术前应用人工泪液对FS-LASIK治疗高度近视眼术后干眼自觉症状和泪膜稳定性影响的临床研究

目的探讨术前应用人工泪液对飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)治疗高度近视眼术后干眼自觉症状和泪膜稳定性的影响。 方法纳入2017年6月至2018年6月在首都医科大学附属北京同仁医院屈光中心行FS-LASIK的高度近视眼患者300例(582只眼)为研究对象。其中，男性143例(279只眼)，女性157例(303只眼)。年龄18~49岁，平均年龄(31.1±1.2)岁。采用数字表法随机分为研究组150例(290只眼)和对照组150例(292只眼)。术前，研究组以人工泪液滴眼4次/d，连续21 d；对照组不予人工泪液滴眼。检查并记录全部患者术前、术后1周、术后1个月、术后2个月及术后3个月的干眼症状评分、泪膜破裂时间(BUT)、角膜荧光素染色(FL)评分、泪液分泌试验(SIt)等指标。干眼症状评分、BUT、FL评分、SIt以均数±标准差表示，组间比较采用两因素重复测量方差分析。 结果术前，研究组和对照组干眼症状评分分别为(12.00±3.16)分和(12.32±3.15)分，二者差异无统计学意义(t＝1.334，P>0.05)。术后1周及术后1个月干眼症状评分，研究组分别为(14.20±3.20)分及(14.60±2.65)分，对照组分别为(16.28±3.34)分及(16.44±3.56)分。术后高于术前，差异有统计学意义(t＝2.031，2.243；P<0.05)；研究组优于对照组，差异有统计学意义(t＝2.103，2.167；P<0.05)。术后2个月及3个月干眼症状评分，研究组分别为(12.89±2.67)分及(12.04±2.88)分，对照组分别为(13.23±2.45)分及(12.71±3.22)分。术前与术后比较，差异无统计学意义(t＝1.607，P>0.05)；两组比较，差异无统计学意义(t＝1.085，0.601；P>0.05)。术前，研究组的BUT、FL评分及SIt分别为(12.31±3.11)s、(0.51±0.25)分及(14.44±2.15)mm/5 min，对照组分别为(12.47±3.18)s、(0.52±0.24)分和(14.43±2.16)mm/5 min。两组比较，差异无统计学意义(t＝0.446，1.547，0.799；P>0.05)。术后1周和术后1个月，研究组SIt分别为(10.89±3.13)mm/5 min和(10.93±3.02)mm/5 min，对照组分别为(9.07±3.11)mm/5 min和(8.19±3.25)mm/5 min。研究组好于对照组，差异有统计学意义(t＝ 2.028，2.350；P<0.05)。两组均差于术前，差异有统计学意义(t＝2.106，2.783，P<0.05)。术后2个月及3个月，研究组SIt分别为(14.14±2.34)mm/5 min和(15.10±3.15)mm/5 min，对照组分别为(14.04±2.67)mm/5 min和(14.76±3.08)mm/5 min。与术前比较，差异无统计学意义(t＝1.607，1.729；P>0.05)。术后1周、术后1个月及术后2个月，研究组的BUT分别为(9.96±3.05)s、(10.07±2.98)s及(10.15±3.03)s，对照组分别为(7.36±3.03)s、(7.46±2.59)s及(7.87±2.65)s。术后比术前缩短，差异均有统计学意义(t＝3.187，2.603，2.441；P<0.05)；研究组优于对照组，差异有统计学意义(t＝2.304，2.192，2.177；P<0.05)。术后1周、术后1个月及术后2个月，研究组的FL评分分别为(1.07±0.48)分、(1.04±0.31)分及(0.93±0.19)分，对照组分别为(2.10±0.18)分、(1.88±0.44)分及(1.84±0.29)分。术后比术前增加，差异均有统计学意义(t＝3.118，2.974，3.057；P<0.05)；研究组均优于对照组，差异有统计学意义(t＝3.119，2.053，3.113；P<0.05)。两组术后3个月的BUT和FL评分与术前比较，差异无统计学意义(t＝0.975，1.801；P>0.05)。 结论高度近视眼FS-LASIK术后可导致干眼的发生，但一般持续时间较短，在术后3个月能恢复至接近术前水平。术前应用人工泪液可促进术后泪膜稳定性的恢复，减轻患者术后的干眼自觉症状。

The clinical study of pre-operation use of artificial tears on dry eye symptoms and stability of lacrimal film after FS-LASIK treatment of high myopia

