FS-LASIK和T-PRK与SMILE术后干眼参数的变化

Comparative study on dry eyes after FS-LASIK, T-PRK and SMILE operations

摘要:

目的：应用眼表综合分析仪研究飞秒激光辅助的准分子激光原位角膜磨镶术(femtosecond laser-assisted laser in situ keratomileusis，FS-LASIK)、经上皮准分子激光角膜切削术(transepithelial photorefractive keratectomy，T-PRK)和全飞秒小切口透镜取出术(small incision lenticule extraction，SMILE)后干眼症状和体征的变化。

方法：收集2017-01/05在我院行角膜屈光手术患者98例196眼，按术式分三组：FS-LASIK组、T-PRK组和SMILE组。所有患者术前和术后1wk，1、3、6mo均行以下检查：眼表疾病指数(ocular suface disease index，OSDI)问卷、眼表综合分析仪红外线下泪河高度测量(tear meniscus height，TMH)、红外线首次泪膜破裂时间(the first tear film break-up time，FBUT)和平均泪膜破裂时间(average tear film break-up time，ABUT)测量、角膜荧光素染色(comeal fluorescence staining，FL)、基础泪液分泌试验Ⅰ(Schirmer Ⅰ test，SⅠt)。

结果：(1)OSDI指数：三组患者间术后OSDI差异有统计学意义(F_组间=2.799，P_组间<0.05)。但各组不同时间点的OSDI值差异具有统计学意义(F_时间=85.942，P_时间<0.001)。各组患者OSDI指数术后1wk，1、3mo时较术前明显增加，术后6mo各组患者均恢复到术前水平。术后3mo时，各组患者OSDI值差异有统计学意义(P=0.019)，其中T-PRK组的OSDI值较其它两组高。(2)TMH：三组患者间术后TMH差异有统计学意义(F_组间=1.720，P_组间<0.05)。各组患者不同时间点的TMH值差异有统计学意义(F_时间=11.202，P_时间<0.001)。各组患者TMH值在术后1wk和1mo时较术前明显降低，术后3、6mo恢复至术前水平。术后3mo时，各组TMH值差异有统计学意义(P=0.004)，其中SMILE组的下泪河高度高于其它两组。(3)FBUT：术后三组患者间FBUT差异无统计学意义(F_组间=1.428，P_组间=0.245)。各组内不同时间点的FBUT值差异有统计学意义(F_时间=4.511，P_时间=0.001)。各组FBUT值在术后1wk、1mo时较术前明显降低，术后3、6mo时恢复至术前水平。术后各时间点，不同组间FBUT差异无统计学意义(P>0.05)。(4)ABUT：术后三组患者间ABUT差异有统计学意义(F_组间=1.290，P_组间<0.05)。但各组内不同时间点的ABUT值差异有统计学意义(F_时间=10.294，P_时间<0.001)。各组ABUT值在术后1wk和1mo时较术前明显降低，术后3、6mo时恢复至术前水平。术后1mo时不同组间的ABUT值差异有统计学意义(P=0.008)； 其中，SMILE组的ABUT值高于T-PRK组和FS-LASIK组。(5)FL：术后三组患者间FL评分差异无统计学意义(F_组间=0.816，P_组间=0.445)。各组内不同时间点的FL评分差异有统计学意义(F_时间=5.539，P_时间=0.004)。各组FL评分值在术后1wk和1mo时较术前明显升高，术后3、6mo时恢复至术前水平。术后各时间点，不同组间的FL值差异无统计学意义(P>0.05)。(6)SⅠt：术后三组患者间SⅠt值差异无统计学意义(F_组间=0.225，P_组间=0.799)。各组内不同时间点的SⅠt值差异有统计学意义(F_时间=4.604，P_时间=0.003)。各组患者SⅠt值在术后1wk和3mo时较术前稍有升高，但均处于正常值范围内； 术后1、6mo的SⅠt值与术前水平差异无统计学意义(P>0.05)。术后各时间点，不同组间的SⅠt值差异无统计学意义(P>0.05)。

结论：FS-LASIK、T-PRK和SMILE三种角膜屈光手术均会在术后一定时间内引起不同程度的干眼，但后期可逐渐恢复。SMILE术后较FS-LASIK及T-PRK术在泪膜稳定性方面恢复更快，而T-PRK术后不适症状改善最慢。

Abstract:

AIM:To compare dry eye symptoms and signs before and after three kinds surgery, femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK), transepithelial photorefractive keratectomy(T-PRK), small incision lenticule extraction(SMILE)using ocular surface analyzer(Oculus Keratograph).

