轻度干眼与非干眼病人行飞秒激光小切口角膜基质透镜取出术后弥漫性层间角膜炎发生率的对比研究  

A comparative study on the incidence of diffuse lamellar keratitis in patients with mild dry eye and non-dry eye after femtosecond laser small incision lenticule extraction

作　　者：刘娟 吴珂 LIU Juan;WU Ke(Clinical School of Medicine,Guizhou Medical University,Guiyang,Guizhou 550000,China;Ophthalmology,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou 550000,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550000 [2]贵州医科大学附属医院眼科,贵州贵阳550000

出　　处：《安徽医药》2024年第12期2412-2417,共6页Anhui Medical and Pharmaceutical Journal

基　　金：2021年贵州省卫生健康委科学技术基金项目(gzwkj2021-323)。

摘　　要：目的分析并比较轻度干眼与非干眼病人行飞秒激光小切口角膜基质透镜取出术(SMILE)后弥漫性层间角膜炎(DLK)的发生率,探讨干眼与SMILE术后DLK的发生是否有相关性,为SMILE手术的适应证提供依据。方法连续性纳入2021年12月至2023年2月在贵州医科大学附属医院眼科接受SMILE手术者627例(627只眼),均选择右眼,根据术前干眼检查结果,将确诊为干眼且裂隙灯显微镜下观察到角膜荧光素染色点小于5个或不超过1个象限,泪膜破裂时间大于2 s的病人纳入轻度干眼组(316只眼),将角膜荧光素染色阴性且泪膜破裂时间大于10 s的病人纳入非干眼组(311只眼)。比较两组病人SMILE术后1 d、1周、1个月DLK的发病率及临床分期,并分析术前一般资料及干眼相关检查指标与DLK的相关性。结果轻度干眼组SMILE术后共有34只眼发生了DLK,发生率为10.76%;非干眼组SMILE术后共有15只眼发生了DLK,发生率为4.82%。两组术后DLK发病率差异有统计学意义(P<0.05)。术前一般资料及干眼检查的相关指标中,眼压、睑板腺形态、泪膜脂质层厚度、泪液分泌试验Ⅰ、角膜荧光素染色5个变量差异有统计学意义(P<0.05),其中,术前眼压、睑板腺形态及角膜荧光素染色为危险因素,泪膜脂质层厚度、泪液分泌试验Ⅰ为保护因素。结论轻度干眼病人行SMILE术后DLK发生率高于非干眼人,干眼及眼压可能是SMILE术后发生DLK的一种危险因素,故术前有轻度干眼及眼压偏高的病人应积极处理后再行SMILE手术,避免术后DLK的发生。Objective To analyze the incidence of diffuse lamellar keratitis(DLK)after femtosecond laser small incision lenticule extraction(SMILE)in patients with mild dry eye and non-dry eye,and to investigate whether there is a correlation between dry eye and DLK after SMILE surgery,in order to provide a basis for the indications of SMILE surgery.Methods A total of 627 patients(627 eyes)who underwent SMILE surgery in the Department of Ophthalmology at Guizhou Medical University Affiliated Hospital between December 2021 and February 2023 were consecutively enrolled,all of whom selected the right eye.According to the results of preoperative dry eye tests,patients diagnosed with dry eye and observed under a slit lamp with less than 5 corneal fluorescein staining spots or no more than one quadrant,and a tear breakup time greater than 2 seconds,were included in the mild dry eye group(316 eyes),patients with negative corneal fluorescein staining and a tear film rupture time greater than 10 seconds were included in the non-dry eye group(311 eyes).The incidence and clinical stage of 1d,1w and 1m DLK after SMILE were compared between the two groups,and the correlation between preoperative general information and dry eye-related examination indicators and DLK were analyzed.Results In the mild dry eye group,34 eyes(10.76%)developed DLK after SMILE surgery;in the non-dry eye group,15 eyes(4.82%)developed DLK after SMILE surgery.The difference in the incidence of DLK after surgery between the two groups was statistically significant(P<0.05).The differences of five variables showed statistical significance(P<0.05)among the preoperative general information and dry eye-related examination indicators:intraocular pressure,meibomian gland morphology,tear film lipid layer thickness,tear secretion testⅠ,and corneal fluorescein staining.Among them,preoperative intraocular pressure,meibomian gland morphology,and corneal fluorescein staining were risk factors,while tear film lipid layer thickness and tear secretion testⅠwere protective facto

关 键 词：角膜炎 干眼 飞秒激光小切口角膜基质透镜取出术 弥漫性层间角膜炎 

分 类 号：R779.63[医药卫生—眼科]