准分子激光原位角膜磨镶术后泪膜的早期改变

目的 探讨准分子激光原位角膜磨镶术（laser in situ keratomileusis,LASIK)术后泪膜的早期改变。方法 对74例（148只眼）近视患者行LASIK,观察术前,术后1d、1周、1个月、3个月的干眼症状,包括干涩感、异物感、烧灼感,以及荧光素试验、孟加拉玫瑰红染色、泪膜破裂时间（breakup time of tear film,BUT)和泪液分泌量结果,并对数据进行统计学分析。结果 术后1周干燥感较术前加重（P＜0．0127）,其他时间与术前比较差异均无显著间谍（P＞0．0127）;术后1d和1周烧灼感较术前加重（P＜0．0127）,术后1个月、3个月与术前比较差异无显著意义（P＞0．0127）;术后1d、1周和1个月异物感染较术前明显加重（P＜0．0127）,3个月接近术前水平（P＞0．0127）。术后1d和1周角膜荧光素着色点较术前明显增多（P＜0．0127）,术后1个月和3个月与术前比较差异无显著意义（P＞0．0127）;术后1d和1周孟加拉玫瑰红着色点较术前明显增多,差异有显著意义（P＜0．0127）,术后1个月和3个月接近术前水平（P＞0．0127）;术后1周和3个月泪液分泌量较术前明显减少,差异有显著意义（P＜0．05）,术后1个月接近术前水平（P＞0．05）;术后1d、1周、1个月和3个月BUT均较术前缩短（P＜0．05）。结论 LASIK对泪膜具有一定程度不良影响,发生机制与多种因素有关;临床应积极采取预防措施,以使LASIK术后干眼症的发生率和严重程度降至最低。

The early changes of tear film after laser in situ keratomileusis

OBJECTIVE: To investigate the early changes of tear film after laser in situ keratomileusis (LASIK). METHODS: One hundred and forty-eight myopic eyes that underwent LASIK were randomly chosen. The eyes were observed for subjective complaints of dry eye, fluorescein staining (Fl), rose bengal staining (Rb), tear break-up time (BUT), Schirmer's I test preoperatively and 1 day, 1 week, 1 month, 3 months postoperatively. RESULTS: The subjective complaints of dry eye were more severe after the operation. There were obvious decreases in BUT at 1 day, 1 week, 1 month and 3 months postoperatively relative to the preoperative level (P < 0.05). The Schirmer's I test result was higher at 1 day but without statistical significance (P > 0.05), but lower at 1 week, 3 months (P < 0.05) after LASIK. No changes were observed in Schirmer's I test between preoperative and 1 month postoperative value (P > 0.05). Rb and Fl staining dots were more concentrated at 1 day and 1 week postoperatively (P < 0.0127). No significant changes were found in Rb staining at 1 month and 3 months postoperatively. CONCLUSION: LASIK does have some effects on tear film.