目的：探究激光辅助原位角膜磨镶术(LASIK)和激光上皮角膜磨镶术(LASEK)术后配合0.1%玻璃酸钠(HA)治疗对干眼症状及泪膜稳定性的影响。

方法：将2017-02/2017-12纳入的230例460眼近视患者分为LASIK组和LASEK组，然后将每个治疗组随机分为0.1% HA治疗亚组和无HA亚组，两个亚组均在角膜屈光手术后应用0.3%加替沙星和0.5%氯替泼诺。观察各组患者不同时间点干眼症状评分、角膜知觉反应、角膜荧光染色(FL)、基本泪液分泌试验(SⅠt)和泪膜破裂时间(BUT)的变化。

结果：LASIK和LASEK患者术后1wk， 1、3、6mo， 0.1% HA治疗组与无HA组的FL、干眼症状评分和角膜知觉反应均存在显著差异(P<0.05)。各组术后1wk BUT均较术前明显下降。术后其他观察时间点BUT及各时间点术后SⅠt水平虽低于术前水平，但仍在正常范围内。LASEK术后患者的干眼主观症状、泪膜稳定性和角膜表面知觉优于LASIK患者，尤其是在术后1wk， 1、3mo。

结论：两种屈光手术可引起不同程度的干眼症状，LASEK组干眼症状在术后早期较LASIK组轻。早期足量使用不含防腐剂的0.1% HA可有效促进角膜修复，对术后干眼症状有很大帮助。

METHODS:A total of 230 myopia patients(460 eyes)were divided into LASIK group and LASEK group from February 2017 to December 2017. Each operation group was randomly assigned to 0.1% HA treatment subgroup and HA-free subgroup. Both subgroups were instructed to apply gatifloxacin(0.3%)and loteprednol(0.5%)after the corneal refractive surgery. The changes of dry eye symptom score, corneal perceptual reaction, corneal fluorescein staining(FL), basic Schirmer Ⅰ test(SⅠt)and tear film break-up time(BUT)were observed in different time points.

RESULTS:There were significant differences in FL, dry eye symptom score and corneal perceptual response between the 0.1% HA treatment group and HA-free group at 1wk, 1, 3 and 6mo after operation both in LASIK and LASEK patients(P<0.05). BUT after operation in each group was significantly deceased at 1wk compared with preoperative level. Other observation time points after surgery of BUT and each postoperative level of SⅠt were still within the normal range although lower than the preoperative levels. The subjective symptoms of dry eyes, tear film stability and corneal surface perception of LASEK patients were better than LASIK patients especially at 1wk, 1 and 3mo after surgery.

CONCLUSION:These two kinds of refractive surgery may cause different degrees of dry eye symptoms. These symptoms in the LASEK group were lighter than that in the LASIK group in the early postoperative period. The early adequate use of preservative-free 0.1% HA could effectively promote the corneal repair and be greatly helpful for postoperative dry eye symptoms.