作者：哈文静，徐惠芳，邹文青，李静，顾青，贾沁 作者单位：750001)中国宁夏回族自治区银川市，宁夏回族自治区人民医院眼科医院
【摘要】 目的：研究LASIK手术后泪液稳定性及功能性视力的变化。
【关键词】 激光原位角膜磨镶术；干眼；功能性视力
Study of tear function and functional visual acuity after LASIK WenJing Ha, HuiFang Xu, WenQing Zou, Jing Li, Qing Gu, Qin Jia Foundation item:Natural Science Foundation of Ningxia, China (No.NZ08133) Department of Ophthalmology, Ningxia Peoples Hospital, Yinchuan 750001, Ningxia Hui Autonomous Region, China Abstract AIM: To investigate the change of tear function and functional visual acuity(FVA) after LASIK. METHODS: Fortyeight consecutive patients (96 eyes) who underwent LASIK for the correction of myopia were investigated. Dry eye symptoms, tear breakup time(BUT), Schirmer test values(STV), and corneal sodium fluorescein(FL),staining were measured before surgery and 1 day, 1 week, 1 month，3 months and 6 months after surgery. The difference of FVA and baseline visual acuity (baseline VA) were also compared(FVA). RESULTS: Before surgery, 16% of patients (15/96) had dry eye symptoms. After surgery, 95% of patients (91/96), 85% of patients (82/96), 59% of patients (57/96), 45% of patients (43/96), and 33% of patients (32/96) experienced dry eye symptoms at 1 day, 1 week, 1 month, 3 months, and 6 months, respectively. One day after operation, BUT (7.06±2.04s) shortened to (4.4±1.8s;t＝2.65，P＝0.00). STⅠ(12.7±6.6mm) increased to (14.5±6.6mm;t＝1.76，P＝0.036). STⅡ(7.2±2.4mm) decreased to (5.47±2.02mm;t＝1.68，P＝0.00). The score of FL (1.0±0.8) increased to (1.4±1.0; t=0.375,P=0.002). All the parameters recovered at the 6th month after operation, except for STⅠ(10.6±7.0mm; t＝1.83，P＝0.03) which was still lower than that of the preoperative. FVA increased from 0.50±0.37 to 0.62±0.35 (t=1.146, P=0.025) 1 day postoperatively and recovered 1 week after operation. CONCLUSION: Dry eye symptoms are common complications after myopic LASIK surgery. LASIK can significantly alter the BUT, STⅠand ST Ⅱ. Patients may experience a transient decrease in FVA that returns to baseline within 1 week.
KEYWORDS: laser in situ keratomileusis; dry eye; functional visual acuity
方法：我们对200804/06在我院接受LASIK治疗近视的48例患者（96眼）进行前瞻性病例对照研究，分别在术前、术后1d;1wk;1,3,6mo进行干眼症状问卷调查，检测泪膜破裂时间（tear breakup time，BUT）、泪液分泌试验（schimer test values，STV）、角结膜荧光素钠染色（sodium fluorescein，FL）、比较功能性视力（functional visual acuity, FVA）与基础视力（baseline VA）的差值（FVA）。
结果：术前有15眼（16%）有干眼症状，术后分别有91眼（95%），82眼（85%），57眼（59%），43眼（45%）,32眼（33%）在术后1d；1wk；1，3，6mo表现有干眼症状；术后第1d BUT由术前7.06±2.04s缩短至4.4±1.8s（t＝2.65，P＝0.00），STⅠ由术前12.7±6.6mm增加到14.5±6.6mm（t＝1.76，P＝0.036），STⅡ由术前7.2±2.4mm减少到5.47±2.02mm（t＝1.68，P＝0.00），术前FL评分1.0±0.8，术后1d增多到1.4±1.0（t=0.375,P=0.002）。术后6mo除STⅠ10.6±7.0mm，仍低于术前（t＝1.83，P＝0.03），其余参数均恢复至术前水平。FVA术后1d由术前0.50±0.37增加至0.62±0.35（t=1.146,P=0.025），1wk后恢复至术前水平。
结论：本研究证实术后干眼是LASIK矫正近视的常见并发症，主要影响BUT，STⅠ，ST Ⅱ。LASIK术后早期功能性视力有所下降，1wk后逐渐好转。
0引言
激光原位角膜磨镶术（laser in situ keratomileusis, LASIK）是目前最为普遍的屈光矫正手术，研究证实该手术是矫正屈光不正的有效、安全的方法，但LASIK术后常常有患者并发干眼症状、精细视力不良及视力波动，其机制尚不明确[1, 2]。我们将观察LASIK术前、术后1d;1wk;1,6mo的干眼症状、泪膜破裂时间（tear breakup time，BUT）、泪液分泌试验（schimer test values，STV）、角膜荧光素染色，及其与功能性视力的变化。
表1LASIK术前及术后各时间段各参数变化（略）
aP <0.05 vs 术前
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