薄瓣LASIK术后泪液功能的临床观察  

Clinical observation of tear function following thin corneal flaps in LASIK

作　　者：刘俐娜[1] 陈海波[1] 邢建强[1] 周俏婧 丁辉[1] 钟兴武[1] 

机构地区：[1]中山大学中山眼科中心海南眼科医院(海南省眼科医院),海南省眼科研究所,海南省海口市570311

出　　处：《眼科新进展》2014年第5期438-440,444,共4页Recent Advances in Ophthalmology

基　　金：国家眼科学重点实验室自主研究基金项目(编号3030902113006)~~

摘　　要：目的探讨飞秒激光制瓣(femtosecond laser in situ keratomileusis,fs-LASIK)和准分子激光前弹力层下角膜磨镶术(one use-plus sub-Bowman’s keratomileusis,OUP-SBK)两种薄瓣LASIK术后患者在泪液功能和角膜染色方面的变化。方法 15例(30眼)行飞秒激光制瓣的LASIK(飞秒激光制瓣组),15例(30眼)行OUP-SBK(OUP-SBK组)。术前及术后1周、1个月、3个月行泪膜破裂时间(tear break-up time,BUT)、基础泪液分泌试验(SchirmerⅠtest,SIt)以及角膜荧光素染色(fluorescent,FL)检查。多个时间点的比较采用重复测量设计的方差分析或Kruskal-Wallis秩和检验,两组间的比较采用两独立样本t检验或秩和检验。结果 fs-LASIK组、OUP-SBK组角膜瓣厚度分别为(105.5±2.7)μm、(103.2±12.5)μm,两组间差异无统计学意义(P>0.05)。术后各时间点飞秒激光制瓣组(F=95.48,P<0.01)和OUP-SBK组(F=78.25,P<0.01)的BUT值均明显低于术前。飞秒激光制瓣组(F=26.96,P<0.01)和OUP-SBK组(F=32.11,P<0.01)术后各时间点的SIt值明显低于术前。术后1周时飞秒激光制瓣组(Z=4.72,P<0.008)和OUP-SBK组(Z=4.18,P<0.008)的FL均较术前增多、术后1个月、3个月时与术前差异均无统计意义(均为P>0.008)。两组间各时间点的各项观察指标差异均无统计学意义(均无P>0.05)。结论飞秒激光制瓣LASIK和OUP-SBK两种术后的BUT、SIt值和FL变化一致,术后的泪膜稳定性和分泌功能随着时间的推移逐渐恢复,且两者的角膜组织损伤均在早期得到修复。Objective To evaluate the changes of tear function and corneal stai- ning after femtosecond laser in situ keratomileusis （FS-LASIK） and One Use-Plus sub- Bowman＇ s keratomileusis （OUP-SBK）. Methods A total of 30 cases （30 eyes） un- derwent FS-LASIK, and 30 cases （30 eyes） underwent OUP-SBK. The fluorescein stai- ning score,tear break-up time （BUT） and Schirmer I test （Sit） were assessed preoper- atively and 1 week, 1 month and 3 months postoperatively. The ANOVA for repeat meas- urements or Kruskal-Wallis ranks test were used for statistical analysis. For the differ- ences between FS-LASIK and OUP-SBK eyes, a independent-samples t test or Wilcoxon matched-samples rank sam test were used. A chi-square test was used for the corneal staining. Results The corneal flap thickness of FS-LASIK group and OUP-SBK group were （ 105.5 ± 2.7 ）μm and （ 103.2 ± 12.5 ） μm, respectively, there was no statistical difference （P 〉 0.05 ）. The postoperative BUT and Sit at different time points in FS- LASIK group and OUP-SBK group were all lower than those before operation （F = 95.48,78.25,all P〈0.01 ;F = 26.95,32. 11 ,all P 〈0.01 ）. The fluorescein staining scores at postoperative 1 week in FS-LASIK group and OUP-SBK group were all higher than those before operation （Z =4.18,4.72 ,all P 〈0.01 ） ,but there was no statistical differ- ence at postoperative 1 month and 3 months （ all P 〉 0.05 ）. There was no statistical difference in any clinical outcomes at different time points between two groups （ all P 〉 0. 05 ）. Conclusion The changes of BUT, Sit and corneal staining are statistically similar between FS-LASIK and OUP-SBK. The postoperative tear film stability and secre- tion function return to normal gradually with the time prolong, and the corneal damage in the both groups are recovered at early time.

关 键 词：飞秒激光 前弹力层下 角膜磨镶术 泪膜破裂时间 Schirmer's试验 

分 类 号：R779.6[医药卫生—眼科]