ObjectiveThe aim of this study was to investigate the effect of preoperative artificial tears on dry eye and the stability of tear film after femtosecond laser flap excimer laser in situ keratomileusis (FS-LASIK). Methods300 high myopia patients (582 eyes) who received FS-LASIK in Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University between June 2017 and June 2018 were included as research subjects. Among of them, there were 143 males (279 eyes), and 157 females (303 eyes) whose ages were between 18 to 49 years (mean 31.1±1.2 years). Subjects were divided into two groups according to the random comparison table, 150 patients (290 eyes) per group. Before the operation, artificial tears were used 4 times per day and for 21 days in the study group. No artificial tears were used before the operation in the control group. The score on the tests of dry eye symptom, tear film break-up time (BUT), Schimer I test (SⅠt), corneal fluorescein staining score (FL) before the operation and after operation for 7, 30, 60 and 90 days were examined and recorded. All the data was expressed in the form of mean±standard deviation. Comparison between groups were conducted by applying analysis of variance for two-factor repeated measurements. ResultsThe scores of dry eye symptom of the study group and the control group were (12.00±3.16) pts and (12.32±3.15) pts, respectively. The difference between two groups was not statistically significant (t=1.334, P>0.05). The scores of the dry eye symptom of the study group after operation for 7 and 30 days were (14.20±3.20) pts and (14.60±2.65) pts, respectively; those of the control group were (16.28±3.34) pts and (16.44±3.56) pts, respectively. The data for the study group was better those of the control group, there was a statistically significant difference (t= 2.103, 2.167; P<0.05). The dry eye score of the study group after operation for 60 and 90 days were (12.89±2.67) pts and (12.04±2.88) pts, respectively; those of the control group were (13.23±2.45) pts and (12.71±3.22) pts, respectively. The difference between two groups was not statistically significant (t=1.085, 0.601; P>0.05). Before operation, the BUT, FL, and SⅠt results of the study group were (12.47±3.18) s, (0.52±0.24) pts and (14.44±2.15) mm/5 min, respectively; those of the control group were (12.31±3.11) s, (0.51±0.25) pts and (14.43±2.16) mm/5 min, respectively. The difference between two groups was not statistically significant (t=0.446, 1.547, 0.799; P> 0.05). The SⅠt results of the study group after operation for 7 and 30 days were (10.89±3.13) mm/5 min and (10.93±3.02) mm/5 min, respectively; those of the control group were (9.07±3.11) mm/5 min and (8.19±3.25) mm/5 min, respectively. The SⅠt results of the study group was better those of the control group. There was a statistically significant difference (t= 2.028, 2.350; P<0.05). The SⅠt before and after operation for 60 and 90 days of the study group were (14.14±2.34) mm/5 min and (15.10±3.15) mm/5 min, respectively; those of the control group were (14.04±2.67) mm/5 min and (14.76±3.08) mm/5 min, respectively. Comparing to the values before the operation, the differences had no statistical significance (t=1.607, 1.729; P>0.05). The BUT results of the study group after operation for 7, 30, and 60 days were (9.96±3.05) s, (10.07±2.98) s , and (10.15±3.03) s, respectively; those of the control group were (7.36±3.05) s, (7.46±2.59) s, and (7.87±2.65) s, respectively. The data after operation was lower than the values before the operation, and the difference was statistically significant (t=3.187, 2.603, 2.441; P<0.05). The overall value of the study group was better than the values for the control group, and the difference was statistically significant (t=2.304, 2.192, 2.177; P<0.05). The FL scores of the study group after operation for 7, 30, and 60 days were (1.07±0.48) pts, (1.04±0.31) pts, and (0.93±0.19) pts, respectively; those of the control group were (2.10±0.18) pts, (1.88±0.44) pts, and (1.84±0.29) pts, respectively. The data value increased after operation, and the difference between before and after operation was statistical significance (t=3.118, 2.974, 3.057; P<0.05). The overall data of the study group was better than those of the control group, there was a statistical significance difference (t=3.119, 2.053, 3.113; P<0.05). There was no statistical significance for the BUT and FL scores before and after operation for 90 days (t=0.975, 1.801; P>0.05). ConclusionsDry eye symptoms usually happen to patients with high myopia after receiving FS-LASIK, but it only lasts for a short period, recovering to the level before the operation after 90 days. The application of artificial tears before surgery could reduce the postoperative dry eye symptoms and propel the recovery of the stability of tear film, which is suggested.