飞秒激光制瓣准分子激光原位角膜磨镶术后泪膜的变化

目的 观察飞秒激光制瓣准分子激光原位角膜磨镶（LASIK）术后泪膜的变化。方法 2013年8月至9月于我院行飞秒激光制瓣LASIK术后随访3月者120例（240眼）。观察术前、术后1周、1月、2月和3月的干眼症状评分、泪膜破裂时间（BUT）、泪液分泌试验（SIt）、角膜荧光素染色（FL）评分的变化及相关因素。结果 干眼症状评分：术后1周、1月、2月与术前差异均有统计学意义（t=-7．746，-8．773，-5．707，P=0．000，0．000，0．000），术后3月与术前差异无统计学意义（t=0．308，P=0．758）。BUT：术前BUT与术后1周、1月、2月、3月差异均有统计学意义（t=2．147，2．262，-2．873，-9．738，P=0．033，0．025，0．004，0．000）。SIt：术后1周、1月与术前差异有统计学意义（t=3．120，3．781，P=0．000，0．002），术后2月、3月与术前差异无统计学意义（t=-0．285，-6．238，P=0．776，0．753）。荧光素染色评分：术后1周、1月与术前差异无统计学意义（t=-3．654，-5．365，P=0．462，0．922），术后2月、3月与术前差异有统计学意义（t=3．659，4．021，P=0．000，0．025）。结论 飞秒激光制瓣LASIK在一定时间和一定程度上影响泪膜的稳定性，发生机制与多种因素有关，持续时间较短，症状较轻。

The change of tear film after laser assisted in situ keratomileusis with corneal flap created with femtosecond laser

Objective To observe the change of tear film after laser assisted in situ keratomileusis （LASIK） with corneal flap created with femtosecond laser. Methods The 120 myopic patients（240 eyes） who underwent LASIK with corneal flap created with femtosecond laser from August 2013 to September 2013 were enrolled in the study. Those patients were followed up for three months. The dry eye symptom score, tear break-up time （BUT） , Schirmer I test, corneal fluorescein staining were recorded preoperatively and in one week, one month, two months and three months postoperatively. Results Dry eye symptom score： There were significant differences observed （t = -7. 746, -8. 773, -5. 707,P =0. 000,0. 000,0. 000） in that of 1 week, 1 months and 2 months compared with the preoperative score. While no significant difference observed （t =0. 308,P =0. 758） in the third month. BUT：There existed significant differences（t =2. 147, 2. 262,-2.873, -9.738,P=0.033,0.025,0.004, 0.000） in that of the 1 week, 1, 2, 3 months compared with the preoperative level. Schirmer I test：There were significant differences （t = 3. 120,3.781, P = 0. 000,0. 002） in that of the 1 week and 1 month compared with the preoperative level. No significant differences （ t = - 0. 285, - 6. 238, P = 0. 776,0. 753 ） existed in 2 months and 3 months. Corneal fluorescein staining：No significant difference （t = -3. 654, -5. 365 ,P =0. 462,0. 922） in the first week and the first month compared with the preoperative level. There were significant differences （ t = 3. 659,4. 021, P = 0. 000 ,0. 025 ） in that of the 2 and 3 months compared with the preoperative level. Conclusion LASIK with corneal flap created by femtosecond laser affects the stability of the tear film in a certain time period and a certain extent. The mechanism relates to many factors. Dry eye manifestation is temporary and slight.