LASIK术后发生慢性干眼的潜在机制和其术前的临床特点

Preoperative characteristics and a potential mechanism of chronic dry eye after LASIK

目的:判定LASIK术后发生慢性干眼是否与术前的临床表现有关。方法:LASIK术后患者24例24眼。评估术后1/4,3,9mo泪膜破裂时间、有/无表面麻醉下的泪液分泌试验、孟加拉玫瑰红染色、中心角膜敏感度、结膜非杯状核质比率和杯状细胞密度。患者分为:非干眼组(nonary-eye group,NDEG)和慢性干眼组(chronicdry-eye group,CDEG)(基于术后9mo的眼表状况)。分析术前每一项参数检查与术后发生慢性干眼的关系。结果:所有参数(玫瑰红染色除外)术后均明显下降但术后3～9mo内恢复到术前水平。CDEG组术前泪液分泌试验值(有/无表面麻醉)明显降低,且术后杯状细胞比率、玫瑰红染色、无表面麻醉泪液分泌试验值和泪膜破裂的恢复时间延迟。术前无表面麻醉泪液分泌试验值与术后9mo泪膜破裂时间呈正相关。结论:术前的泪液量可能影响LASIK的眼表面的恢复且可能增加发生慢性干眼的危险。

AIM： To determine whether measurable preoperative characteristics predispose patients to chronic dry eye after laser in situ keratomileusis （LASlK）. METHODS. The study consisted of 24 eyes of 24 patients who underwent LASlK. Tear breakup time, Schirmer testing with and without anesthesia, rose bengal staining, central corneal sensitivity, nucleus-to-cytoplasmic ratio, and goblet cell density were evaluated 2 weeks before and 1 week, 3 and 9 months after surgery. Patients were classified into two outcome groups, the no dry-eye group （NDEG） and the chronic dry-eye group （CDEG）, on the basis of dry eye status 9 months after surgery, The authors tested whether preoperative values of each parameter were associated with the development of chronic dry eye. RESULTS： All parameters, except rose bengal staining, deteriorated significantly after surgery but returned to preoperative levels within 3 to 9 months. The CDEG became significantly lower. Preoperative Schirmer test values with and without anesthesia and were delayed in recovery after surgery in goblet cell density raised bengal staining, Schirmer test values without anesthesia, and tear breakup time. Results of preoperative Schirmer tests without anesthesia positively correlated with tear breakup time 9 months after surgery. CONCLUSION. Preoperative tear volume may affect recovery of the ocular surface after LASIK and may increase the risk for chronic dry eye.