Sun Chi-Chin, Chang Chao-Kai, Ma David Hui-Kang, Lin Yi-Fang, Chen Kuan-Jen, Sun Ming-Hui, Hsiao Ching-Hsi, Wu Pei-Hsuan
*MD, PhD †BS ‡MD §PhD Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan (C-CS, Y-FL); Department of Chinese Medicine, Chang Gung University, Kwei-shan, Taoyuan, Taiwan (C-CS, DH-KM); Nobel Laser Eye Center, Taipei, Taiwan (C-KC); Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (DH-KM, K-JC, M-HS, C-HH); and Department of Beauty Science, Meiho Institute of Technology, Pingtung, Taiwan (P-HW).
Optom Vis Sci. 2013 Oct;90(10):1048-56. doi: 10.1097/OPX.0b013e31829d9905.
Dry eye is the most common complication after LASIK procedure and is associated with corneal denervation. We conducted the study to compare dry eye parameters and corneal sensitivity (CS) after laser in situ keratomileusis (LASIK) with a femtosecond laser (FS) or microkeratome (MK).
In this prospective, nonrandomized, comparative study, 87 consecutive patients with myopia were assigned to receive either LASIK surgery with an FS (n = 44) or MK-assisted LASIK surgery (n = 43). The groups were age and sex matched. Corneal sensitivity, Schirmer testing, tear breakup time (TBUT), conjunctival and corneal stainings, and a subjective questionnaire (Ocular Surface Disease Index [OSDI]) were evaluated preoperatively, at 1 week, and at 1, 3, and 6 months postoperatively.
Preoperative spherical equivalent and sphere, calculated ablation depth, and suction time differed significantly between the two groups (p < 0.01, all comparisons). Postoperatively, CS decreased in both groups and gradually recovered. Schirmer test values were not significantly different throughout the postoperative time points between the groups. Laser in situ keratomileusis-induced corneal epitheliopathy was also increased after operation in both groups. However, there was no significant difference between the groups in corneal and conjunctival staining scores. The OSDI scores were increased postoperatively in both groups. After adjustment for the calculated ablation depth, TBUT was the only parameter that was statistically higher in the FS group than in the MK group (p = 0.03).
Both FS- and MK-assisted LASIK reduced CS and TBUT and increased corneal staining and OSDI scores. However, TBUT was significantly higher in the FS group than in the MK group after operation.
干眼是准分子原位角膜磨镶术（LASIK）术后最常见的并发症，且与角膜去神经支配有关。我们开展本研究以比较飞秒激光（FS）或微型角膜刀（MK）行准分子原位角膜磨镶术（LASIK）后的干眼参数和角膜敏感性（CS）。
在这项前瞻性、非随机、对照研究中，87例连续的近视患者被分配接受FS-LASIK手术（n = 44）或MK辅助的LASIK手术（n = 43）。两组在年龄和性别上相匹配。术前、术后1周、术后1、3和6个月评估角膜敏感性、泪液分泌试验、泪膜破裂时间（TBUT）、结膜和角膜染色，以及一份主观问卷（眼表疾病指数[OSDI]）。
两组术前等效球镜度和球镜度、计算的切削深度和负压吸引时间差异有统计学意义（所有比较p < 0.01）。术后，两组的CS均下降并逐渐恢复。两组在术后各时间点的泪液分泌试验值差异无统计学意义。两组术后LASIK诱导的角膜上皮病变也均增加。然而，两组在角膜和结膜染色评分上差异无统计学意义。两组术后OSDI评分均升高。在调整计算的切削深度后，TBUT是唯一在FS组中统计学上高于MK组的参数（p = 0.03）。
FS辅助和MK辅助的LASIK均降低了CS和TBUT，并增加了角膜染色和OSDI评分。然而，术后FS组的TBUT显著高于MK组。
