Keratograph 5M眼表综合分析仪观察飞秒激光制瓣LASIK手术对泪膜和睑板腺的影响

Effects of femtosecond laser LASIK on tear film and meibomian gland observed by Keratograph 5M

目的使用Keratograph 5M眼表综合分析仪观察准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)对泪膜和睑板腺的影响。方法选取近视眼患者65例(130眼),均行飞秒激光制瓣LASIK手术。于LASIK术前及术后1周、1个月、6个月检查患者,检查项目包括:干眼症状评分、泪膜破裂时间(tear break up time,TBUT)、角膜荧光素钠染色,采用Keratograph 5M眼表综合分析仪检查非侵入性泪膜破裂时间(non-invasive breakup time,NITBUT)、非侵入性泪河高度(non-invasive tear meniscus height,NITMH)。睑板腺检查项目有睑缘评分,采用Keratograph 5M眼表综合分析仪检查脂质层厚度分级,睑板腺现存面积比。分析TBUT、NITBUT(f)(首次)和NITBUT(av)(平均)之间的相关性。结果与术前相比,术后1周、1个月干眼症状评分均升高(均为P<0.05);术后1周、1个月TBUT分别为(7.00±2.17)s、(7.21±2.15)s,与术前(15.00±5.01)s相比,差异均有统计学意义(均为P<0.05);术后1周、1个月NITBUT(f)分别为(5.48±2.08)s、(5.63±1.92)s,与术前(11.44±5.00)s相比,差异均有统计学意义(均为P<0.05);术后1周、1个月NITBUT(av)分别为(9.04±2.80)s、(8.94±2.46)s,较术前(13.79±4.00)s缩短(均为P<0.05);角膜荧光素钠染色评分和NITMH结果与术前比较,差异均无统计学意义(均为P>0.05);术后1周、1个月睑板腺脂质层厚度较术前变薄,差异均有统计学意义(均为P<0.05);睑缘评分及睑板腺现存面积比与术前比较,差异均无统计学意义(均为P>0.05)。术后6个月各项检查结果与术前相比差异均无统计学意义(均为P>0.05)。术后各时间所测NITBUT(f)比NITBUT(av)短。NITBUT(f)与NITBUT(av)、NITBUT(f)与TBUT、NITBUT(av)与TBUT均呈正相关性(r=0.65,P<0.001;r=0.36,P=0.025;r=0.38,P=0.028)。结论 Keratograph 5M眼表综合分析仪作为非侵入性检测仪器可以快速、客观地评估泪膜的功能和睑板腺的状态,为干眼的诊断以及睑板腺功能的评估提供了参考依据。LASIK术后患者短期内会发生干眼或原有干眼不同程度加重,但术后0.5 a大部分患者的TBUT和泪河高度可恢复到术前水平,且未观察到LASIK手术对睑板腺的不良影响。

Objective To observe the effects of femtosecond laser LASIK surgery on tear film and meibomian gland using Keratograph 5 M. Methods Sixty-five myopia patients（ 130 eyes） underwent femtosecond laser LASIK were recruited. A series of examinations,including dry eye symptom assessment,tear break-up time（ TBUT）,corneal fluorescein staining,non-invasive tear break-up time（ NITBUT）,non-invasive tear meniscus height（ NITMH）,lipid layer thickness grading,the ratio of meibomian gland exist area to the total area（ %）,were measured at pre-operation and 1 week,1 month,6 months postoperatively by Keratograph 5 M. Then,the correlations among the TBUT,NITBUT（ f） and NITBUT（ av） were analyzed. R esults At 1 week and 1 month postoperatively,the dry eye symptom assessment score increased（ all P 〈0. 0 5）; TBUT were（ 7. 0 0 ± 2. 1 7） s,（ 7.2 1 ± 2. 1 5） s,respectively,there were statistical differences compared with pre-operation（ 15. 00 ± 5. 01） s（ all P 〈0. 05）; NITBUT（ f） were（ 5. 48 ± 2. 08） s,（ 5. 63 ± 1. 92）s,respectively,there were statistical differences compared with pre-operation（ 1 1. 4 4 ± 5.0 0） s（ all P 〈0. 0 5）; NITBUT（ av） were（ 9. 0 4 ± 2. 8 0） s,（ 8. 9 4 ± 2. 4 6） s,respectively,there were statistical differences compared with pre-operation（ 1 3. 7 9 ± 4. 0 0） s（ all P 〈0. 05）; There was no significant difference in corneal fluorescein staining and Nl TMH（ all P 〈0. 0 5）; Compared with pre-operation,the meibomian gland lipid layer thickness decreased（ all P 〈0. 0 5）,there was no significant difference in limbus observed score examination and the ratio of meibomian gland exist area to the total area（ all P 〈0. 0 5）. There was no significant difference at 6 months postoperatively in all examinations compared with pre-operation（ all P 〈0. 0 5）. The positive correlation was found between NITBUT（ f） and NITBUT（ av）,NITBUT（ f） and TBUT,NITBUT（ av） and TBUT（ r = 0. 65,P 〈0. 001; r = 0. 36,P = 0. 025; r = 0. 38,P = 0. 028）. Conclusion As noninvasive ocular analyzer,Keratograph 5 Mcan evaluate function of the tear film and meibomian gland status quickly and objectively,it can provide a reference for the diagnosis of dry eye and meibomian gland function assessment. While LASIK has adverse effect on the stability and secretion of tear in short term postoperatively,but has no significant effect on meibomian gland. TBUT and tear meniscus height can be restored within 6 months postoperatively.