| Research BasicsDry eye is a multi-factor ocular surface disease characterized by the imbalance of the stability of the tear film and accompanied by the symptoms of ocular discomfort.The main pathophysiological mechanisms include the instability of the tear film,inflammation and damage of the eye surface,increased tear permeability and neuroparesthesia.With the popularization of electronic products and the change of eye habits,dry eye has become one of the most common eye diseases except refractive error.In recent decades,with the rapid development of corneal refractive surgery and the increasingly mature technology,corneal refractive surgery has been favored by the majority of patients with refractive error,but some patients will have some complications after surgery,one of the most common complications is dry eye.ObjectiveTo observe the effect of FS-LASIK and SMILE on the ocular surface after operation,so as to provide clinical evidence for the timely detection and treatment of dry eyes after operation.MethodsA total of 674 patients(1384 eyes)who underwent corneal refractive surgery at the excimer terminal in the first affiliated hospital of Zhengzhou University from January 2018 to June 2019 were followed up and observed.Preoperative line dry eye questionnaire(ocular surface disease index,OSDI),best corrected visual acuity(BCVA),slit lamp examination,corneal topography,corneal fluorescent dye,ocular surface composite analyzer(Oculus Keratograph)such as inspection,of which included in the standard of 63 cases(126 eyes)of observational study.The data were collected and sorted out,and the patients were followed up for 6 months.The ocular surface changes after two kinds of corneal refractive surgery were analyzed based on the collected clinical data.There were 31 cases of FS-LASIK in group A(62 eyes)and 32 cases of SMILE in group B(64 eyes).The two groups were followed up for 1 week,1 month and 6 months after the operation to observe the changes of ocular surface,naked eye vision and complications.Results1.The OSDI score of group A and group B increased one week and one month after the operation,and the difference was statistically significant(P<0.05).The OSDI score of group A increased six months after the operation and the difference was statistically significant,while the OSDI score of group B basically recovered to the preoperative level six months after the operation.The variation trend of OSDI scores in groups A and B after repeated measures anova was statistically significant(F=5.734,P=0.014),and the difference in OSDI scores in the two groups at each time period was statistically significant.2.A,B two groups uncorreted visual acuity naked eye eyesight(UCVA)in postoperative 1 week,1 month,6 month more preoperative obviously improved(P<0.05),but the difference between A and B two groups has no statistical significance(P>0.05).There was no significant difference in BCVA between groups A and B 1 week,1 month and 6 months after surgery(P>0.05).3.The corneal fluorescence staining score in both groups A and B was improved one week after surgery compared with that before surgery,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups 1 and 6 months after surgery compared with that before surgery(P>0.05).The repeated measurement variance was used to analyze the variation trend of corneal fluorescence staining score between groups A and B(F=0.567,P=0.534),and the difference between different time nodes was not statistically significant(P>0.05).4.The tear river height(TMH)of the two groups A and B decreased one week and one month after the operation compared with that before the operation,and the difference was statistically significant(P<0.05),and the most significant one week after the operation.There was A statistically significant difference between group A and group B 6 months after surgery,and no statistically significant difference between group B and group B 6 months after surgery(P>0.05).The repeated measurement variance was used to analyze the influence of different surgical methods on TMH,and there was no statistically significant difference in the variation trend of TMH between groups A and B after surgery(F=1.534,P=0.343).5.Noninvasive keratography break-up time(NIKBUT)in group A and group B was reduced in 1 week,1 month and 6 months after the operation compared with that before the operation,and the difference was statistically significant(P<0.05),and the most significant one week after the operation.Repeated measures of variance were used to analyze the change of NIKBUT in group A and group B.There was no statistically significant difference in the trend of NIKBUT in group A and group B after surgery(F=3.525,P=0.562),but there was statistical significance in the difference between different time nodes(F=1.863,P=0.017).6.A,B two groups lipid layer grade lipid layer level(LLG)in postoperative 1 week,1 month in June,compared with the preoperative declined,statistically significant difference(P<0.05).The repeated measurement variance was used to analyze the change of LLG in group A and group B.There was no statistically significant difference in the change trend of LLG in group A and group B after surgery(F=0.073,P=0.781),but there was statistical significance in the difference between different time nodes(F=2.341,P=0.007).7.Meibomian gland evaluation of meibomian gland(MGE):there was no statistically significant difference in MGE between groups A and B before and after surgery(P>0.05).8.Hyperemia index(HI):compared with that before the operation,both groups A and B had an increase in HI one week after the operation,with statistically significant difference(P<0.05).However,there was no statistically significant difference between groups A and B in HI at each time node(P>0.05).ConclusionsThe efficacy and safety of FS-LASIK and SMILE for myopia correction are similar,and both surgeries have different effects on the ocular surface,but the effect of FS-LASIK group on the ocular surface after surgery is more obvious and lasts longer than that of SMILE group. |
PDF Full Text Request