目的：观察LASIK手术前后干眼与高阶像差(HOAs)改变及对视觉质量的影响。

方法：选取2008-06/2010-06在我院接受LASIK手术并随访5a的患者58例116眼，术前及术后1、3、5a记录UCVA、等效球镜、瞬目后0s和10s角膜前表面总HOAs、三阶彗差、三阶三叶草、四阶球差、BUT、SⅠt，填写OSDI问卷。

结果：术后5a，LASIK术后OSDI评分由术前10.003±1.462分逐渐提高至20.252±2.540分，BUT由术前8.402±2.640s降低至6.897±3.408s，SⅠt也较术前(14.382±6.241mm/5min)降低，但术后5a恢复至术前水平13.432±4.206mm/5min。瞬目后10s像差高于0s，以球差最显著。术后像差提高且随时间增加，仍以球差最显著。术后5a非干眼和干眼患者瞬目后0s获取的像差间无差异(均P>0.05)。术后5a瞬目后10s的HOAs轻度干眼与术前无差异(均P>0.05)，中、重度干眼患者像差均高于非干眼患者(均P<0.05)。干眼患者两时间点HOAs差值与OSDI评分正相关。

结论：LASIK术后远期患者干眼引起泪膜稳定性下降使患者眼部HOAs增加并最终导致患者视觉质量下降，其中球差的显著增加可能是造成患者视觉质量下降的主要原因。

METHODS: Totally 58 myopia patients(116 eyes)were enrolled from June 2008 to June 2010, who were interviewed before and on 1a, 3a, 5a after operation. Their total HOAs, third-order coma, third-order trefoil and fourth-order spherical aberration of the corneal surface 0s and 10s after blinking were measured, and uncorrected visual acuity(UCVA), spherical equivalent(SE), corneal fluorescent staining, S I t were taken. OSDI questionnaire was scored, dry eye was diagnosed and graded.

RESULTS: Five years after LASIK, OSDI scores gradually increased from 10.003±1.462 to 20.252±2.540, BUT decreased from 8.402±2.640s to 6.897±3.408s and S I t decreased from preoperative level 14.382±6.241mm/5min, but recovered to preoperative level of 13.432±4.206mm/5min. The HOAs obtained 10s after blink were higher than 0s, and the augment of spherical aberration was the most significant. As to the same time point, the post operative HOAs were higher than that before operation, and the elevation of spherical aberration was still the most significant. 5a after operation, there was no difference between dry eye and non-dry eye patients on HOAs obtained 0s after blinking(all P>0.05). There was no significant difference between mild dry eye and preoperative HOAs 10s after blink 5a after operation(all P>0.05). However, the HOAs of moderate and severe dry eye patients were higher than non-dry eye patients(all P<0.05). 5a after surgery, the HOAs differences between two time points of dry eye patients had positively correlated with OSDI scores.

CONCLUSION: The instability of tear film caused by dry eye in patients long-term after LASIK increases patient's HOAs and ultimately impair patient's visual quality, which mainly owe to the significant increase of spherical aberration.