Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface
Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface
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DOI：
10.1016/s0161-6420(01)00623-6
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发表时间：
2001-07-01
期刊：
影响因子：
13.7
通讯作者：
Pflugfelder, SC
中科院分区：
文献类型：
--
作者：
Battat, L;Macri, A;Pflugfelder, SC
目的：评价双侧准分子激光原位角膜磨镶术(LASIK)前后眼表/泪腺联合单元的组成。设计前瞻性非对比病例序列。研究对象：接受双侧准分子激光原位角膜磨镶术(LASIK)的患者，男14例，女34例，年龄26~54岁，平均39.2岁。患者完成了一份包含11个问题的问卷，以评估眼睛刺激症状的特征和严重程度。测量每只眼的Snellen视力、泪液荧光素清晰度、角膜荧光素染色、Schirmer 1泪液分泌量以及角膜和结膜敏感度。用Tomey TMS-I(Tomey，Cambridge，MA)地形图仪测量角膜表面规则性(SRI)。分别于术前1~2天(T0)、术后7天(T1)、1(T2)、2(T3)、6(T4)、12(T5)、16(T6)个月对每只眼进行评估。结果：术后1周、1个月、12个月、16个月角膜和结膜敏感度均较术前显著降低(P<；各时间点P<；0.0002)。症状严重程度评分在术后1周、12个月和16个月显著增加(P<；在所有时间点均为0.007)。Schirmer-1评分平均为24+/-14 mm，术后1个月降至18+/-14 mm(P<；0.001)。术后泪液荧光素清除量呈线性增加，且在各时间点均显著高于基线(P<；0.001)。术后1周点状角膜荧光素染色较术前明显增加(P<；0.0001)，术后12个月恢复至术前水平，术后1周与术前比较差异有统计学意义(P
Purpose: To evaluate components of the integrated ocular surface/lacrimal gland unit in a series of patients before and after undergoing bilateral laser in situ keratomileusis (LASIK).Designs Prospective, noncomparative case series.Participants: Forty-eight eyes of 14 men and 34 women (age range, 26-54; mean, 39.2 years) who underwent bilateral LASIK for myopia or myopic astigmatism.Methods: LASIK was performed using a VISX Star Excimer Laser (Santa Clara, CA). Patients completed a questionnaire containing 11 questions that evaluated the character and severity of ocular irritation symptoms. Snellen visual acuity, tear fluorescein clearance, corneal fluorescein staining, aqueous tear production by the Schirmer 1 test, and corneal and conjunctival sensitivity were measured in each eye. Corneal surface regularity (SRI) was evaluated with the Tomey TMS-I (Tomey, Cambridge, MA) topography instrument. Each randomly chosen eye was evaluated 1 to 2 days (T0) before LASIK and 7 days (T1), 1 (T2), 2 (T3), 6 (T4), 12 (T5), and 16 (T6) months postoperatively. A Wilcoxon test, two-tailed paired t test, Friedman test, or analysis of variance were used for statistical comparisons.Main outcome measures: Components of the integrated ocular surface/lacrimal gland unit.Results: Both corneal and conjunctival sensitivity were noted to be significantly decreased from preoperative levels at 1 week, 1 month, 12 months, and 16 months postoperatively (P < 0.0002 at each time point). Symptom severity scores were significantly increased at 1 week, 12 months, and 16 months postoperatively (P < 0.007 at all time points). The mean Schirmer 1 test scores were 24 +/- 14 mm preoperatively, and they decreased to 18 +/- 14 mm by 1 month postoperatively (P < 0.001). Tear fluorescein clearance showed a linear increase postoperatively and was significantly greater than baseline (P < 0.001) at each time point. There was a significant increase in punctate corneal fluorescein staining at 1 week postoperatively (P < 0.0001), but staining returned to baseline by 12 months, There was a statistically significant increase in SRI 1 week postoperatively (P