口服维生素D_(3)治疗飞秒激光辅助LASIK术后干眼

Efficacy of Oral Vitamin D_(3)Supplementation for Dry Eye after Femtosecond Laser-Assisted LASIK

目的:探讨口服维生素D_(3)对飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)后干眼的治疗效果。方法:前瞻性临床研究。选择2019年1─12月在柳州市工人医院接受FS-LASIK且术后1个月有明显干眼的患者90例(90眼)。所有患者被随机分为2组:研究组45例(45眼),连续12周服用维生素D_(3)2000 IU/d;对照组45例(45眼),不口服任何药物。分别在用药前及用药后第1、3、6个月测定患者的眼表疾病指数(OSDI)、泪液破裂时间(TBUT)、SchirmerⅠ试验、泪河高度,血清维生素D_(3)水平以及对比敏感度情况。采用Kolmogorov-Smirnov、LSD-t检验和独立样本t检验进行统计分析。结果:服药后1个月,研究组OSDI评分均值明显低于对照组,差异有统计学意义(t=4.32,P=0.007)。研究组的TBUT(t=3.02,P=0.027)和SchirmerⅠ试验值(t=2.78,P=0.030)均高于对照组。服药后3个月,研究组OSDI(t=2.50,P=0.010)、TBUT(t=2.32,P=0.031)和SchirmerⅠ试验值(t=3.25,P=0.026)均优于对照组,差异均具有统计学意义。服药后6个月,2组患者OSDI(t=2.31,P=0.025)、TBUT(t=2.30,P=0.039)和SchirmerⅠ试验值(t=3.03,P=0.028)差异均具有统计学意义,研究组恢复更好。研究组患者血清维生素D_(3)水平与OSDI评分呈负相关(r=-0.90,P<0.001),与SchirmerⅠ试验值(r=0.88,P<0.001)、TBUT评分(r=0.89,P<0.001)和TMH(r=0.80,P<0.001)呈正相关。服药后6个月时,研究组患者的明视对比敏感度和暗视对比敏感度均优于对照组(3 cpd:t=2.40,P=0.04;6 cpd:t=2.16,P=0.04;12 cpd:t=2.23,P=0.04;18 cpd:t=2.37,P=0.04)。结论:维生素D_(3)不仅改善了术后干眼症状及泪膜稳定性,而且可以改善FS-LASIK术后的视觉质量。

Objective:To assess the effect of oral vitamin D_(3)supplementation for dry eye after femtosecond laser-assisted LASIK(FS-LASIK).Methods:In this prospective study,90 patients who underwent FS-LASIK surgery in Liuzhou Workers'Hospital from January to December 2019 and who had obvious dry eyes one month after the operation were selected.The subjects were randomly divided into two groups:An experimental group(n=45)that received vitamin D_(3)2000 IU/d continuously for 12 weeks after the operation and a control group(n=45)that did not take vitamin D_(3)orally.The ocular surface disease index(OSDI),tear break up time(TBUT)and ShirmerⅠtest were used to evaluate patients preoperatively and 1,3 and 6 months after treatment.Serum vitamin D level was also measured.Kolmogorov-Smirnov,LSD-t test and independent sample t test were used for statistics analysis.Results:One month after treatment,the mean OSDI score of the experimental group was significantly lower than that of the control group(t=4.32,P=0.007).TBUT and SchirmerⅠof the experimental group were higher than those of the control group.The OSDI(t=2.50,P=0.010),TBUT(t=2.32,P=0.031)and SchirmerⅠtest values(t=3.25,P=0.026)of the experimental group were significantly lower than those of the control group at 3 months after treatment.There were significant differences in OSDI(t=2.31,P=0.025),TBUT(t=2.30,P=0.039)and SchirmerⅠtest values(t=3.03,P=0.028)between the two groups at 6 months after treatment.Serum vitamin D_(3)level was negatively correlated with the OSDI score(r=-0.90,P<0.001),and positively correlated with the SchirmerⅠtest(r=0.88,P<0.001),TBUT score(r=0.89,P<0.001)and TMH(r=0.80,P<0.001).Conclusions:Vitamin D_(3)has positive effects on post-LASIK dry eye symptoms,tear quality and the ocular surface condition.Vitamin D_(3)also improved visual quality after FS-LASIK.