Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
J Refract Surg. 2012 Sep;28(9):625-31. doi: 10.3928/1081597X-20120815-07.
To evaluate the effect of superior- versus nasal-hinged flaps on corneal sensation and dry eye after femtosecond laser-assisted LASIK.
A total of 43 patients who had undergone bilateral femtosecond laser-assisted LASIK for myopia were evaluated in a prospective, nonrandomized, contralateral eye study to compare the difference between different hinges on corneal sensation and dry eye. Corneal esthesiometry, Schirmer basic tear secretion test (BST), tear break-up time (BUT), ocular surface stainings, and the Ocular Surface Disease Index (OSDI) questionnaire were used to evaluate corneal sensation and dry eye parameters preoperatively as well as at 1 week and 1, 3, and 6 months postoperatively.
Corneal sensation decreased significantly in both groups 1 week after surgery (P<.05 in the nasal hinge group; P<.01 in the superior hinge group) and gradually recovered over the first 3 months. No significant change was noted in BUT after surgery in either group (P>.05). Significant increases were noted in BST values at 1 and 3 months (P<.05) and 6 months (P<.01) postoperatively in both groups. Corneal fluorescein staining increased significantly in both groups at 1 week (P<.01) and returned to baseline by 6 months. Conjunctival Rose Bengal staining decreased significantly by 6 months in the superior hinge group only (P<.05). The OSDI significantly increased 1 week after surgery (P<.01) and did not completely return to baseline by 6 months postoperatively in either group (P<.05). No significant differences were noted in any of the parameters between groups at any time point (P>.05).
Hinge position had no significant effect on corneal sensation or dry eye parameters. Aggressive dry eye regimens are needed for patients with preoperative dry eye.
评估飞秒激光辅助 LASIK 术后上睑缘和鼻侧缘切口对角膜知觉和干眼的影响。
本前瞻性、非随机、对侧眼研究纳入了 43 例双眼接受飞秒激光辅助 LASIK 治疗近视的患者，旨在比较不同切口位置对角膜知觉和干眼的影响。术前及术后 1 周、1、3、6 个月时，采用角膜知觉仪、基础泪液分泌试验（Schirmer basic tear secretion test，BST）、泪膜破裂时间（tear break-up time，BUT）、眼表面染色和眼表疾病指数（ocular surface disease index，OSDI）问卷评估角膜知觉和干眼相关参数。
术后 1 周，两组的角膜知觉均明显下降（鼻侧组 P<.05；上睑缘组 P<.01），且在前 3 个月逐渐恢复。两组术后 BUT 均无明显变化（P>.05）。术后 1 个月和 3 个月时，两组的 BST 值均显著升高（P<.05），6 个月时显著升高（P<.01）。两组术后 1 周时角膜荧光素染色均明显增加（P<.01），6 个月时恢复至基线。仅上睑缘组术后 6 个月时结膜丽丝胺绿染色显著减少（P<.05）。术后 1 周时 OSDI 显著升高（P<.01），两组均未完全恢复至基线（P<.05）。各时间点两组间各参数均无显著差异（P>.05）。
切口位置对角膜知觉和干眼参数无显著影响。术前有干眼的患者需要进行积极的干眼治疗。
