| LASIK术后泪膜及角膜知觉改变的临床研究
广西医科大学一附院眼科 曾静 黄明汉 颜鲁宁
[目的]：探讨LASIK术后泪膜及角膜知觉的早期改变，研究泪膜变化及其与角膜知觉改变的关系及LASIK术后眼干的原因，指导LASIK术后治疗。
[方法]：选择2003年2月至2003年6月期间在我院近视治疗中心行LASIK手术的患者37例（73只眼）分别于术前、术后1天、1周、1月、3月询问患者主观症状并常规检查非矫正视力、裂隙灯检查角膜瓣愈合情况，同时行角膜知觉、泪膜破裂时间、荧光素染色、SchirmerI试验。
[结果]：LASIK术后眼干较术前加重（P<0.05），术后3月时仍未恢复。SchirmerI试验术后1天与术前比较差异无显著性（P>0.05），但术后1周、1月、3月较术前均减少(P<0.05)，且术后3月时仍未恢复。泪膜破裂时间术后1天与术前比较差异无显著性（P>0.05），但术后1周、1月、3月与术前相比缩短(P<0.05)。角膜知觉术后1天较术前下降，1周、1月阈值均低于术前(P<0.05)，术后3月时基本恢复至术前（P>0.05）。
[结论]：LASIK术后病人眼干及局部刺激症状加重，术后第1天由于眼局部刺激症状明显，泪液反射性分泌增多，而后泪液分泌量减少，明显低于术前水平，术后3月时仍未恢复。同时泪膜稳定性也受到破坏，3月时仍未恢复。LASIK手术会导致角膜知觉下降，术后1天、1周下降明显，1月后逐渐恢复，3月时基本恢复至术前。
[关键词]：准分子激光原位角膜磨镶术 角膜知觉 泪膜破裂时间 SchirmerI试验。
The early changes of tear film and corneal sensitivity after LASIK .
Objective: To investigate the early changes in tear film as well as corneal sensitivity after LASIK and the relationship between postoperative tear film and corneal sensitivity .
Methods: 37 patients(73 eyes) underwent LASIK were checked with corneal sensitivity, fluorescein staining, tear break up time (BUT) and SchirmerI test before and 1day, 1week, 1month, 3months after LASIK.
Results: The dryness sensation was more severe postoperative(P<0.05). No significant changes were found in SchirmerI test at 1day postoperatively(P>0.05), but lower at 1week, 1month, 3months postoperatively(P<0.05). There were obvious decrease in BUT at 1week, 1month, 3months(P<0.05), but no significant changes were found in BUT at 1day postoperatively(P>0.05). There were obvious decreases in corneal sensitivity at 1day, 1week, 1month postoperatively(P<0.05), the corneal sensitivity was recovered at 3months after LASIK(P>0.05).
Conclusions: The symptoms of dry eye were more severe after LASIK, More tear was secreted reflexively on the first day postoperatively, after that tear volume decreased at 1week, 1month, 3months after the surgery. Tear film stability was destroyed and didn’t rehabilitate until 3months. The mean corneal sensitivity values were decrease at 1day, 1week, 1month after LASIK, but recovered at 3months postoperatively.
Key words: LASIK, corneal sensitivity, tear break up time, SchirmerI test
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