Effects of small incision lamellar extraction, femtosecond-laser <i>in situ</i> keratomileusis and sub-Bowman keratomileusis on postoperative dry eye and corneal sensation _West China Medical Journal

Authors：

ZHANG Ying , QIU Lemei , WANG Shunqing , ZHANG Xiaolan , SUN Chengshu ,  MA Ke

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

MA Ke, Email: 280463919@qq.com

Keywords：

Small incision lamellar extraction; Femtosecond-laser in situ keratomileusis; Sub-Bowman keratomileusis; Dry eye; Corneal sensation

DOI：

10.7507/1002-0179.201709122

Video：

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Objection To compare the effects of three mainstream surgical methods on the ocular surface and investigate the optimal corneal myopia correction surgery. Methods We selected 118 patients (236 eyes) undergoing small incision lamellar extraction (SMILE) (40 patients, 80 eyes), femtosecond-laser in situ keratomileusis (FS-LASIK) (36 patients, 72 eyes) or sub-Bowman keratomileusis (SBK) (42 patients, 84 eyes) surgery for corneal myopia correction from March 2015 to January 2016. Before surgery, one week and one month after surgery, tear film rupture time, tear river height and eye red index were measured using ocular surface analyzer. The Schimer Ⅰ test was used to detect tear secretion. Corneal sensory gauge was used to measure corneal sensation. Analysis of variance was used to analyze the measurements of the three surgical methods at various time points. Results The tear film rupture time of the three groups decreased after one week (P<0.05), but the time in the SMILE group [(9.643±4.751) seconds] was longer than those in the other two groups [FS-LASIK (8.172±4.300) seconds, SBK (7.612±3.691) seconds,P<0.05]. The time in the SMILE group at one month after surgery was not different from that before surgery (P>0.05). At one month after surgery, the rupture times of the other two groups were still shortened (P<0.05). The tear river heights in the three groups were decreased at one week and one month after surgery (P<0.05), except FS-LASIK group (P>0.05). In the SBK group, at one week after surgery, the decrease of the height was the most obvious (P<0.05). There was no difference in eye red index among the three groups at the time of observation (P>0.05). Corneal sensation decreased in the three groups at one week and one month after surgery. In the SBK group, that was the most obvious decline (P<0.05). In the three groups, the tear secretion did not change at each observation time point (P>0.05). Conclusion In the three surgical methods, SMILE has the minimal impact on the ocular surface, followed by FS-LASIK, and SBK has the greatest impact.

Citation： ZHANG Ying, QIU Lemei, WANG Shunqing, ZHANG Xiaolan, SUN Chengshu, MA Ke. Effects of small incision lamellar extraction, femtosecond-laser in situ keratomileusis and sub-Bowman keratomileusis on postoperative dry eye and corneal sensation . West China Medical Journal, 2018, 33(11): 1371-1375. doi: 10.7507/1002-0179.201709122 Copy

1.	中华医学会眼科学分会角膜病学组. 干眼临床诊疗专家共识 (2013 年). 中华眼科杂志, 2013, 49(1): 73-75.
2.	Rodriguez AE, Rodriguez-Prats JL, Hamdi IM, et al. Comparison of goblet cell density after femtosecond laser and mechanical microkeratome in LASIK. Invest Ophthalmol Vis Sci, 2007, 48(6): 2570-2575.
3.	葛庆曼, 崔传波, 孔德言, 等. 激光扫描共焦显微镜对飞秒激光小切口基质透镜取出术后角膜帽神经修复的动态观察. 中华实验眼科杂志, 2017, 35(2): 151-155.
4.	Chan A, Ou J, Manche EE. Comparison of the femtosecond laser and mechanical keratome for laser in situ keratomileusis. Arch ophthalmol, 2008, 126(11): 1484-1490.
5.	Kanellopoulos AJ, Asimellis G. Three-dimensional LASIK flap thickness variability: topographic central, paracentral and peripheral assessment, in flaps created by a mechanical mierokeratome (M2) and two different femtosecond lasers (FS60 and FS200). Clin Ophthalmol, 2013, 7: 675-683.
6.	Ahn H, Kim JK, Kim CK, et al. Comparison of laser in situ keratomileusis flaps created by 3 femtosecond lasers and a microkeratome. J Cataract Refract Surg, 2011, 37(2): 349-357.
7.	Barequet IS, Hirsh A, Levinger S. Femtosecond thin-flap LASIK for the correction of ametropia after penetrating keratoplasty. J Refract Surg, 2010, 26(3): 191-196.
8.	买志彬, 刘苏冰, 聂晓丽, 等. 飞秒激光和微型角膜刀制瓣 LASIK 术后共焦显微镜检查比较. 中华实验眼科杂志, 2012, 30(7): 633-637.
9.	魏升升, 王雁, 耿维莉, 等. 飞秒激光 LASIK 术后早期不同部位角膜敏感性变化研究. 中国实用眼科杂志, 2012, 30(4): 397-401.
10.	危平辉, 王雁, 李华, 等. 飞秒激光小切口角膜基质透镜取出术光学区大小对角膜生物力学特性影响的研究. 中华眼科杂志, 2017, 53(3): 182-187.
11.	徐婧, 李莹, 余晨颖, 等. 角膜板层刀和飞秒激光制瓣准分子激光原位角膜磨镶术后泪液功能及角膜神经再生速度的比较. 中华眼视光学与视觉科学杂志, 2013, 15(7): 396-400.
12.	张丰菊, 孙明甡. 飞秒激光辅助 LASIK 与飞秒激光小切口角膜基质透镜取出术孰优孰劣. 中华眼科杂志, 2018, 54(1): 7-10.
13.	Benito A, Pérez GM, Mirabet S, et al. Objective optical assessment of tear-film quality dynamics in normal and mildly symptomatic dry eyes. J Cataract Refract Surg, 2011, 37(8): 1481-1487.
14.	梁刚, 张丰菊. 飞秒激光小切口角膜基质透镜取出术在眼科临床应用的新进展. 中华眼科杂志, 2016, 52(1): 68-72.
15.	邢星, 李世洋, 赵爱红, 等. 飞秒激光小切口角膜基质透镜取出术与准分子激光原位角膜磨镶术治疗近视对角膜内皮细胞密度影响的比较. 眼科新进展, 2016, 36(3): 247-249.

