[1]杜娟,赵少贞,黄悦.Keratograph 5M眼表综合分析仪观察飞秒激光制瓣LASIK手术对泪膜和睑板腺的影响[J].眼科新进展,2016,36(5):447-449.[doi:10.13389/j.cnki.rao.2016.0119]
　DU Juan,ZHAO Shao-Zhen,HUANG Yue.Effects of femtosecond laser LASIK on tear film and meibomian gland observed by Keratograph 5M[J].Recent Advances in Ophthalmology,2016,36(5):447-449.[doi:10.13389/j.cnki.rao.2016.0119]
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Keratograph 5M眼表综合分析仪观察飞秒激光制瓣LASIK手术对泪膜和睑板腺的影响
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
36卷
期数:
2016年5期
页码:
447-449
栏目:
应用研究
出版日期:
2016-05-05

文章信息/Info

Title:
Effects of femtosecond laser LASIK on tear film and meibomian gland observed by Keratograph 5M
作者:
杜娟; 赵少贞; 黄悦
300384　天津市，天津医科大学眼科医院屈光角膜科
Author(s):
DU Juan; ZHAO Shao-Zhen; HUANG Yue
Tianjin Medical University Eye Hospital , Tianjin 300384 . China
关键词:
眼表综合分析仪; 准分子激光原位角膜磨镶术; 泪膜; 睑板腺
Keywords:
Keratograph 5M ;  LASIK ;  tear film ;  meibomian gland
DOI:
10.13389/j.cnki.rao.2016.0119
文献标志码:
A
摘要:
目的　使用Ｋｅｒａｔｏｇｒａｐｈ５Ｍ眼表综合分析仪观察准分子激光原位角膜磨镶术（ｌａｓｅｒｉｎｓｉｔｕｋｅｒａｔｏｍｉｌｅｕｓｉｓ，ＬＡＳＩＫ）对泪膜和睑板腺的影响。方法　选取近视眼患者６５例（１３０眼），均行飞秒激光制瓣ＬＡＳＩＫ手术。于ＬＡＳＩＫ术前及术后１周、１个月、６个月检查患者，检查项目包括：干眼症状评分、泪膜破裂时间（ｔｅａｒｂｒｅａｋｕｐｔｉｍｅ，ＴＢＵＴ）、角膜荧光素钠染色，采用Ｋｅｒａｔｏ-ｇｒａｐｈ５Ｍ眼表综合分析仪检查非侵入性泪膜破裂时间（ｎｏｎ-ｉｎｖａｓｉｖｅｂｒｅａｋｕｐｔｉｍｅ，ＮＩＴＢＵＴ）、非侵入性泪河高度（ｎｏｎ-ｉｎｖａｓｉｖｅｔｅａｒｍｅｎｉｓｃｕｓｈｅｉｇｈｔ，ＮＩＴＭＨ）。睑板腺检查项目有睑缘评分，采用Ｋｅｒａｔｏｇｒａｐｈ５Ｍ眼表综合分析仪检查脂质层厚度分级，睑板腺现存面积比。分析ＴＢＵＴ、ＮＩＴＢＵＴ（ｆ）（首次）和ＮＩＴＢＵＴ（ａｖ）（平均）之间的相关性。结果　与术前相比，术后１周、１个月干眼症状评分均升高（均为Ｐ＜０．０５）；术后１周、１个月ＴＢＵＴ分别为（７．００±２．１７）ｓ、（７．２１±２．１５）ｓ，与术前（１５．００±５．０１）ｓ相比，差异均有统计学意义（均为Ｐ＜０．０５）；术后１周、１个月ＮＩＴＢＵＴ（ｆ）分别为（５．４８±２．０８）ｓ、（５．６３±１．９２）ｓ，与术前（１１．４４±５．００）ｓ相比，差异均有统计学意义（均为Ｐ＜０．０５）；术后１周、１个月ＮＩＴＢＵＴ（ａｖ）分别为（９．０４±２．８０）ｓ、（８．９４±２．４６）ｓ，较术前（１３．７９±４．００）ｓ缩短（均为Ｐ＜０．０５）；角膜荧光素钠染色评分和ＮＩＴＭＨ结果与术前比较，差异均无统计学意义（均为Ｐ＞０．０５）；术后１周、１个月睑板腺脂质层厚度较术前变薄，差异均有统计学意义（均为Ｐ＜０．０５）；睑缘评分及睑板腺现存面积比与术前比较，差异均无统计学意义（均为Ｐ＞０．０５）。术后６个月各项检查结果与术前相比差异均无统计学意义（均为Ｐ＞０．０５）。术后各时间所测ＮＩＴＢＵＴ（ｆ）比ＮＩＴＢＵＴ（ａｖ）短。ＮＩＴＢＵＴ（ｆ）与ＮＩＴＢＵＴ（ａｖ）、ＮＩＴＢＵＴ（ｆ）与ＴＢＵＴ、ＮＩＴＢＵＴ（ａｖ）与ＴＢＵＴ均呈正相关性（ｒ＝０．６５，Ｐ＜０．００１；ｒ＝０．３６，Ｐ＝０．０２５；ｒ＝０．３８，Ｐ＝０．０２８）。结论　Ｋｅｒａｔｏｇｒａｐｈ５Ｍ眼表综合分析仪作为非侵入性检测仪器可以快速、客观地评估泪膜的功能和睑板腺的状态，为干眼的诊断以及睑板腺功能的评估提供了参考依据。ＬＡＳＩＫ术后患者短期内会发生干眼或原有干眼不同程度加重，但术后０．５ａ大部分患者的ＴＢＵＴ和泪河高度可恢复到术前水平，且未观察到ＬＡＳＩＫ手术对睑板腺的不良影响。
Abstract:
