FS-LASIK与SMILE术后干眼参数与角膜知觉的比较  

Comparison of Dry Eye Parameters and Corneal Sensation after FS-LASIK and SMILE Surgery

作　　者：郭丰芳 方学军 Fengfang Guo;Xuejun Fang(Aier School of Ophthalmology,Central South University,Changsha 410015,China;Shenyang Aier Eye Hospital,Shenyang 110003,China)

机构地区：[1]中南大学爱尔眼科学院,长沙410015 [2]沈阳爱尔眼视光医院,110003

出　　处：《中华眼视光学与视觉科学杂志》2019年第12期930-936,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:比较飞秒激光制瓣准分子激光原位角膜磨镶术(FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)术后不同时间点干眼参数与角膜知觉的变化,探讨不同手术方式对泪膜及角膜知觉的影响并分析2项指标之间的相关性。方法:前瞻性非随机对照研究。行FS-LASIK患者24例(48眼),行SMILE患者21例(41眼)。在术前及术后1、3个月采用Keratograph 5M眼表综合分析仪行泪河高度(TMH)、非入侵性泪膜破裂时间(NIBUT)[包括首次泪膜破裂时间(NIF-BUT)与平均泪膜破裂时间(NIAvg-BUT)]的检查,并进行中央角膜知觉检查。组内手术前后各观察指标的比较采用重复测量方差分析;组间一般资料及各观察指标的比较用独立样本t检验;角膜知觉与干眼参数的相关性采用Spearman相关分析。结果:2组间术前各干眼参数与中央角膜知觉差异均无统计学意义。FS-LASIK组与SMILE组TMH在术后1个月和3个月较术前均下降(F=21.213,P<0.001;F=14.648,P<0.001),SMILE组术后2个时间点的TMH高于FS-LASIK组(t=-5.549,P<0.001;t=-3.028,P=0.003)。FS-LASIK组NIF-BUT术后1个月较术前下降(F=4.603,P=0.019);而SMILE组NIF-BUT在术后2个时间点较术前值虽下降,但差异无统计学意义(F=0.599,P=0.516);术后1个月SMILE组NIF-BUT优于FS-LASIK组(t=-3.430,P=0.001)。FS-LASIK组NIAvg-BUT在术后1个月较术前下降(F=3.580,P=0.042);SMILE组NIAvg-BUT术后2个时间点较术前虽下降,但差异均无统计学意义(F=0.274,P=0.761);SMILE组NIAvg-BUT 2个时间点均在术后优于FS-LASIK组(t=-2.395,P=0.019;t=-2.431,P=0.017)。FS-LASIK组中央角膜知觉术后各时间点较术前下降,术后3个月高于术后1个月(F=121.919,P<0.001);SMILE组中央角膜知觉术后1个月较术前下降(F=54.032,P<0.001);术后各时间点SMILE组均优于FS-LASIK组(t=-5.367,P<0.001;t=-3.242,P=0.002)。2组术后各时间点中央角膜知觉与干眼参数均呈正相关性(均P<0.05)。结论:FS-LASIK和SMILE组的干眼参数与中央Objective:To compare the changes in dry eye parameters and corneal sensation between FS-LASIK(femtosecond laser-assisted in situ keratomileusis)and SMILE(small incision lenticule extraction),and to investigate the effect of the type of surgery on tear film and corneal sensation;to analyze the correlation between the two indicators.Methods:In this prospective non-randomized control study,48 eyes of 24 patients underwent FS-LASIK and 41 eyes of 21 patients underwent SMILE.The tear meniscus height(TMH)and non-invasive tear film break-up time,including NIF-BUT and NIAvg-BUT,were measured by a Keratograph 5M ocular surface analyzer and were evaluated preoperatively and at 1 and 3 months postoperatively.Central corneal sensation was examined as well.Repeated measures ANOVA was used for preoperative and postoperative comparison within the same group;an independent sample t test was used for comparison of general data and dry eye parameters between the different groups;Spearman correlation analysis was used for the correlation between central corneal sensation and dry eye parameters.Results:The values of all dry eye parameters and central corneal sensation showed no differences before surgery between the two groups.In the FS-LASIK and SMILE groups,the TMH results decreased at both postoperative time points(F=21.213,P<0.001;F=14.648,P<0.001).The TMH results were higher in the SMILE group than that in the FS-LASIK group at both postoperative time points(t=-5.549,P<0.001;t=-3.028,P=0.003).In the FS-LASIK group,the NIF-BUT values decreased within 1 month after surgery(F=4.603,P=0.019).In the SMILE group,the NIF-BUT values presented no significant decrease at both postoperative time points(F=0.599,P=0.516).The NIF-BUT values were higher in the SMILE group than in the FS-LASIK group at 1 month postoperatively(t=-3.430,P=0.001).The NIAvg-BUT values in the FS-LASIK group decreased within 1 month after surgery(F=3.580,P=0.042).The NIAvg-BUT values presented no significant decrease at both postoperative time points in the SMILE gr

关 键 词：飞秒激光制瓣准分子激光原位角膜磨镶术 飞秒激光小切口角膜基质透镜取出术 干眼参数 角膜知觉 Keratograph 5M眼表综合分析仪 

分 类 号：R47[医药卫生—护理学]