SMILE术中第二术眼不同保护措施泪膜稳定性的对比研究

Comparative study of the effects of different protective measures of the non-operative eye during SMILE surgery on tear film stability

目的通过应用Keratograph 5M眼表综合分析仪对飞秒激光小切口角膜基质透镜取出手术(SMILE)术中第二术眼不同保护措施的首次泪膜破裂时间(NIKBUTf)和平均泪膜破裂时间(NIKBUTav)变化情况进行对比研究,观察不同保护措施对泪膜稳定性的影响。方法选取2019年6月至2019年11月在重庆眼视光眼科医院行SMILE手术的患者作为研究对象。患者左眼为观察眼,SMILE术中在右眼行手术时,左眼按照不同处理方法分为3组,分别给予小牛血去蛋白眼用凝胶点眼、使用眼罩,以及空白对照。并分别在右眼手术前后,使用Keratograph 5M眼表综合分析仪,完成左眼NIKBUTf和NIKBUTav检测,进行对比研究。采用SPSS 25.0进行统计学分析。结果共35例患者(35左眼)纳入研究,其中小牛血去蛋白眼用凝胶组12例,眼罩组11例,空白对照组12例。重复测量方差分析NIKBUTf和NIKBUTav均存在时间效应和分组效应,且时间与分组存在交互作用(P<0.05)。凝胶组左眼NIKBUTf在右眼手术前和右眼手术后即刻无统计学差异(P>0.05),凝胶组左眼NIKBUTav在右眼SMILE手术后即刻较右眼手术前延长(P<0.05)。眼罩组和对照组(空白)左眼NIKBUTf和NIKBUTav在右眼手术后即刻均缩短(P<0.05)。对照组NIKBUTf和NIKBUTav缩短最明显(P<0.05)。结论不同保护措施和时间变化均对NIKBUTf和NIKBUTav产生了影响,小牛血去蛋白提取物眼用凝胶应用于SMILE术中第二术眼的保护措施起到了保护泪膜稳定性的作用。眼罩对第二术眼的泪膜保护作用并不明显,常规手术操作对第二术眼无保护措施的情况下泪膜稳定性最差。

Objective To observe the changes in the first non-invasive keratograph tear break-up time(NIKBUTf) and average non-invasive keratograph tear break-up time(NIKBUTav) of the non-operative eye with different protective measures during small incision lenticule extraction(SMILE) using the Keratograph 5 M ocular surface analyzer and to observe the effects of different protective measures on tear film stability. Methods A prospective cohort study was conducted. From September 2019 to November 2019, patients who underwent SMILE in the Chongqing Vision Institute were included. The left eye was the observation eye. During SMILE of the right eye, the left eye was protected using deproteinized calf blood eye gel or eyeshade. The control group did not receive protective measures. The NIKBUTf and NIKBUTav of the left eye were measured using the Keratograph 5 M ocular surface analyzer before and after the surgery of the right eye. SPSS 25.0 was used for statistical analysis. Results Thirty-five patients accounting for 35 left eyes were included in the study, of which 12 were allocated to the gel group, 11 to the eyeshade group, and 12 to the blank control group. Per the results of repeated-measurement analysis of variance, the variations in the NIKBUTf and NIKBUTav were significant in each group regarding time and grouping(P<0.05). These two parameters also showed an interaction between time and grouping(P<0.05). There was no significant difference in the left eye NIKBUTf of the gel group before and after surgery of the right eye(P>0.05). The NIKBUTav of the left eye in the gel group was longer immediately after surgery of the right eye(P<0.05). In the eyeshade and blank control groups, both the NIKBUTf and NIKBUTav in the left eye decreased immediately after surgery of the right eye(P<0.05). In the control group, the reductions in the NIKBUTf and NIKBUTav were the most significant(P<0.05). Conclusion Different protective measures and time changes had an impact on the NIKBUTf and NIKBUTav. The protective measure of deproteinized calf blood eye gel in the non-operative eyes during SMILE played a protective role in the stability of the tear film. The protective effect of eyeshade on the tear film of the non-operative eye was not obvious, and the stability of the tear film was the worst during the conventional surgery with no protective measures for the non-operative eye.