Shaaban Yasmine Maher, Badran Tamer Abdel Fattah
Faculty of Medicine, Ain Shams University, Cairo, Egypt,
Clin Ophthalmol. 2018 Jul 31;12:1337-1345. doi: 10.2147/OPTH.S169091. eCollection 2018.
The purpose of this study was to compare the effects of three different corneal refractive surgeries: microkeratome laser in situ keratomileusis (LASIK), femtosecond laser in situ keratomileusis (FS-LASIK) and femtosecond small incision lenticule extraction (FS-SMILE) on 6-month postoperative stability of tear film to provide a basis for selection of operative procedures.
This is a prospective, randomized, comparative study that included 90 eyes of three equal groups of patients. Each group was subjected to a different laser technique: LASIK, FS-LASIK and FS-SMILE. Using anterior segment spectral domain optical coherence tomography (AS-SD-OCT), the lower tear meniscus parameters were measured preoperatively and 1 week, 1 month, 3 months and 6 months postoperatively. Changes were studied and compared.
There was a statistically significant difference in tear meniscus height (TMH) between FS-SMILE and FS-LASIK in the first week ( = 0.003) and first month ( = 0.002) with no statistically significant difference between both techniques at 3 and 6 months postoperatively. In FS-SMILE, TMH returned to 95% of its preoperative level after 1 month. There was no statistically significant difference in TMH between FS-LASIK and microkeratome LASIK techniques after 1 week and 1 month, but there was a statistically significant difference between both techniques in 3 months ( = 0.019) and 6 months ( = 0.032). Tear meniscus area (TMA) showed no statistically significant difference between FS-SMILE and FS-LASIK at all points of follow-up, but there was a statistically significant difference between both techniques and microkeratome LASIK (all < 0.05). Microkeratome LASIK parameters failed to reach the preoperative level till 6 months.
Early recovery of the lower TMH can be achieved as early as 1 month post-operatively with the FS-SMILE technique compared to FS-LASIK and microkeratome LASIK techniques.
本研究旨在比较三种不同的角膜屈光手术：微型角膜刀准分子原位角膜磨镶术（LASIK）、飞秒激光原位角膜磨镶术（FS-LASIK）和飞秒小切口基质透镜切除术（FS-SMILE）对术后6个月泪膜稳定性的影响，为手术方式的选择提供依据。
这是一项前瞻性、随机、对照研究，纳入90只眼，分为三组，每组患者数量相等。每组采用不同的激光技术：LASIK、FS-LASIK和FS-SMILE。使用眼前节谱域光学相干断层扫描（AS-SD-OCT），在术前、术后1周、1个月、3个月和6个月测量下方泪河参数。对变化情况进行研究和比较。
FS-SMILE与FS-LASIK在术后第1周（P = 0.003）和第1个月（P = 0.002）时泪河高度（TMH）存在统计学显著差异，术后3个月和6个月时两种技术之间无统计学显著差异。在FS-SMILE手术中，术后1个月时TMH恢复至术前水平的95%。FS-LASIK与微型角膜刀LASIK技术在术后1周和1个月时TMH无统计学显著差异，但在术后3个月（P = 0.019）和6个月（P = 0.032）时两种技术之间存在统计学显著差异。在所有随访时间点，FS-SMILE与FS-LASIK之间的泪河面积（TMA）无统计学显著差异，但这两种技术与微型角膜刀LASIK之间存在统计学显著差异（均P < 0.05）。微型角膜刀LASIK的参数直到术后6个月才恢复到术前水平。
与FS-LASIK和微型角膜刀LASIK技术相比，FS-SMILE技术可使下方TMH在术后1个月就实现早期恢复。
