目的：比较智能脉冲技术辅助的经上皮准分子激光角膜切削术(SPT-TPRK)与飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)术后泪液炎症介质水平及眼表健康恢复的差异。

方法：选取2024年7月至2025年2月在河南医药大学第一附属医院眼科行角膜屈光手术患者，按照术式不同分为SPT-TPRK组和FS-LASIK组。于术前及术后1 wk，1、3、6 mo采集泪液样本，通过酶联免疫吸附实验检测肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)、细胞间黏附分子-1(ICAM-1)和神经生长因子(NGF)水平，并行泪膜破裂时间(BUT)、眼表疾病指数(OSDI)问卷检查。

结果：本研究共纳入患者60例120眼，SPT-TPRK组30例60眼(男17例34眼，女13例26眼，平均年龄23.13±3.82岁)，FS-LASIK组30例60眼(男16例32眼，女14例28眼，平均年龄24.77±4.63岁)。SPT-TPRK组术后1 wk泪液中TNF-α、IL-1β、IL-6、MMP-9和ICAM-1水平均显著高于FS-LASIK组(均P<0.05)，但自术后1 mo起迅速下降，至术后3、6 mo时上述泪液炎症介质水平低于FS-LASIK组。FS-LASIK组术后各时间点NGF浓度均显著高于SPT-TPRK组(均P<0.05)，且下降更为缓慢。术后1 wk，SPT-TPRK组BUT显著低于FS-LASIK组，OSDI评分显著高于FS-LASIK组(均P<0.05)； 术后1 mo，两组间BUT与OSDI评分无差异(均P>0.05)。相关性分析显示，所有炎症介质水平均与BUT呈负相关、与OSDI评分呈正相关(均P<0.001)。

结论：SPT-TPRK与FS-LASIK术后均可引起炎症介质升高以及眼表功能指标下降，SPT-TPRK术后早期炎症反应更剧烈但消退迅速，而FS-LASIK术后NGF升高更显著且回落缓慢。SPT-TPRK与FS-LASIK术后患者的泪膜稳定性与主观不适感与炎症介质水平密切相关。

METHODS:Patients undergoing corneal refractive surgery at the Department of Ophthalmology, the First Affiliated Hospital of Henan Medical University, from July 2024 to February 2025 were enrolled and divided into an SPT-TPRK group and an FS-LASIK group based on the surgical procedure. Tear samples were collected preoperatively and at 1 wk, 1, 3, and 6 mo postoperatively. Levels of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), matrix metalloproteinase-9(MMP-9), intercellular cell adhesion molecule-1(ICAM-1), and nerve growth factor(NGF)were measured using enzyme-linked immunosorbent assay. Tear film break-up time(BUT)and ocular surface disease index(OSDI)questionnaire were also assessed.

RESULTS:A total of 60 patients(120 eyes)were enrolled in this study. There were 30 patients(60 eyes)in the SPT-TPRK group, including 17 males(34 eyes)and 13 females(26 eyes), with an average age of 23.13±3.82 y, and 30 patients(60 eyes)in the FS-LASIK group,including 16 males(32 eyes)and 14 females(28 eyes), with an average age of 24.77±4.63 y. At 1 wk postoperatively, tear levels of TNF-α, IL-1β, IL-6, MMP-9, and ICAM-1 in the SPT-TPRK group were significantly higher than those in the FS-LASIK group(all P<0.05). However, these levels decreased rapidly from 1 mo postoperatively and were lower in the SPT-TPRK group than in the FS-LASIK group at 3 and 6 mo postoperatively. NGF concentrations in the FS-LASIK group were significantly higher than those in the SPT-TPRK group at all postoperative time points(all P<0.05)and declined more slowly. At 1 wk postoperatively, BUT was significantly lower and OSDI scores significantly higher in the SPT-TPRK group compared to the FS-LASIK group(both P<0.05). At 1 mo postoperatively, no statistically significant differences were observed in BUT or OSDI scores between the two groups(both P>0.05). Correlation analysis revealed that all inflammatory mediator levels were significantly negatively correlated with BUT and significantly positively correlated with OSDI scores(all P<0.001).

CONCLUSION:Both SPT-TPRK and FS-LASIK induce elevated inflammatory mediator levels and decreased ocular surface function postoperatively. The early inflammatory response is more intense but resolves rapidly after SPT-TPRK, whereas NGF elevation is more pronounced and declines slowly after FS-LASIK.Postoperative tear film stability and subjective discomfort in patients undergoing SPT-TPRK and FS-LASIK are closely correlated with inflammatory mediator levels.