METHODS:Totally 98 patients(196 eyes)undergoing corneal refractive surgery from January 2017 to May 2017 were recruited. They were divided into three groups, namely, FS-LASIK group, T-PRK group and SMILE group. All patients underwent observation and assessment in the following order: ocular surface disease index(OSDI), tear meniscus height(TMH), measure using the infrared pattern of Oculus Keratograph. The first tear film break-up time(FBUT)and average tear break-up time(ABUT)measure using the infrared pattern of Oculus Keratograph, corneal fluorescein staining(FL), Schirmer Ⅰ test(SⅠt).

RESULTS:1)OSDI index: There was statistically significant difference between the three groups(F_groups=2.799, P_groups<0.05). However, the difference in the OSDI values of different time points in each group was statistically significant(F_time=85.942, P_time<0.001). The OSDI index were significantly increased at 1wk, 1 and 3mo after operation in each group. All groups recovered to the preoperative level at 6mo after operation. After 3mo, there was an inter-group difference in the OSDI values(P=0.019), and the OSDI values of the T-PRK group were higher than those of the other two groups. 2)TMH: There was statistically significant difference among the three groups postoperatively(F_groups=1.720, P_groups<0.05). The TMH values of different time points in each group were significantly different(F_time=11.202, P_time<0.001). The TMH values of each group were significantly reduced after 1wk and 1mo and were restored to preoperative levels after 3 and 6mo. After 3mo, there was a difference TMH among the three groups(P=0.004), and the inferior TMH in the SMILE group was higher than that of the other two groups. 3)FBUT: There was statistically significant difference among the three groups after surgery(F_groups=1.428, P_groups=0.245). The difference in FBUT values between different time points in each group was statistically significant(F_time=4.511, P_time=0.001). The FBUT values of each group were significantly reduced after 1wk and 1mo, and recovered to preoperative levels after 3mo and 6mo. There was no significant difference in FBUT between different groups at each time points(P>0.05). 4)ABUT: There was statistically significant difference in ABUT among the three groups after surgery(F_groups=1.290, P_groups<0.05). However, the difference in ABUT values between different time points in each group was statistically significant(F_time=10.294, P_time<0.001). The ABUT values of each group were significantly reduced after 1wk and 1mo, and recovered to preoperative levels after 3mo and 6mo. There was a statistical difference in ABUT values between different groups after 1mo(P=0.008); among them, the ABUT value of the SMILE group was higher than that of the T-PRK group and the FS-LASIK group. 5)FL: There was no statistical difference in the FL score between the three groups(F_groups=0.816, P_groups=0.445). The differences in the FL scores at different points in each group were statistically significant(F_time=5.539, P_time=0.004). The FL score of each group was significantly higher than before surgery at 1wk and 1mo, and recovered to preoperative levels at 3mo and 6mo after surgery. There was no statistical difference in the FLs between different groups at different points in time(P>0.05). 6)SⅠt: There was no statistically significant difference in SⅠt values among the three groups after surgery(F_groups=0.225, P_groups=0.799). The difference in SⅠt values between different time points in each group was statistically significant(F_time=4.604, P_time=0.003). The SⅠt values of each group were slightly higher than the preoperative values afyer 1wk and 3mo, but they were all within normal values. There was no significant difference between the SⅠt values of 1mo or 6mo after operation and the preoperative level. There was no statistical difference in SⅠt values between different groups at each points in time(P>0.05).

CONCLUSION:The three types of corneal refractive surgery FS-LASIK, T-PRK, and SMILE all cause different degrees of dry eyes within a certain period of time after surgery, but they can gradually recover later. After SMILE surgery, the stability of the tear film recovered faster, while the symptoms after T-PRK surgery improved the least.