市中心医院眼科,山东省济南市250013

出　　处：《眼科新进展》2010年第4期367-369,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨不同手术方式制作不同厚度角膜瓣的准分子激光术后泪膜稳定性的变化。方法选择我院行准分子激光近视矫正手术的患者161例(300眼),其中行EPI-LASIK者59例(108眼),其余患者均行LASIK,其中角膜瓣厚度约为110μm(90刀头薄瓣组)和130μm(常规瓣组)的患者分别为52例(96眼)和50例(96眼)。观察患者术后1周、1个月、3个月、6个月、1a的干眼症状,包括干涩感、烧灼感、异物感,依次行基础泪液分泌试验(SchirmerItest,SIt)、泪膜破裂时间(breakuptime,BUT)、角膜荧光素染色检查(fluorescein,FL),并对其泪膜稳定性的变化进行对比分析。结果术后1周、1个月EPI-LASIK组干眼主观症状评分与LASIK薄瓣组及常规瓣组比较,差异均有统计学意义(均为P<0.05);LASIK薄瓣组和常规瓣组比较,差异无统计学意义(P>0.05)。术后1周、1个月时EPI-LASIK组FL检查评分与LASIK薄瓣和常规瓣组比较,差异均有统计学意义(均为P<0.05);LASIK薄瓣组和LASIK常规瓣组比较,差异无统计学意义(P>0.05)。FL试验:术后1周时,EPI-LASIK组评分较高,术后1个月、3个月时,LASIK组FL评分较高,EPI-LASIK组与LASIK(薄瓣和常规瓣)组间比较,差异均有统计学意义(均为P<0.05)。SIt试验:术后3个月时,EPI-LASIK组SIt值(14.11±3.01)mm较LASIK薄瓣组(13.55±3.18)mm和LASIK常规瓣组(12.05±2.18)mm长,差异均有统计学意义(均为P<0.05);术后6个月时,LASIK薄瓣组(13.72±3.58)mm较LASIK常规瓣组(12.54±3.22)mm长,差异有统计学意义(P<0.05)。BUT检查:术后1个月、3个月、6个月时,LASIK薄瓣组分别为(5.27±3.11)s、(8.41±2.79)s、(9.53±4.07)s和LASIK常规瓣组(6.25±1.92)s、(7.75±1.53)s、(8.34±2.05)s,均较同时间点EPI-LASIK组(7.21±2.32)s、(9.35±3.58)s、(12.59±4.02)s短,差异均有统计学意义(均为P<0.05);术后3个月时,薄瓣组和常规瓣组比较,差异有统计学意义(P<0.05)。结论角膜屈光手术对泪膜稳定性有不良影响,制瓣方式不同决定其Objective To explore the stability changes of tear film after excimer laser operation with making different depth of corneal valva by different surgeries.Methods There were 161 cases（300 eyes）performing excimer laser operation to correct myopia in our hospital,among which 59 cases（108 eyes）were with EPI-LASIK,others with LASIK.There were 52 cases（96 eyes）with 110 μm corneal valva（90 bit thin valva group）,50 cases（96 eyes）with 130 μm corneal valva（routine valva group）in cases with LASIK.The symptoms of dry eye,including dry eye sensation,burning sensation and foreign body sensation,were observed at postoperative 1 week,1 month,3 months,6 months and 1 year.Schirmer experiment（SIt）,break up time（BUT）of tear film,corneal and conjunctival fluorescence（FL）chromoscopy were performed in turn,and stability changes of tear film were compared and analyzed.Results There were statistical differences in dry eye sensation for EPI-LASIK group comparing with thin valva LASIK group or routine valva LASIK group at postoperative 1 week and 1 month（Both P0.05）;And no statistical difference was found between thin valva LASIK group and routine valva LASIK group（P0.05）;There were statistical differences in FL mark for EPI-LASIK group comparing with thin valva LASIK group or routine valva LASIK group at postoperative 1 week and 1 month（Both P0.05）;And no statistical difference was found between thin valva LASIK group and routine valva LASIK group（P0.05）;With SIt,SIt value was（14.11±3.01）mm in EPI-LASIK group longer than（13.55±3.18）mm in thin valva LASIK group and（12.05±2.18）mm in routine valva LASIK group at postoperative 3 months,there was statistical difference（Both P0.05）;SIt value was（13.72±3.58）mm in thin valva LASIK group longer than（12.54±3.22）mm in routine valva LASIK group at postoperative 6 months,there was statistical difference（P0.05）.BUT were（5.27±3.11）s,（8.41±2.79）s and（9.53±4.07）s in thin valva LASIK group at postoperative

关 键 词：EPI-LASIK 泪膜 角膜 

分 类 号：R779.6[医药卫生—眼科]