术前配戴软性角膜接触镜对激光原位角膜磨削术后泪膜稳定性的影响

Effects of preoperative soft contact lenswear on tear film stability after laser in situ keratomileusis

目的观察术前配戴软性角膜接触镜与未戴镜患者行激光原位角膜磨削术（LASIK）后泪膜相关指标的差异。方法92例（183眼）近视眼患者在我院行LASIK于术，其中术前配戴角膜接触镜者37例（74眼）为A组，冉根据戴镜时间分为3组，未戴镜者55例（109眼）为B组，分别观察术前，术后1个月、2个月、3个月、6个月、12个月的干眼症状、角膜荧光染色、泪膜破裂时间、泪膜分泌量，两组数据对比并进行统计学分析。结果术前、术后1个月、2个月、3个月、6个月、12个月两组泪膜相关指标均存在差异；戴镜组术后1个月、2个月、3个月、6个月干眼症状、角膜荧光染色、泪膜破裂时间与术前相比均有显著差异。术后12个月恢复至术前水平，术后1个月、2个月、3个月泪液分泌量较术前减少，术后6个月恢复至术前水平；非戴镜组术后1个月、2个月干眼症状、角膜荧光染色、泪膜破裂时间及泪液分泌量与术前相比存在差异，术后3个月恢复至术前水平。戴镜组3组对比，术前术后各组泪膜破裂时间及渭液分泌量亦有差异，并且与戴镜时间呈负相关。结论术前配戴软性角膜接触镜可加重LASIK术后泪膜不稳定，戴镜时间与泪膜相关指标呈负相关，术前术岳应积极预防、治疗，以确保手术疗效。

Objective To observe the difference in tear film stability after LASIK between patients wearing and not wearing soft contact lens preoperatively. Methods 92 myopia patients（ 183 eyes）undergoing LASIK were divided into two groups. Group A consisted of 37 patients （74 eyes）wearing soft contact lens preoperatively, and group B included 55 patients （ 109 eyes） not wearing. Group A was divided into three subgroups depending on how long they had worn soft contact lens. Those eyes were all observed for symptoms of eye dryness, epithelial defect, tear break - up time （BUT） and Schirmer＇s test 1 preoperatively and 1 ,2,3,6, and 12 months postoperatively. Results There were significant differences between the two groups in all the tear film indexes at any time point. In group A, marked decrease in eye dryness, epithelial defect and BUT at 1,2,3,and 6 months postoperatively relative to the preoperative level, and the symptoms returned to the preoperative level at 12 months postoperatively. There were Group A showed marked decreases in Schirmer＇ s test 1 at 1,2,and 3 months postoperatively relative to the preoperative level, and return to the preoperative level at 6 months postoperatively. In group B, there were obviously decreases in eye dryness, epithelial defect, BUT and Schirmer＇ s test 1 at 1, and 2 months postoperatively relative to the preoperative level, and return to the preoperative level at 3 months postoperatively. Conclusions Preoperative soft contact lens wearing aggravates the tear film instability after LASIK, and the longer wearing, the worse.