飞秒激光制瓣的准分子激光原位角膜磨镶术与全飞秒激光小切口角膜基质内透镜取出术对屈光不正患者眼表的影响

目的　比较飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK ）与全飞秒激光小切口角膜基质内透镜取出术 (SMILE）对屈光不正患者眼表的影响。方法　选取 2018年 1月至 2019年 6月于郑州大学第一附属医院行角膜屈光手术的63例（126眼）屈光不正患者进行观察。根据患者接受的手术方式不同分为两组，FS-LASIK组 31 例（62 眼），SMILE组 32 例（64 眼），术后随访 6个月，观察并收集数据。观察指标包括:眼表疾病指数 (OSDI)量表评分、角膜荧光素染色评分、泪河高度（TMH）、非侵入式泪膜破裂时间（NIKBUT）、脂质层厚度、睑板腺功能评估得分、眼红指数（HI）。对两组患者各项指标进行统计学分析。结果　FS-LASIK组患者术后 1 周、1 个月、6 个月OSDI评分较术前均增加，差异均有统计学意义（均为P<0.05）；在术后 1 周时 OSDI 评分增加最明显。SMILE组患者术后1 周、1 个月OSDI评分较术前增加，差异均有统计学意义（均为P<0.05）。两组患者术后1 周、1 个月、6 个月OSDI 评分相比，差异均有统计学意义（均为P＜0.05），FS-LASIK组均高于SMILE组。两组患者术后 1 周角膜荧光素染色评分均较术前提高，差异均有统计学意义（均为P<0.05）；术后 1 个月、6 个月与术前相比，差异均无统计学意义（均为P>0.05）。FS-LASIK组患者术后 1周、1 个月、6 个月TMH与术前相比均减小，差异均有统计学意义（均为P<0.05），且在术后 1 周减小最为显著。SMILE组患者术后 1周、1 个月TMH亦均较术前减小（均为P<0.05）。FS-LASIK组患者术后 1周、1 个月、6个月NIKBUT与术前相比均减小，差异均有统计学意义（均为P<0.05），且在术后 1 周减小最为显著。SMILE组患者术后 1周、1 个月、6 个月NIKBUT与术前相比均减小，差异均有统计学意义（均为P<0.05）。两组患者术后1 周、1 个月、6 个月NIKBUT相比，差异均有统计学意义（均为P＜0.05），FS-LASIK组均小于SMILE组。FS-LASIK组患者术后 1 周、1 个月、6 个月脂质层厚度均较术前减小，差异均有统计学意义（均为P<0.05）。SMILE组患者术后 1 周、1 个月脂质层厚度亦均较术前减小，差异均有统计学意义（均为P<0.05）。两组患者术后 1 周、1 个月、6 个月睑板腺功能评估得分与术前相比，差异均无统计学意义（均为P>0.05）。FS-LASIK组和SMILE组患者术后 1周HI与术前相比均升高，差异均有统计学意义（均为P<0.05）。两组患者术后 1 周HI 相比，差异有统计学意义（P<0.05），FS-LASIK组高于SMILE组。结论　FS-LASIK与SMILE均会对患者眼表产生不同程度的影响，但 FS-LASIK对术后眼表的影响较SMILE明显，且这种影响作用的时间更长。

Effects of femtosecond laser in situ keratomileusis and full femtosecond laser small incision corneal stromal lens removal refractive surgery on ocular surface in patients with ametropia

Objective To compare the effects of femtosecond laser in situ keratomileusis(FS-LASIK)and full femtosecond laser small incision corneal stromal lens removal(SMILE)on ocular surface of patients with ametropia.Methods A total of 63 patients(126 eyes)with ametropia who underwent corneal refractive surgery in the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2019 were selected.According to different surgical methods,the patients were divided into two groups 31 patients(62 eyes)in the FS-LASIK group and 32 patients(64 eyes)in the SMILE group.The patients were followed up for 6 months to observe and collect data.Observation indicators included ocular surface disease index(OSDI)scale score,corneal fluorescein staining score,tear meniscus height(TMH),non-invasive Keratograph tear film break-up time(NIKBUT),lipid layer thickness,meibomian gland function evaluation score,and ocular redness index(HI).Results The OSDI scores of FS-LASIK group increased 1 week,1 month and 6 months after surgery compared with those before surgery,and the differences were statistically significant(all P<0.05).The OSDI score increased most significantly at 1 week postoperatively.OSDI scores of SMILE group increased 1 week and 1 month after surgery compared with those before surgery,and the differences were statistically significant(both P<0.05).There were statistically significant differences in OSDI scores between the two groups at 1 week,1 month and 6 months after surgery(all P<0.05),and the FS-LASIK group was higher than the SMILE group.The corneal fluorescein staining score was increased 1 week after surgery in both groups compared with that before surgery,with statistical significance(both P<0.05);there was no significant difference between 1 month and 6 months after operation and before operation(all P>0.05).TMH in FS-LASIK group decreased 1 week,1 month and 6 months after surgery compared with that before surgery,with statistically significant differences(all P<0.05),and the decline was most significant at 1 week after surgery.TMH of SMILE group also decreased 1 week and 1 month after surgery compared with that before surgery(both P<0.05).NIKBUT in FS-LASIK group decreased 1 week,1 month and 6 months after surgery compared with that before surgery,with statistically significant differences(all P<0.05),and the decline was the most significant one week after surgery.NIKBUT of SMILE group decreased 1 week,1 month and 6 months after surgery compared with that before surgery,and the differences were statistically significant(all P<0.05).Compared with NIKBUT at 1 week,1 month and 6 months after surgery,there were statistically significant differences between the two groups(all P<0.05),and the FS-LASIK group was lower than SMILE group.The lipid layer thickness in FS-LASIK group decreased 1 week,1 month and 6 months after surgery,with statistical significance(all P<0.05),while the SMILE group also decreased 1 week and 1 month after surgery compared with that before surgery,with statistical significance(all P<0.05).There were no statistical differences in the meibomian gland function evaluation score in 2 groups 1 week,1 month and 6 months after surgery compared with that before surgery(all P>0.05).The HI in FS-LASIK group and SMILE group at 1 week after surgery was higher than that before surgery,and the differences were statistically significant(both P<0.05).One week after surgery,there was a statistically significant difference in HI between the two groups(P<0.05),and the FS-LASIK group was higher than SMILE group.Conclusion Both FS-LASIK and SMILE had different degrees of influence on ocular surface,but the postoperative influence of FS-LASIK group on ocular surface is more obvious than that of SMILE group,and the effect lasts longer.