角膜瓣蒂部位置对LASIK术后角膜知觉和泪膜的影响

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

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。

Objective To evaluate the differences on corneal sensation and the day eye syndrome after laser in situ keratomileusis（LASIK） with superior- or temporal-hinge corneal flap. Methods One hundred and ninety-four petients （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 day eye, fluorescein staining （F1）, rose bengal staining（Rb）, break-up time（BUT）, Schinner＇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 FI 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）.Tne difference on Schinner＇s I test between two groups was significant at 1 day, 1 week, 1 month after LASIK （P〈0.01）. The difference on the comeal have some effects on corneal sensation and file ＆y eye syndrome.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 day eye syndrome.