两种角膜屈光手术方式手术前后泪液功能变化的比较
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摘要
目的比较不同角膜屈光手术方式对泪液功能指标的影响。设计回顾性比较性病例系列。研究对象 42例接受角膜屈光手术并随访6个月的近视患者,其中LASIK组20例,前弹力层下角膜磨镶术(SBK)组22例。方法对两组患者分别于术前,术后10天,1、3和6个月用Oculus眼表综合分析仪行非侵入性首次泪膜破裂时间(NIBUT_f)、非侵入性平均泪膜破裂时间(NIBUT_a)、下泪河高度(LTMH)检查,均取右眼资料进行分析,比较两组间不同时间各指标差异,及组内不同时间各指标差异。主要指标NIBUT_f、NIBUT_a、LTMH。结果两组NIBUT_f和LTMH在各个时间点均无统计学差异(P均>0.05);术后3个月SBK组NIBUT_a比LASIK组升高(P=0.02),其余时间点均无统计学差异(P均>0.05)。LASIK组NIBUT_f术后1、3个月与术前相比降低(P均<0.05),与术后10天、术后6个月比较无明显差异(P均>0.05);NIBUT_a、LTMH术后各时间点比术前均降低,但差异均无统计学意义(P均>0.05)。SBK组NIBUT_f术后10天,1、3个月与术前相比均降低(P均<0.05),术后6个月与术前相比降低,但无统计学差异(P=0.14);NIBUT_a术后10天比术前降低(P=0.04),术后1、3个月比术前降低,但无统计学差异(P均>0.05);LTMH术前与术后各时间点差异均无统计学意义(P均>0.05)。结论两种角膜屈光手术术后早期NIBUT_f和NIBUT_a均较术前降低,术后6个月恢复至术前水平。术后3个月SBK组NIBUT_a比LASIK组升高,SBK组比LASIK组泪膜功能恢复快。
Objective To analyze the influence of different corneal refractive surgical methods on non-invasive tear function indicators. Design Retrospective comparative case series. Participants 42 cases( 42 eyes) who underwent corneal refractive surgery and followed-up for at least 6 months. There were 20 patients( 20 eyes) in LASIK group and 22 patients( 22 eyes) in SBK group. Methods Non-invasive first tear film break-up time( NIBUT_f),non-invasive average tear film break-up time( NIBUT_a) and lower tear meniscus height( LTMH) were assessed pre-and post-operative 10 days,1 month,3 months,6 months using oculus keratograph. The right eye data were analyzed for comparison between the two groups. Main Outcome Measures NIBUT_f,NIBUT_a and LTMH. Results There was no significant difference of NIBUT_f and LTMH between the two groups at all time points( all P > 0. 05). Compared to LASIK group,the NIBUT_a was elevated at postoperative 3 months in SBK group( P = 0. 02). For LASIK group,compared to preoperative value,postoperative NIBUT_f decreased at 1 month and 3 months( all P < 0. 05),but not at 10 days,and 6 months( both P > 0. 05); both NIBUTaand LTMH value reduced at postoperative time points,but the differences were not statistically significant( all P > 0. 05). For SBK group,compared to preoperative value,NIBUT_f decreased at postoperative 10 days,1 month,3 months( all P < 0. 05),but recovered at 6 months after surgery( P = 0. 14); NIBUT_a decreased at postoperative 10 days( P = 0. 04),but not at 1 month and 3 months( both P > 0. 05). There was no statistical difference of LTMH at every postoperative time point compared to preoperative value( all P > 0. 05). Conclusion Compared to preoperative value,NIBUT_f and NIBUT_a temporally decreased after LASIK and SBK,recovered to preoperative level at postoperative 6 months. Compared to LASIK,the NIBUT_a was higher at postoperative 3 months in SBK group. The tear film function restored faster in SBK than LASIK group.
