FS-LASIK与SMILE术后干眼参数与角膜知觉的比较

比较飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）与飞秒激光小切口角膜基质透镜取出术（SMILE）术后不同时间点干眼参数与角膜知觉的变化，探讨不同手术方式对泪膜及角膜知觉的影响并分析2项指标之间的相关性。方法：前瞻性非随机对照研究。行FS-LASIK患者24例（48眼），行SMILE患者21例（41眼）。在术前及术后1、3个月采用Keratograph 5M眼表综合分析仪行泪河高度（TMH）、非入侵性泪膜破裂时间（NIBUT）包括首次泪膜破裂时间（NIF-BUT）与平均泪膜破裂时间（NIAvg-BUT）]的检查，并进行中央角膜知觉检查。组内手术前后各观察指标的比较采用重复测量方差分析；组间一般资料及各观察指标的比较用独立样本t检验；角膜知觉与干眼参数的相关性采用 Spearman相关分析。结果：2组间术前各干眼参数与中央角膜知觉差异均无统计学意义。FS-LASIK 组与SMILE组TMH在术后1个月和3个月较术前均下降（F=21.213，P<0.001；F=14.648，P<0.001）， SMILE组术后2 个时间点的TMH高于FS-LASIK组（t=-5.549，P<0.001；t=-3.028，P=0.003）。 FS-LASIK组NIF-BUT术后1个月较术前下降（F=4.603，P=0.019）；而SMILE组NIF-BUT在术后2个时间点较术前值虽下降，但差异无统计学意义（F=0.599，P=0.516）；术后1个月SMILE组NIF-BUT优 于FS-LASIK组（t=-3.430，P=0.001）。FS-LASIK组NIAvg-BUT在术后1个月较术前下降（F=3.580， P=0.042）；SMILE组NIAvg-BUT术后2个时间点较术前虽下降，但差异均无统计学意义（F=0.274， P=0.761）；SMILE组NIAvg-BUT 2 个时间点均在术后优于FS-LASIK组（t=-2.395，P=0.019； t=-2.431，P=0.017）。FS-LASIK组中央角膜知觉术后各时间点较术前下降，术后3个月高于术后1个月（F=121.919，P<0.001）；SMILE组中央角膜知觉术后1个月较术前下降（F=54.032，P<0.001）；术后各时间点SMILE组均优于FS-LASIK组（t=-5.367，P<0.001；t=-3.242，P=0.002）。2组术后各时间点中央角膜知觉与干眼参数均呈正相关性（均P<0.05）。结论：FS-LASIK和SMILE组的干眼参数与中央角膜知觉均会出现不同程度的下降，患者行SMILE术后干眼参数与中央角膜知觉优于行FS-LASIK 者，且中央角膜知觉与干眼参数均呈正相关性。

Comparison of Dry Eye Parameters and Corneal Sensation after FS-LASIK and SMILE Surgery

To compare the changes in dry eye parameters and corneal sensation between FS-LASIK (femtosecond laser-assisted in situ keratomileusis) and SMILE (small incision lenticule extraction), and to investigate the effect of the type of surgery on tear film and corneal sensation; to analyze the correlation between the two indicators. Methods: In this prospective non-randomized control study, 48 eyes of 24 patients underwent FS-LASIK and 41 eyes of 21 patients underwent SMILE. The tear meniscus height (TMH) and non-invasive tear film break-up time, including NIF-BUT and NIAvg-BUT, were measured by a Keratograph 5M ocular surface analyzer and were evaluated preoperatively and at 1 and 3 months postoperatively. Central corneal sensation was examined as well. Repeated measures ANOVA was used for preoperative and postoperative comparison within the same group; an independent sample t test was used for comparison of general data and dry eye parameters between the different groups; Spearman correlation analysis was used for the correlation between central corneal sensation and dry eye parameters. Results: The values of all dry eye parameters and central corneal sensation showed no differences before surgery between the two groups. In the FS-LASIK and SMILE groups, the TMH results decreased at both postoperative time points (F=21.213, P<0.001; F=14.648, P<0.001). The TMH results were higher in the SMILE group than that in the FS-LASIK group at both postoperative time points (t=-5.549, P<0.001; t=-3.028, P=0.003). In the FS-LASIK group, the NIF-BUT values decreased within 1 month after surgery (F=4.603, P=0.019). In the SMILE group, the NIF-BUT values presented no significant decrease at both postoperative time points (F=0.599, P=0.516). The NIF-BUT values were higher in the SMILE group than in the FS-LASIK group at 1 month postoperatively (t=-3.430, P=0.001). The NIAvg-BUT values in the FS-LASIK group decreased within 1 month after surgery (F=3.580, P=0.042). The NIAvg-BUT values presented no significant decrease at both postoperative time points in the SMILE group (F=0.274, P=0.761). The NIAvg-BUT values were higher at both postoperative time points in the SMILE group than in the FS-LASIK group (t=-2.395, P=0.019; t=-2.431, P=0.017). The central corneal sensation results had decreased at both postoperative time points in the FS-LASIK group (F=121.919, P<0.001), but had decreased at only 1 month after surgery in the SMILE group (F=54.032, P<0.001). The central corneal sensation results were better in the SMILE group than in the FS-LASIK group at both postoperative time points (t=-5.367, P<0.001; t=-3.242, P=0.002). There was a positive correlation between central corneal sensation and dry eye parameters at both follow-up time points in both groups (P<0.05). Conclusions: There are different degrees of change in dry eye parameters and central corneal sensation at the early postoperative period in the FS-LASIK and SMILE groups. The dry eye parameters and central corneal sensation in the SMILE group are better than those in the FS-LASIK group. There is a positive correlation between central corneal sensation and dry eye parameters in both groups.