使用泪膜稳定性分析系统评估准分子原位角膜磨镶术后的泪膜稳定性。

Evaluation of the tear film stability after laser in situ keratomileusis using the tear film stability analysis system.

作者信息

Goto Tomoko, Zheng Xiaodong, Klyce Stephen D, Kataoka Hisashi, Uno Toshihiko, Yamaguchi Masahiko, Karon Mike, Hirano Sumie, Okamoto Shigeki, Ohashi Yuichi

机构信息

Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.

出版信息

Am J Ophthalmol. 2004 Jan;137(1):116-20. doi: 10.1016/s0002-9394(03)00901-2.

DOI:10.1016/s0002-9394(03)00901-2

PMID:14700653

Abstract

PURPOSE

To evaluate the tear film stability of patients before and after laser in situ keratomileusis (LASIK) using the tear film stability analysis system (TSAS).

DESIGN

Prospective observational case series.

METHODS

New videokeratography software for a topographic modeling system (TMS-2N) was developed that can automatically capture consecutive corneal surface images every second for 10 seconds. Thirty-four subjects (64 eyes) who underwent myopia LASIK were enrolled in this study. All subjects were examined with the new system before LASIK and at 1 week, 1 month, 3 months, and 6 months after the surgery. Corneal topographs were analyzed for tear breakup time (TMS breakup time) and breakup area (TMS breakup area). Based on pre-LASIK TSAS analysis, subjects were separated into normal and abnormal TSAS value groups. The criteria for the normal group were either TMS breakup time more than 5 seconds or TMS breakup area less than 0.2. The percentage of the occurrence of superficial punctuate keratitis was compared between the two groups with regard to subject's dry eye signs and symptoms.

RESULTS

Tear film stability decreased significantly during the early period after LASIK, as indexed by decreased TMS breakup time and increased TMS breakup area. Tear film instability resolved at 6 months after surgery. Before LASIK, 22 subjects (43 eyes) had normal TSAS evaluation and 12 subjects (21 eyes) were abnormal. After LASIK, among normal TSAS value eyes, 8 of 43 (18.6%) eyes developed superficial punctuate keratitis. In sharp contrast, 14 of 21 (66.7%) eyes in the abnormal group displayed superficial punctuate keratitis, correlating well with the patients' dry eye symptoms. The difference in the presence of superficial punctuate keratitis after LASIK between normal and abnormal TSAS value groups was statistically significant (P <.001). Subjects with abnormal TSAS evaluation also displayed resistance to dry eye treatment and had extended period of recovery.

CONCLUSIONS

Tear film stability analysis can be a useful means for screening LASIK candidates before surgery and for prognosticating dry eye symptoms thereafter.

摘要

目的

使用泪膜稳定性分析系统（TSAS）评估准分子原位角膜磨镶术（LASIK）患者术前和术后的泪膜稳定性。

设计

前瞻性观察病例系列。

方法

开发了一种用于地形建模系统（TMS - 2N）的新型视频角膜地形图软件，该软件可以每秒自动连续采集10秒的角膜表面图像。34名接受近视LASIK手术的受试者（64只眼）纳入本研究。所有受试者在LASIK术前以及术后1周、1个月、3个月和6个月时使用新系统进行检查。分析角膜地形图以获取泪膜破裂时间（TMS破裂时间）和破裂面积（TMS破裂面积）。根据LASIK术前TSAS分析，将受试者分为TSAS值正常组和异常组。正常组的标准为TMS破裂时间超过5秒或TMS破裂面积小于0.2。比较两组受试者干眼体征和症状方面浅层点状角膜炎的发生率。

结果

LASIK术后早期泪膜稳定性显著下降，表现为TMS破裂时间缩短和TMS破裂面积增加。泪膜不稳定性在术后6个月时消失。LASIK术前，22名受试者（43只眼）TSAS评估正常，12名受试者（21只眼）异常。LASIK术后，在TSAS值正常的眼中，43只眼中有8只（18.6%）发生了浅层点状角膜炎。形成鲜明对比的是，异常组21只眼中有14只（66.7%）出现了浅层点状角膜炎，这与患者的干眼症状密切相关。LASIK术后TSAS值正常组和异常组浅层点状角膜炎的发生率差异具有统计学意义（P <.001）。TSAS评估异常的受试者对干眼治疗也有抵抗，恢复时间延长。