角膜瓣蒂部位置对LASIK术后角膜知觉和泪膜的影响

目的了解颞侧蒂角膜瓣对准分子激光原位角膜磨镶术(LASIK)后的角膜知觉和泪膜的影响。方法将双眼屈光度相近的近视患者194例的左右眼角膜瓣蒂部随机置于角膜上方或颞侧,随后进行常规LASIK手术。分别在术前、术后1d、1周、1月、3月及6月时询问干眼症状,检测中央角膜知觉、荧光素试验、虎红染色、泪膜破裂时间和Schirmer’sⅠ试验。结果干涩感:在术后1周和1月时,上方蒂组的干涩感明显严重于颞侧蒂组(P<0.01)。异物感:两组间在术后1d和1周时存在差异(P<0.05)。灼烧感:两组间在术后1周时存在差异(P=0.025)。荧光素试验:两组间在术后1周时存在差异(P=0.003)。泪膜破裂时间:在术后所有时间点组间均存在差异(P<0.01)。虎红染色:在术后1周时,上方蒂组的虎红着色点明显多于颞侧蒂组(P=0.002)。Schirmer’sⅠ试验:两组间在术后1d、1周和1月时(P<0.01)。中央角膜知觉:两组间在术后1d、1周、1月和3月时(P<0.01)。结论颞侧蒂角膜瓣可保持较高的角膜敏感度,部分缓解干眼症。

The effect of hinge position on corneal sensation and tear film after LASIK

Objective To evaluate the differences on corneal sensation and the dry eye syndrome after laser in situ keratomileusis(LASIK) with superior- or temporal-hinge corneal flap. Methods One hundred and ninety-four patients (388 eyes) with similar myopic degree of two eyes were underwent bilateral LASIK with the superior-hinge flap in one eye and the temporal-hinge flap in the fellow eye randomly. These patients were evaluated for subjective complaints of dry eye, fluorescein staining (Fl), rose bengal staining(Rb), break-up time(BUT), Schirmer's I test and corneal sensations preoperatively and 1 day, 1 week, 1, 3 and 6 months postoperatively. Results The difference in the dry eye sensation was significant between two groups (P<0.01) at 1 week and 1 month postoperatively. There was significant difference between two groups on foreign body sensation at 1 day and 1 week (P<0.05) postoperatively. There was significant difference between two groups on burning sensation only at 1 week postoperatively (P=0.025). There was obvious difference between two groups in Fl staining at 1 week postoperatively (P=0.003). BUT in eyes with superior-hinge group was obvious shorter than that of temporal-hinge group at all time postoperatively. Rb staining in superior-hinge group was more obvious than that of temporal-hinge group at 1 week postoperatively (P=0.002). The difference on Schirmer's I test between two groups was significant at 1 day, 1 week, 1 month after LASIK (P<0.01). The difference on the corneal sensations between two groups were significant at 1 day, 1 week, 1 month, and 3 months postoperatively (P<0.01). Conclusions LASIK with temporal-hinge corneal flap dose have some effects on corneal sensation and the dry eye syndrome.