Di Pascuale Mario A, Liu Tzong-Shyue, Trattler William, Tseng Scheffer C G
Ocular Surface Center, Miami, Florida 33173, USA.
J Cataract Refract Surg. 2005 Sep;31(9):1741-9. doi: 10.1016/j.jcrs.2005.02.041.
To determine whether lipid tear deficiency is a significant pathogenic factor in persistent dry eyes after laser in situ keratomileusis (LASIK).
Ocular Surface Center, Miami, Florida, USA.
Thirty-four eyes of 17 patients (mean 46.35 years +/- 11 [SD]) complaining of persistent dryness more than 12 months after LASIK were prospectively studied by symptom scoring and kinetic analysis of tear interference image, tear breakup time, and fluorescein clearance test. Once patients had been clear of inflammation and treated for aqueous tear deficiency, lipid tear deficiency was further confirmed and treated with Eyefeel (Kao, Inc.), an eye-warming device, 4 times daily for 4 weeks.
Sixteen patients were asymptomatic before LASIK but dryness persisted for 41 +/- 19.3 months. Delayed tear clearance was observed in 15 patients (88.2%) and floppy lids in 12 patients (70.5%). Aqueous tear deficiency was reconfirmed in 16 eyes (53.3%). After Eyefeel treatment, there was a subjective improvement of ocular surface diseases index from 60.6 +/- 10.6 to 25.8 +/- 18.5 (P = .0007). Tear breakup time was improved from 2.4 +/- 3.9 seconds to 7.9 +/- 3.6 seconds (P = .004). There was a tear interference pattern change from a vertical lipid tear deficiency to a horizontal normal in 7 eyes. There was a mean lipid spread time improvement from 1.3 +/- 0.4 sec to 0.8 +/- 0.4 sec (P = .001), and there was a mean lipid thickness improvement from 63.5 +/- 23 nm to 79.5 +/- 27 nm (P = .04).
Persistent nature of dry eye after LASIK is attributed to in part to delayed tear clearance, undercorrected aqueous tear deficiency, and nonrecognized lipid tear deficiency.
确定脂质泪液缺乏是否是准分子原位角膜磨镶术（LASIK）后持续性干眼的一个重要致病因素。
美国佛罗里达州迈阿密眼表中心。
对17例患者（平均年龄46.35岁±11[标准差]）的34只眼睛进行前瞻性研究，这些患者在LASIK术后12个月以上仍有持续性干眼症状，通过症状评分以及泪液干扰图像、泪膜破裂时间和荧光素清除试验的动力学分析进行研究。一旦患者炎症消退并接受了水样泪液缺乏的治疗，进一步确认脂质泪液缺乏后，使用眼部温热装置Eyefeel（花王株式会社）进行治疗，每天4次，共4周。
16例患者在LASIK术前无症状，但干眼症状持续41±19.3个月。15例患者（88.2%）观察到泪液清除延迟，12例患者（70.5%）出现眼睑松弛。16只眼睛（53.3%）再次确认存在水样泪液缺乏。经过Eyefeel治疗后，眼表疾病指数主观上从60.6±10.6改善至25.8±18.5（P = .0007）。泪膜破裂时间从2.4±3.9秒改善至7.9±3.6秒（P = .004）。7只眼睛的泪液干扰模式从垂直的脂质泪液缺乏转变为水平的正常模式。脂质扩散时间平均从1.3±0.4秒改善至0.8±0.4秒（P = .001），脂质厚度平均从63.5±23纳米改善至79.5±27纳米（P = .04）。
LASIK术后干眼的持续性部分归因于泪液清除延迟、未矫正的水样泪液缺乏以及未被认识到的脂质泪液缺乏。
