两种飞秒激光LASIK术后泪液功能的变化

Comparison of tear function following laser in situ keratomileusis with two femtosecond laser platforms

目的:评估两种不同的飞秒激光制瓣准分子原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后患者在泪液功能和角膜染色方面的变化。方法:患者40眼行FS200飞秒激光制瓣LASIK手术,40眼行VisuMax飞秒激光制瓣LASIK手术。观察术前及术后1wk;1,3mo的泪膜破裂时间(tear film break-up time,TBUT)、基础泪液分泌试验(SchirmerⅠtest,SⅠt)以及角膜荧光素染色(fluorescent,FL)检查。多个时间点的比较采用重复测量设计的方差分析或Kruskal—Wallis秩和检验,两组间的比较采用两独立样本t检验或Wilcoxon符号秩和检验。结果:FS200组术后的TBUT有较VisuMax组更少的趋势,但两组间的各项观察指标均没有统计学意义的差别。术后各时间点两组的TBUT值均低于术前(F=100.37,P<0.01;F=112.25,P<0.01)。两组在术后各时间点SⅠt明显低于术前(F=42.15,P<0.01;F=37.27,P<0.01)。术后1wk时FS200的FL(Z=4.28,P<0.01)和VisuMax组(Z=4.83,P<0.01)均较术前增多,但在1mo时恢复到术前水平。结论:研究表明两种飞秒激光制瓣ASIK术后的TBUT、SⅠt以及FL的变化一致,但是VisuMax飞秒制瓣LASIK术后的TBUT有比FS200飞秒制瓣LASIK手术更快恢复的趋势。

AIM： To evaluate changes in tear function and corneal staining in patients who underwent laser in situ keratomileusis （ LASIK ） using two different femtosecond lasers. METHODS：Forty eyes underwent FS200 and 40 eyes underwent VisuMax. The tear film break - up time （TBUT）, Schirmer I test （SⅠt） and fluorescein staining were assessed preoperatively at 1wk; 1 and 3mo postoperatively. The analysis of variance （ ANOVA ） for repeat measurements or Kruskal-Wallis ranks test were used. For the differences between FS200 and VisuMax-operated eyes, a independent-samples t test or Wilcoxon matched-samples rank sum test were used. RESULTS： There were no statistical differences in any clinical outcome measure between the two kinds of lasers （P〈0. 05）, although there was a trend towards slightly reductions for TBUT in FS200-operated eyes. TBUT of the two groups eyes showed the same reductions （F=100. 37, P〈0. 01;F=112. 25, P〈0. 01） when compared preoperative levels to 1wk; 1 and 3mo postoperatively levels. Moreover, there were obvious decreases of the SchirmerⅠtest were observed on any visit after the operation for both groups （F= 42. 15, P〈0. 01; F= 37. 27, P〈0. 01）. Furthermore, corneal staining was significantly increased＆amp;nbsp;at 1wk postoperatively （ FS200 Z=4. 88, P〈0. 01; VisuMax Z=4. 28, P〈0. 01） after LASIK compared to preoperative conditions, and recovered to the level of preoperative at 1mo postoperatively. CONCLUSION：This study shows that changes in TBUT, Schirmer I test and corneal staining are statistically similar in LASIK using FS200 and VisuMax femtosecond lasers for flap creation. However, the VisuMax-operated eyes of TBUT after LASIK have faster recovery than in FS200 eyes.