飞秒激光角膜屈光手术后的泪膜变化

The changes of tear film after femtosecond laser assisted LASIK surgery

目的分析飞秒激光制瓣准分子激光原位角膜磨镶术(LASIK)后泪液分泌、泪膜变化及与干眼的关系。设计回顾性病例系列。研究对象2011年3月-6月在宁波市眼科医院施行飞秒激光LASIK手术的120例(235眼)近视患者。方法用In-tralse飞秒激光制作蒂位于上方的角膜瓣后行常规LASIK术。术后次日开始予左氧氟沙星滴眼液每日4次滴眼,1周后停药,0.1%艾氟龙(FML)滴眼液,第一周每日4次,以后每周逐减一次,至1个月停药。对手术患者分别用角膜荧光素染色检查、泪膜破裂时间(BUT)、泪液分泌试验来测定患者术前,术后10天,1、3、6个月的泪膜变化情况。主要指标角膜荧光素染色、BUT、泪液分泌值。结果 BUT值:术前(15.00±2.56)s,术后10天,1、3、6个月分别为(8.51±3.22)s,(11.40±2.71)s,(14.29±3.46)s,(14.84±3.01)s。泪液分泌试验:术前(16.23±3.48)mm,术后10天,1、3、6个月分别为(9.86±3.13)mm,(13.46±2.72)mm,(15.18±3.02)mm,(16.11±2.84)mm。此二种测试结果,术后10天,1、3个月分别与术前比较,差异均有统计学意义(P均<0.05),术后6个月与术前比较,差异无统计学意义(P=0.22)。结论飞秒激光制瓣准分子激光原位角膜磨镶术,术后早期可致泪膜稳定性下降,泪液分泌减少,术后3个月开始泪液分泌功能和泪膜稳定性逐渐恢复,术后6个月泪膜情况已趋稳定。

Objective To analyze the change of tear film after femtosecond laser assisted LASIK surgery. Design Retrospective case series. Participants The 120 myopic patients （235 eyes） who underwent femtosecond laser surgery from March to June 2011 in Ningbo Ophthalmic Hospital Myopia Laser Center. Methods The Intralse femtosecond laser was used to produce the corneal flap with an above root. The routine excimer LASIK was performed. The Levofioxacin eye drops were used 4 times/day, beginning from post surgery 1st day and stopping at one week post surgery. The 0.1% fluorometholone eye drops were used post surgery, 4 times a day at the first week, 3 times a day at the second week, twice a day at the third week and once a day at the fourth week and then stopped. The tear film break-up-time （BUT） and Schirmer I test were performed in all patients before surgery, and at post surgery 10th day, 1st, 3rd, 6th month, to observe the tear film changes after surgery. Main Outcome Measures BUT, Schirmer I test results. Results At pre-operation, the BUT was （15.00±2.56）s. At post surgery 10th day, the 1st month , the 3rd month and the 6th month, the value of BUT was 8.51±3.22 s, 11.4±2.71 s, 14.29±3.46 s and 14.84±3.01 s, respectively. The corresponding Value of Schirmer I test was 16.23± 3.48 mm, 9.86±3.13 mm, 13.46±2.72 mm, 15.18±3.02 mm and 16.11±2.84 mm, respectively. At the 10th day, the 1st month and the 3rd month after surgery, these two results were statistically significantly different compared to preoperations＇（all P〈0.05）; but at the 6th month, the difference was not significant （P=0.22）. Conclusion Femtosecond laser assisted LASIK, at early period postoperatively, lead to an tear film unstability and tear secretion reduction, which created the feeling of dry eye in patients. But the tear secretion and tear film stability gradually restored at 3rd month after surgery. After 6th month, the tear recovered completely and became stabilized again.