Objective To analyze the influence of different corneal refractive surgical methods on non-invasive tear function indicators. Design Retrospective comparative case series. Participants 42 cases( 42 eyes) who underwent corneal refractive surgery and followed-up for at least 6 months. There were 20 patients( 20 eyes) in LASIK group and 22 patients( 22 eyes) in SBK group. Methods Non-invasive first tear film break-up time( NIBUT_f),non-invasive average tear film break-up time( NIBUT_a) and lower tear meniscus height( LTMH) were assessed pre-and post-operative 10 days,1 month,3 months,6 months using oculus keratograph. The right eye data were analyzed for comparison between the two groups. Main Outcome Measures NIBUT_f,NIBUT_a and LTMH. Results There was no significant difference of NIBUT_f and LTMH between the two groups at all time points( all P > 0. 05). Compared to LASIK group,the NIBUT_a was elevated at postoperative 3 months in SBK group( P = 0. 02). For LASIK group,compared to preoperative value,postoperative NIBUT_f decreased at 1 month and 3 months( all P < 0. 05),but not at 10 days,and 6 months( both P > 0. 05); both NIBUTaand LTMH value reduced at postoperative time points,but the differences were not statistically significant( all P > 0. 05). For SBK group,compared to preoperative value,NIBUT_f decreased at postoperative 10 days,1 month,3 months( all P < 0. 05),but recovered at 6 months after surgery( P = 0. 14); NIBUT_a decreased at postoperative 10 days( P = 0. 04),but not at 1 month and 3 months( both P > 0. 05). There was no statistical difference of LTMH at every postoperative time point compared to preoperative value( all P > 0. 05). Conclusion Compared to preoperative value,NIBUT_f and NIBUT_a temporally decreased after LASIK and SBK,recovered to preoperative level at postoperative 6 months. Compared to LASIK,the NIBUT_a was higher at postoperative 3 months in SBK group. The tear film function restored faster in SBK than LASIK group.
引文
[1]Nichols JJ,Nichols KK,Puent B,et al.Evaluation of tear film interference patterns and measures of tear break-up time.Optom Vis Sci,2002,79(6):363-369.
[2]Koh S,Ikeda C,Watanabe S,et al.Effect of non-invasive tear stability assessment on tear meniscus height.Acta Ophthalmol,2015,93(2):e135-139.
[3]Lan WZ,Lin LX,Yang X,et al.Automatic noninvasive tear breakup time(TBUT)and conventional fluorescent TBUT.Optom Vis Sci,2014,91(12):1412-1418.
[4]Pedro AV,JoséIgnacio FV,David DV,et al.Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourier-domain optical-coherence tomography.Br J Ophthalmol,2015,99(8):1120-1125.
[5]蓝倩倩,满平仪,陈琦,等.角膜地形综合分析仪在干眼诊断中的应用.眼科新进展,2015,35(12):1149-1151.
[6]万珊珊,杨燕宁,袁静,等.眼表综合分析仪评价干眼患者相关指标的临床分析.中华眼视光与视觉科学杂志,2015,17(3):171-175.
[7]张媛,贾冰冰,张岩,等.飞秒激光制瓣LASIK术后泪膜变化及相关性分析.中国实用眼科杂志,2014,32(11):1313-1316.
[8]陈曦,杨路.不同角膜屈光手术后泪膜稳定性分析.浙江省眼科学术年会论文集,2014:145-146.
[9]付梦军,王锐,张浩润,等.飞秒激光与机械板层刀制瓣的LASl K术后干眼的临床对比研究.国际眼科杂志,2015,15(2):215-218.
[10]Sudi P,Jorge LA,Alberto A,et al.Tear volume and stability after LASIK.J Refract Surg,2007,23(3):290-298.
[11]Lee KW,Joo CK.Clinical results of laser in situ keratomileusis with superior and nasal hinges.J Cataract Refract Surg,2003,29(3):457-461.
[2]Koh S,Ikeda C,Watanabe S,et al.Effect of non-invasive tear stability assessment on tear meniscus height.Acta Ophthalmol,2015,93(2):e135-139.
[3]Lan WZ,Lin LX,Yang X,et al.Automatic noninvasive tear breakup time(TBUT)and conventional fluorescent TBUT.Optom Vis Sci,2014,91(12):1412-1418.
[4]Pedro AV,JoséIgnacio FV,David DV,et al.Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourier-domain optical-coherence tomography.Br J Ophthalmol,2015,99(8):1120-1125.
[5]蓝倩倩,满平仪,陈琦,等.角膜地形综合分析仪在干眼诊断中的应用.眼科新进展,2015,35(12):1149-1151.
[6]万珊珊,杨燕宁,袁静,等.眼表综合分析仪评价干眼患者相关指标的临床分析.中华眼视光与视觉科学杂志,2015,17(3):171-175.
[7]张媛,贾冰冰,张岩,等.飞秒激光制瓣LASIK术后泪膜变化及相关性分析.中国实用眼科杂志,2014,32(11):1313-1316.
[8]陈曦,杨路.不同角膜屈光手术后泪膜稳定性分析.浙江省眼科学术年会论文集,2014:145-146.
[9]付梦军,王锐,张浩润,等.飞秒激光与机械板层刀制瓣的LASl K术后干眼的临床对比研究.国际眼科杂志,2015,15(2):215-218.
[10]Sudi P,Jorge LA,Alberto A,et al.Tear volume and stability after LASIK.J Refract Surg,2007,23(3):290-298.
[11]Lee KW,Joo CK.Clinical results of laser in situ keratomileusis with superior and nasal hinges.J Cataract Refract Surg,2003,29(3):457-461.
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