SMILE、飞秒激光制瓣LASIK及去瓣机械法LASIK术后干眼参数的比较

目的 比较SMILE、飞秒激光制瓣LASIK(FS-LAISK)以及机械法去瓣LASIK(Epi-LASIK)手术前后不同时间点干眼参数的变化情况,探讨不同手术方式对泪膜的影响.方法 前瞻性病例对照研究.行SMILE者(SMILE组)33例(66眼),行FS-LAISK者(FS-LAISK组)24例(48眼),行Epi-LASIK者(Epi-LASIK组)31例(61眼).分别在术前、术后1周、1个月、3个月、6个月采用眼前节OCT测量患者的泪河高度(TMH)、泪膜破裂时间(BUT)、基础泪液分泌量(SIT).不同组别一般资料及干眼参数的比较采用单因素方差分析,同一组内手术前后的比较采用重复测量方差分析.结果 SMILE组术后各时间点TMH与术前相比,差异均无统计学意义(F=1.225,P＞0.05);FS-LASIK组TMH在术后1个月内较术前降低,差异有统计学意义,并于术后3个月逐渐恢复(F=3.806,P＜0.05);Epi-LASIK组TMH在术后3个月内较术前下降,差异有统计学意义,直至术后6个月恢复术前水平(F=4.564,P＜0.05).术后各时间点,3组间TMH差异均有统计学意义(F=4.749、8.173、3.850、2.830,P＜0.05).SMILE组和FS-LASIK组BUT在术后3个月内,与术前相比差异有统计学意义,并在术后6个月恢复至术前水平(F=2.860、3.590,P＜0.05).Epi-LASIK组术后各时间点的BUT较术前降低,差异有统计学意义(F=12.800,P＜0.01).3组间BUT在术前、术后1周及术后1个月差异均无统计学意义(F=0.966、0.115、0.991,P＞0.05),而术后3、6个月,3组间BUT差异有统计学意义(F=4.448、6.634,P＜0.05).SMILE组和FS-LASIK组SIT在术后1周、1个月均较术前降低,且差异有统计学意义,并于术后3个月恢复至术前水平(F=14.160、13.323,P＜0.01);EPi-LASIK直至术后6个月才恢复至术前水平(F=10.085,P＜0.01).除术后3个月外(F=10.021,P＜0.01),术后其余时间点3组间SIT差异无统计学意义(F=0.005、2.210、1.054,P＞0.05).结论 3种屈光手术后早期均会出现不同程度的干眼参数改变.SMILE术后干眼参数最佳,恢复最快.

Comparison of dry-eye parameters after SMILE,femtosecond LASIK and off-flap Epi-LASIK

ObjectiveTo investigate the changes in dry eye parameters after small incision lenticule extraction （SMILE）， femtosecond LASIK （FS-LASIK） and off-flap epipolis LASIK （Epi-LASIK）， and to investigate the effect of the type of surgery on tear film. MethodsIn this prospective case-control study， 66 eyes of 33 patients underwent SMILE， 48 eyes of 24 patients underwent FS-LASIK， and 61 eyes of 31 patients underwent Epi-LASIK. Tear meniscus height （TMH） measured by anterior segment optical coherence tomography （OCT）， break-up time （BUT） and Schirmer I test （SIT） were evaluated preoperatively， and at 1 week and 1， 3， and 6 months postoperatively. Differences in preoperative general information and dry eye parameters among the different groups were performed using a one-way ANOVA. Repeat measures ANOVA was used for preoperative and postoperative comparisons within the same group. ResultsThe TMH results presented no significant decrease at all postoperative time points in the SMILE group （F=1.225， P>0.05）. The TMH results in the FS-LASIK group decreased significantly within 1 month after surgery and returned to preoperative levels at 3 months postoperatively （F=3.806， P<0.05）. The TMH results in the Epi-LASIK group decreased significantly within 3 months after surgery and did not return to preoperative levels until 6 months postoperatively （F=4.564， P<0.05）. There were significant differences in the TMH among the 3 groups after surgery （F=4.749， 8.173， 3.850， 2.830， P<0.05）. The BUT values in the SMILE and FS-LASIK groups decreased significantly within 3 months after surgery， and recovered to their preoperative levels at 6 months postoperatively （F=2.860， 3.590， P<0.05）. The BUT values at the postoperative time points were obviously lower than preoperative levels in the Epi-LASIK group （F=12.800， P<0.01）. Differences in the BUT values among the 3 groups were not statistically significant preoperatively and at 1 week and 1 month postoperatively （F=0.966， 0.115， 0.991， P>0.05） except for postoperative 3 and 6 months （F=4.448， 6.634， P<0.05）. The SIT values in the SMILE and FS-LASIK groups decreased significantly within 1 month after surgery， and recovered to their preoperative levels at 3 months postoperatively （F=14.160， 13.323， P<0.01）. The SIT values in the EPi-LASIK group recovered to their preoperative levels at 6 months postoperatively （F=10.085， P<0.01）. There were no statistically significant differences in SIT at all postoperative time points among the 3 groups （F=0.005， 2.210， 1.054， P>0.05） except 3 months postoperatively （F=10.021， P<0.01）. ConclusionThe three refractive surgery techniques can result in different degrees of short-term dry eye. The dry eye parameters are best in the SMILE group and have the fastest recovery.