非干眼人群小切口基质透镜取出术后短期泪膜变化及其危险因素研究  

Short-term changes and risk factor analysis of tear film in preoperative non-dry eye disease population after small incision lenticule extraction

作　　者：沈燕 王季芳 张洪 万惜晨 周行涛 于志强[1,4,5] 杨培 周淑云[2] 洪佳旭 乐琦骅 SHEN Yan;WANG Jifang;ZHANG Hong;WAN Xichen;ZHOU Xingtao;YU Zhiqiang;YANG Pei;ZHOU Shuyun;HONG Jiaxu;LE Qihua(Department of Ophthalmology,Eye&ENT Hospital of Fudan University,Shanghai 200031,China;Department of Nursing,Eye&ENT Hospital of Fudan University,Shanghai 200031,China;Department of Ophthalmology,The Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China;Research Center,Eye&ENT Hospital of Fudan University,Shanghai 200031,China;Myopia Key Laboratory of Ministry of Health,Eye&ENT Hospital of Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]复旦大学附属眼耳鼻喉科医院护理部,上海200031 [3]贵州医科大学附属医院眼科,贵阳550004 [4]复旦大学附属眼耳鼻喉科医院研究中心,上海200031 [5]复旦大学附属眼耳鼻喉科医院卫生部近视眼重点实验室,上海200031

出　　处：《中国眼耳鼻喉科杂志》2023年第6期446-453,共8页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家自然科学基金(81970767)。

摘　　要：目的 探讨小切口基质透镜取出术(SMILE)对非干眼人群的泪膜影响并分析其危险因素。方法前瞻性病例系列研究。本研究纳入2022年7—9月在复旦大学附属眼耳鼻喉科医院就诊并行SMILE术的28例(28眼)患者资料,其中男性11例、女性17例,平均年龄(25.96±5.41)岁。术前和术后20 d使用眼表疾病指数(OSDI)问卷评估患者的干眼症状,裂隙灯结合荧光素染色观察患者的角膜上皮情况,Oculus K5M评估泪膜情况,基础泪液分泌试验检测基础泪液分泌量。结果 术后共有13眼(13/28,46.43%)诊断为干眼。相较于术前,术后20 d的OSDI评分明显升高(P=0.001 8),基础泪液分泌量、荧光素泪膜破裂时间、首次及平均非侵入性泪膜破裂时间与泪河高度均显著低于基线水平(P值分别为0.001 2,<0.000 1,0.000 1,0.001 6和0.011 2)。年龄>25岁和术前睑板腺缺失评分>1分者术后更容易发生泪膜异常。年龄为术后20 d发生干眼的独立危险因素。结论 术前非干眼人群在接受SMILE术后20 d出现明显泪膜质和量异常,应注意术前对患者的干眼评估和术后及时规范的干眼治疗。Objective To investigate the impact of small incision lenticule extraction(SMILE)on tear film and explore its risk factors in preoperative non-dry eye disease(DED)population.Methods This prospective case series study enrolled a total of 28 patients(28 eyes)who received SMILE in the Eye,Ear,Nose&Throat Hospital of Fudan University from July 2022 to September 2022.The average age was 25.96±5.41 years,with 11 males and 17 females.Before surgery and on day 20 after surgery,DED symptoms were quantified by the Ocular Surface Disease Index(OSDI)questionnaire,the corneal epithelium was evaluated under a slit lamp biomicroscope with fluorescein staining,the tear film was assessed by Oculus K5M,and tear secretion volume was examined with Schirmer I test without anaesthesia.Results A total of 13 eyes(46.43%)were diagnosed as DED on day 20 after surgery.Compared with the preoperative baseline,the OSDI score was significantly increased(P=0.0018)on day 20 postoperatively,along with significant reduction of Schirmer I test value,tear film break-up time,first and average non-invasive tear film break-up time and tear meniscus height(P=0.0012,<0.0001,0.0001,0.0016 and 0.0112,respectively).Patients>25-year-old and those with meibomian gland loss score>1 were more prone to develop tear film abnormality.Age was the independent risk factor associated with newly-developed DED on day 20 after surgery.Conclusion Abnormal tear film quality and quantity were found in the preoperative non-DED population on day 20 after SMILE,which highlighted the importance of preoperative evaluation on the risk of DED development and proper treatment after surgery.

关 键 词：干眼 泪膜 小切口基质透镜取出术 

分 类 号：R77[医药卫生—眼科]