两种角膜屈光手术方式手术前后泪液功能变化的比较

Comparison of non-invasive tear function changes in two corneal refractive surgery

目的比较不同角膜屈光手术方式对泪液功能指标的影响。设计回顾性比较性病例系列。研究对象 42例接受角膜屈光手术并随访6个月的近视患者,其中LASIK组20例,前弹力层下角膜磨镶术(SBK)组22例。方法对两组患者分别于术前,术后10天,1、3和6个月用Oculus眼表综合分析仪行非侵入性首次泪膜破裂时间(NIBUT_f)、非侵入性平均泪膜破裂时间(NIBUT_a)、下泪河高度(LTMH)检查,均取右眼资料进行分析,比较两组间不同时间各指标差异,及组内不同时间各指标差异。主要指标NIBUT_f、NIBUT_a、LTMH。结果两组NIBUT_f和LTMH在各个时间点均无统计学差异(P均>0.05);术后3个月SBK组NIBUT_a比LASIK组升高(P=0.02),其余时间点均无统计学差异(P均>0.05)。LASIK组NIBUT_f术后1、3个月与术前相比降低(P均<0.05),与术后10天、术后6个月比较无明显差异(P均>0.05);NIBUT_a、LTMH术后各时间点比术前均降低,但差异均无统计学意义(P均>0.05)。SBK组NIBUT_f术后10天,1、3个月与术前相比均降低(P均<0.05),术后6个月与术前相比降低,但无统计学差异(P=0.14);NIBUT_a术后10天比术前降低(P=0.04),术后1、3个月比术前降低,但无统计学差异(P均>0.05);LTMH术前与术后各时间点差异均无统计学意义(P均>0.05)。结论两种角膜屈光手术术后早期NIBUT_f和NIBUT_a均较术前降低,术后6个月恢复至术前水平。术后3个月SBK组NIBUT_a比LASIK组升高,SBK组比LASIK组泪膜功能恢复快。

Objective To analyze the influence of different corneal refractive surgical methods on non-invasive tear function indicators. Design Retrospective comparative case series. Participants 42 cases（ 42 eyes） who underwent corneal refractive surgery and followed-up for at least 6 months. There were 20 patients（ 20 eyes） in LASIK group and 22 patients（ 22 eyes） in SBK group. Methods Non-invasive first tear film break-up time（ NIBUTf）,non-invasive average tear film break-up time（ NIBUTa） and lower tear meniscus height（ LTMH） were assessed pre-and post-operative 10 days,1 month,3 months,6 months using oculus keratograph. The right eye data were analyzed for comparison between the two groups. Main Outcome Measures NIBUTf,NIBUTa and LTMH. Results There was no significant difference of NIBUTf and LTMH between the two groups at all time points（ all P 0. 05）. Compared to LASIK group,the NIBUTa was elevated at postoperative 3 months in SBK group（ P = 0. 02）. For LASIK group,compared to preoperative value,postoperative NIBUTf decreased at 1 month and 3 months（ all P 0. 05）,but not at 10 days,and 6 months（ both P 0. 05）; both NIBUTaand LTMH value reduced at postoperative time points,but the differences were not statistically significant（ all P 0. 05）. For SBK group,compared to preoperative value,NIBUTf decreased at postoperative 10 days,1 month,3 months（ all P 0. 05）,but recovered at 6 months after surgery（ P = 0. 14）; NIBUTa decreased at postoperative 10 days（ P = 0. 04）,but not at 1 month and 3 months（ both P 0. 05）. There was no statistical difference of LTMH at every postoperative time point compared to preoperative value（ all P 0. 05）. Conclusion Compared to preoperative value,NIBUTf and NIBUTa temporally decreased after LASIK and SBK,recovered to preoperative level at postoperative 6 months. Compared to LASIK,the NIBUTa was higher at postoperative 3 months in SBK group. The tear film function restored faster in SBK than LASIK group.