1. 中华医学会眼科学分会角膜病学组. 干眼临床诊疗专家共识 (2013 年). 中华眼科杂志, 2013, 49(1): 73-75.
2. Rodriguez AE, Rodriguez-Prats JL, Hamdi IM, et al. Comparison of goblet cell density after femtosecond laser and mechanical microkeratome in LASIK. Invest Ophthalmol Vis Sci, 2007, 48(6): 2570-2575.
3. 葛庆曼, 崔传波, 孔德言, 等. 激光扫描共焦显微镜对飞秒激光小切口基质透镜取出术后角膜帽神经修复的动态观察. 中华实验眼科杂志, 2017, 35(2): 151-155.
4. Chan A, Ou J, Manche EE. Comparison of the femtosecond laser and mechanical keratome for laser in situ keratomileusis. Arch ophthalmol, 2008, 126(11): 1484-1490.
5. Kanellopoulos AJ, Asimellis G. Three-dimensional LASIK flap thickness variability: topographic central, paracentral and peripheral assessment, in flaps created by a mechanical mierokeratome (M2) and two different femtosecond lasers (FS60 and FS200). Clin Ophthalmol, 2013, 7: 675-683.
6. Ahn H, Kim JK, Kim CK, et al. Comparison of laser in situ keratomileusis flaps created by 3 femtosecond lasers and a microkeratome. J Cataract Refract Surg, 2011, 37(2): 349-357.
7. Barequet IS, Hirsh A, Levinger S. Femtosecond thin-flap LASIK for the correction of ametropia after penetrating keratoplasty. J Refract Surg, 2010, 26(3): 191-196.
8. 买志彬, 刘苏冰, 聂晓丽, 等. 飞秒激光和微型角膜刀制瓣 LASIK 术后共焦显微镜检查比较. 中华实验眼科杂志, 2012, 30(7): 633-637.
9. 魏升升, 王雁, 耿维莉, 等. 飞秒激光 LASIK 术后早期不同部位角膜敏感性变化研究. 中国实用眼科杂志, 2012, 30(4): 397-401.
10. 危平辉, 王雁, 李华, 等. 飞秒激光小切口角膜基质透镜取出术光学区大小对角膜生物力学特性影响的研究. 中华眼科杂志, 2017, 53(3): 182-187.
11. 徐婧, 李莹, 余晨颖, 等. 角膜板层刀和飞秒激光制瓣准分子激光原位角膜磨镶术后泪液功能及角膜神经再生速度的比较. 中华眼视光学与视觉科学杂志, 2013, 15(7): 396-400.
12. 张丰菊, 孙明甡. 飞秒激光辅助 LASIK 与飞秒激光小切口角膜基质透镜取出术孰优孰劣. 中华眼科杂志, 2018, 54(1): 7-10.
13. Benito A, Pérez GM, Mirabet S, et al. Objective optical assessment of tear-film quality dynamics in normal and mildly symptomatic dry eyes. J Cataract Refract Surg, 2011, 37(8): 1481-1487.
14. 梁刚, 张丰菊. 飞秒激光小切口角膜基质透镜取出术在眼科临床应用的新进展. 中华眼科杂志, 2016, 52(1): 68-72.
15. 邢星, 李世洋, 赵爱红, 等. 飞秒激光小切口角膜基质透镜取出术与准分子激光原位角膜磨镶术治疗近视对角膜内皮细胞密度影响的比较. 眼科新进展, 2016, 36(3): 247-249.

West China Medical Journal

Effects of small incision lamellar extraction, femtosecond-laser in situ keratomileusis and sub-Bowman keratomileusis on postoperative dry eye and corneal sensation

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