Objective To observe the effects of femtosecond laser LASIK surgery on tear film and meibomian gland using Keratograph 5M. Methods Sixty-five myopia patients ( 130 eyes) underwent femtosecond laser LASIK were recruited. A series of examinations ,including dry eye symptom assessment ,tear break-up time ( TBUT) . corneal fluorescein staining ,non-invasive tear break-up time ( NITBUT ) . non-invasive tear meniscus height ( NITMH) ,lipid layer thickness grading ,the ratio of meibomian gland exist area to the total area ( % ) , were measured at pre-operation and I week. I month.6 months postoperatively by Keratograph 5M. Then, the correlations among the TBUT, NITBUT(f) and NITBUT( av) were analyzed. Results At I week and I month postoperatively , the dry eye symptom assessment score increased ( all P < 0. 05 ) ;TBUT were ( 7. 00 + 2. 17 ) s . ( 7. 21 + 2. 15 ) s , respectively , there were statistical differences compared with pre-operation ( 15. 00 +5. 01 ) s ( all P < 0. 05 ) ; NITBUT ( f) were ( 5. 48 + 2. 08 ) s. ( 5. 63 + 1. 92 ) s , respectively , there were statistical differences compared with pre-operation ( 11. 44 +5. 00 ) s ( all P < 0. 05 ) ; NITBUT ( av) were ( 9. 04 +2. 80) s. ( 8. 94 + 2. 46) s. respectively, there were statistical differences compared with pre-operation ( 13. 79 + 4. 00 ) s ( all P < 0. 05 ) ; There was no sigruficant difference rn corneal fluorescein stairung and NITMH ( all P > 0. 05 ) ; Compared with pre-operation , the meibomian gland lipid layer thickness decreased ( all P < 0. 05 ) , there was no sigruficant difference in limbus observed score exanunation and the ratio of meibomian gland exist area to the total area ( all P > 0. 05 ) . There was no significant difference at 6 months postoperatively in all examinations compared with pre-operation ( all P > 0. 05 ) . The positive correlation was found between NITBUT( f) and NITBUT( av) .NITBUT( f) and TBUT .NITBUT( av) and TBUT( r = 0. 65 ,P < 0. 001 ;r = 0. 36 ,P = 0. 025 ; r = 0. 38 ,P = 0. 028 ) . Conclusion As norunvasive ocular analyzer , Keratograph 5M can evaluate function of the tear film and meibomian gland status quickly and objectively,it can provide a reference for the diagnosis of dry eye and meibomian gland function assessment. While LASIK has adverse effect on the stability and secretion of tear in short term postoperatively , but has no significant effect on meibomian gland. TBUT and tear meniscus height can be restored within 6 months postoperatively.

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备注/Memo

备注/Memo:
国家自然科学基金资助（编号：８１２７０９７５）
更新日期/Last Update: 2016-05-04