LASIK术后角膜知觉的变化及干眼的发生(英文)

Corneal sensitivity and dry eye after LASIK

目的:探讨准分子激光原位角膜磨镶术(LASIK)后角膜知觉的变化及其对干眼的影响与切削深度的关系。方法:观察上方蒂做瓣的LASIK手术30例(60眼),观察指标包括患者术中切削深度及术前,术后1wk,1mo,3mo的角膜中央知觉、基础泪液分泌量、泪膜破裂时间(BUT)、角膜荧光素钠染色评分、干眼主觉症状评分。结果:术后1wk,1mo角膜知觉敏感度与术前相比差异均非常显著(P<0.01),术后3mo平与术前相比差异无统计学意义(P>0.05);术后1wk患者的主觉症状与术前相比无显著差异(P=0.079>0.05),术后mo时差异显著(P=0.025<0.05),术后3mo时差异极其显著(P=0.001<0.01);患者术后泪流量在术后1wk;1mo时明显低于术前(P<0.01),直至术后3mo仍未恢复至术前水平(P<0.01);术后1wk,1mo,3mo泪膜破裂时间缩短,术后3mo时与术前相比差异显著(P<0.01);角膜荧光素钠染色评分方面,术后1mo时角膜上皮损伤最明显,术后3mo时与术前仍有显著差异(P<0.01)直线回归与相关分析结果,说明在两者之间存在直线相关的关系r=0.798,P<0.01。结论:LASIK术后角膜中央知觉明显下降并随时间延续而逐渐恢复,3mo时与术前无统计学差异;但是干眼的相关指标并未随之恢复至术前水平;术后角膜知觉的下降与术中切削深度间存在正相关。

AIM. Firstly to evaluate the changes of corneal sensation and its effect to dry eye syndrome after laser in situ keratomileusis （LASIK）; secondly to evaluate the relation between the changes of corneal sensation and the laser ablation depth. METHODS.. 30 patients （60 eyes） had bilateral LASIK with a superior-hinged flap. Every patient underwent preoperative and postoperative （after one week, one month and three months） evaluations, including corneal sensation, Schirmer＇s basic tear secretion test, tear breakup time （TBUT）, corneal fluorescein stainting, and a questionnaire evaluating dry eye obtained from each patient. RESULTS： Compared with preoperative level, after one week and one month, the difference of corneal sensation was very significant （ P〈 0.01 ） ; after three months, there was no statistical difference （ P 〉 0.05）. After one week, there was no statistical difference （P 〉 0. 05） in the subjective dry eye symptoms, after one month, the difference was significant（ P= 0. 025 〈 0.05） and after three months, the difference was very significant （ P = 0. 001 〈 0.01）. Compared with preoperative level, the basic tear secretion decreased significantly after one week and one month（P 〈 0.01 ）, it did not return to the baseline level after three months （ P 〈 0. 01 ）. Tear breakup time decreased significantly after the surgery, and after three months, there was still statistical difference compared with preoperative level （ P 〈 0. 01 ）; with cornea fluorescence staining, we found corneal epithelial defect was most serious after one month after LASIK, and did not return to the baseline level after three months （ P 〈 0. 01）. Linear regression analysis and relevant were used to evaluate the relation between the changes of corneal sensation and the laser ablation depth（ r=0.798,P〈0.01 ）. CONCLUSION： The central corneal sesation decreased noticeable after LASIK, and it recovered three months postoperatively, but the indicators of dry eye syndrome did not return to their preoperative levels following it. We have found that the decreasation of corneal sensation had positive correlation with the laser ablation depth.