FLEx与SMILE术后早期干眼指标对比

目的：比较飞秒激光角膜基质透镜取出术（FLEx）与飞秒激光小切口角膜基质透镜取出术（SMILE）术后早期的干眼情况。方法：前瞻性非随机对照研究。选取2014年2-10月在中山眼科中心海南省眼科医院屈光中心接受全飞秒激光手术的近视散光患者，按患者选择的手术方式不同分为FLEx组28例（56眼）和SMILE组33例（66眼），分别在术前，术后1 d、1周、1个月进行泪液收集，检测TNF-α和IL-1α表达，同时行眼表疾病指数（OSDI）评分、基础泪液分泌实验Ⅰ（SⅠT）、无创性泪膜破裂时间（NIBUT）、泪河高度（TMH）检测，并于术后1周、1个月进行角膜荧光素染色（FL）检查。采用重复测量方差分析进行数据比较。结果：术后1周，SMILE组的NIBUT比FLEx组长（P=0.029），FL程度比FLEx组轻（P=0.037）。2组OSDI术后1 d、1周评分均较术前增高（均P<0.001），而2组间OSDI、SⅠT、TMH差异无统计学意义。FLEx组术后1 d泪液中的IL-1α表达较SMILE组高（P=0.019），2组术后各时间点泪液中TNF-α表达差异无统计学意义。结论：与FLEx术后患者相比，SMILE术后患者早期干眼程度较轻。

Comparison of short-term Changes in Dry Eye Indexes between Femtosecond Lenticule Extraction and small Incision Lenticule Extraction

Objective: To compare early changes in dry eye after femtosecond lenticule extraction (FLEx) and small incision lenticule extraction (SMILE). Methods: Twenty-eight subjects (56 eyes) underwent FLEx and 33 subjects (66 eyes) underwent SMILE in this prospective non-randomized study at the Refractive Center of Hainan Eye Hospital and Key Laboratory of Ophthalmology from February to October 2014. Ocular surface disease index (OSDI), Schirmer Ⅰ test (SⅠT), noninvasive tear breakup time (NIBUT), and tear meniscus height (TMH) were evaluated at 1 day, 1 week and 1 month after surgery but corneal fluorescein staining (FL) was measured only at 1 week and 1 month postoperatively in all patients. Concentrations of interleukin-1α (IL-1α) and tumor necrosis factor-α (TNF-α) in collected tears were assessed by multiplex antibody microarray at 1 day, 1 week and 1 month after surgery in both groups. Data were analyzed usingrepented measured ANOVA. Results: The NIBUT of the FLEx group was shorter than that of the SMILE group (P=0.029) and the FL scores of FLEx were worse than that of the SMILE group (P=0.037) at 1 week after surgery. OSDI scores of both groups were better than baseline levels (all P<0.001). There were no significant changes found in OSDI, SⅠT and TMH between the FLEx and SMILE groups. Higher tear concentrations of IL-1α were found in the FLEx group than that in the SMILE group (P=0.019). There was no significant difference in tear concentrations of TNF-α between the two groups. Conclusions: The early dry eye in the SMILE group was milder than in the FLEx group.