轻度干眼患者SMILE与FS-LASIK术后眼表和干眼严重程度变化比较  

Comparison of Changes in Ocular Surface and Dry Eye Disease Severity after SMILE and FS-LASIK in Patients with Mild Dry Eye

作　　者：刘嘉 钟定娟 陈蛟[1] 张莉苑 吴灏 王华[1] Jia Liu;Dingjuan Zhong;Jiao Chen;Liyuan Zhang;Hao Wu;Hua Wang(Department of Optometry and Ophthalmology,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410005,China)

机构地区：[1]湖南省人民医院、湖南师范大学附属第一医院眼视光中心,长沙410005

出　　处：《中华眼视光学与视觉科学杂志》2023年第5期354-360,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：湖南省科技厅项目(2020SK2118)。

摘　　要：目的:比较轻度干眼患者行飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)术后眼表和干眼严重程度变化。方法:回顾性临床研究。连续纳入2021年7月至2022年12月于湖南省人民医院眼视光中心行角膜屈光手术的轻度干眼患者55例(98眼)进行观察。根据患者接受的手术方式分为2组,其中SMILE组30例(52眼),FS-LASIK组25例(46眼)。于术前和术后1、3、6、12个月进行眼表疾病指数(OSDI)量表评分,于术前和术后1、3个月观察并收集首次非侵入性泪膜破裂时间(NI-BUTf)和平均非侵入性泪膜破裂时间(NI-BUTave)、泪河高度(TMH)、脂质层厚度等级、眼红分析、角膜荧光素染色评分等指标。组间计量资料比较采用独立样本t检验,计数资料比较采用卡方检验。结果:SMILE组术后1、3、6个月的OSDI评分较FS-LASIK组低(t=2.43,P=0.017;t=2.35,P=0.021;t=2.44,P=0.017),术后12个月2组间OSDI评分差异无统计学意义(P>0.05)。SMILE组术后1、3个月OSDI评分均较术前增加(t=-8.67,P<0.001;t=3.86,P<0.001),术后6、12个月逐渐恢复至术前水平(均P>0.05);FS-LASIK组术后1、3、6个月OSDI评分均较术前增加(t=-13.48,P<0.001;t=-8.33,P<0.001;t=-2.84,P=0.007),术后12个月逐渐恢复至术前水平(P>0.05);2组术后12个月的OSDI评分等级分布差异无统计学意义(P>0.05)。SMILE组术后1、3个月的NI-BUTf、NI-BUTave值均较FS-LASIK组高(均P<0.05)。FS-LASIK组和SMILE组术后1个月中度干眼的发生率分别为50.0%、32.7%,重度干眼的发生率分别为8.7%、0%;术后3个月中度干眼的发生率分别为32.6%、17.3%,均无重度干眼患者。2组间术后1、3个月的干眼严重程度分布差异有统计学意义(χ^(2)=10.89,P=0.012;χ^(2)=6.71,P=0.035)。结论:FS-LASIK对轻度干眼患者术后眼表的影响较SMILE明显,且影响作用的时间更长。FS-LASIK相较于SMILE增加了术后中度、重度干眼发生率,术后干眼�Objective:To compare alterations in the ocular surface and severity of dry eye disease in patients with mild dry eye who underwent small incision lenticule extraction(SMILE)and femtosecond-assisted laser in situ keratomileusis(FS-LASIK).Methods:This retrospective clinical study included 55 patients(98 eyes)with mild dry eye disease who underwent corneal refractive surgery.Thirty patients(52 eyes)underwent SMILE and 25(46 eyes)underwent FS-LASIK.Ocular surface disease index(OSDI)scores were recorded before surgery and at 1,3,6,and 12 months after surgery.The dry eye disease parameters were evaluated preoperatively and postoperatively after 1 and 3 months following the respective procedures.The parameters of dry eye disease assessed included the first noninvasive tear film break-up time(NIBUTf),average noninvasive tear film break-up time(NI-BUTave),tear meniscus height(TMH),lipid layer thickness grade,hyperemia index,and corneal fluorescein staining score.The measurement data between the two groups were compared using the independent sample t-test,and the count data were compared using the Chi-square test.Results:The OSDI scores of the SMILE group at 1,3,and 6 months after the operation were lower than those of the FS-LASIK group(t=2.43,P=0.017;t=2.35,P=0.021;t=2.44,P=0.017),and there was no significant difference between the two groups at 12 months after operation(P>0.05).In the SMILE group,the OSDI score increased 1 and 3 months after the operation compared to before the operation(t=-8.67,P<0.001;t=3.86,P<0.001)and gradually recovered to the preoperative levels 6 to 12 months after operation(all P>0.05).In the FS-LASIK group,the OSDI score increased at 1,3,and 6 months after the operation compared to before the operation(t=-13.48,P<0.001;t=-8.33,P<0.001;t=-2.84,P=0.007,respectively)and gradually recovered to the preoperative levels 12 months after the operation(P>0.05).There was no statistical difference in the distribution of OSDI scores in the two groups 12 months after the operation(P>0.05).The NI-BUTf and NI-

关 键 词：飞秒激光小切口角膜基质透镜取出术 飞秒激光制瓣的准分子激光原位角膜磨镶术 眼表参数 干眼 

分 类 号：R779.63[医药卫生—眼科]