飞秒激光和板层刀制瓣准分子激光原位角膜磨镶术对泪膜稳定性的影响

Effect of femtosecond laser created flaps and mechanical microkeratome flap in laser in situ keratom- ileusis on tear film stability

目的探讨飞秒激光和角膜板层刀制作角膜瓣的准分子激光原位角膜磨镶术（LASIK）术前术后半年内泪膜稳定性的变化情况及对比分析。方法78例（156只眼）接受LASIK矫正近视者，依受术者要求分为飞秒组和板层刀组，分别观察两组术前、术后不同时间段的主观症状、泪液分泌实验、角膜荧光素染色评分和泪膜破裂时间（BUT）。结果两组泪液分泌量在术后3个月内，差异有统计学意义（t=3．125，P〈0．05），术后6个月差异无统计学意义（t=0．014，P〉0．05）。两组BUT比较，术后3个月内差异有统计学意义（t=0．579，P〈0．05），术后6个月BUT差异无统计学意义（t=0．310，P〉0．05）。角膜荧光素染色，术后1个月内两组差异有统计学意义（t=0．741，P〈0．05），术后3个月、6个月差异无统计学意义（t=0．017，P〉0．05）。结论两组术后早期泪膜稳定性均下降。飞秒组术后干眼症状轻，恢复快。两组术后短期内出现的干眼多在6个月时恢复正常。

Objective To compare the changes of tear film stability between femtosecond laser cre- ated flap and mechanical microkeratome corneal flap in excimer laser in situ keratomileusis （LASIK） before and after operation. Methods Seventy-eight cases of correctional myopia （ 156 eyes） were randomly divid- ed into two groups： femtosecond laser created flap group and mechanical microkeratome created flap group. The preoperative, postoperative subjective symptoms, Schirmer test, corneal fluorescein staining scores and BUT in two groups were observed. Results The tear secretion volume of two groups were compared at 3 months after the operation, the difference had statistical significance （ t = 3. 125, P 〈 0.05 ）, the result at 6 months after the operation had no statistical significance （ t = 0. 014, P 〉 0.05 ）. About the comparision of the BUT between these two groups, the result at 3 months after the operation had statistical significance （ t = 0. 579, P 〈0.05）, the difference had no statistical significance after 6 months （t =0. 310,P 〉0.05）. A- bout the corneal tluorescein staining, the difference at 1 months after the operation had statistial significance （ t = 0. 741, P 〈 0. 05 ）, it had no statistical significance at 3 months （ t = 0. 017, P 〉 0. 05 ）. Conclusion The early stability of tear film decrease after operation in both of the two groups. The dry eye symptoms are lighter and recove faster in the femtosecond laser flap group. The dry eye symptoms can be restored to normal about at 6 months after the operation in both two groups.