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.	中華醫學會眼科學分會角膜病學組. 干眼臨床診療專家共識 (2013 年). 中華眼科雜志, 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.	葛慶曼, 崔傳波, 孔德言, 等. 激光掃描共焦顯微鏡對飛秒激光小切口基質透鏡取出術后角膜帽神經修復的動態觀察. 中華實驗眼科雜志, 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.	買志彬, 劉蘇冰, 聶曉麗, 等. 飛秒激光和微型角膜刀制瓣 LASIK 術后共焦顯微鏡檢查比較. 中華實驗眼科雜志, 2012, 30(7): 633-637.
9.	魏升升, 王雁, 耿維莉, 等. 飛秒激光 LASIK 術后早期不同部位角膜敏感性變化研究. 中國實用眼科雜志, 2012, 30(4): 397-401.
10.	危平輝, 王雁, 李華, 等. 飛秒激光小切口角膜基質透鏡取出術光學區大小對角膜生物力學特性影響的研究. 中華眼科雜志, 2017, 53(3): 182-187.
11.	徐婧, 李瑩, 余晨穎, 等. 角膜板層刀和飛秒激光制瓣準分子激光原位角膜磨鑲術后淚液功能及角膜神經再生速度的比較. 中華眼視光學與視覺科學雜志, 2013, 15(7): 396-400.
12.	張豐菊, 孫明甡. 飛秒激光輔助 LASIK 與飛秒激光小切口角膜基質透鏡取出術孰優孰劣. 中華眼科雜志, 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.	梁剛, 張豐菊. 飛秒激光小切口角膜基質透鏡取出術在眼科臨床應用的新進展. 中華眼科雜志, 2016, 52(1): 68-72.
15.	邢星, 李世洋, 趙愛紅, 等. 飛秒激光小切口角膜基質透鏡取出術與準分子激光原位角膜磨鑲術治療近視對角膜內皮細胞密度影響的比較. 眼科新進展, 2016, 36(3): 247-249.

1. 中華醫學會眼科學分會角膜病學組. 干眼臨床診療專家共識 (2013 年). 中華眼科雜志, 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. 葛慶曼, 崔傳波, 孔德言, 等. 激光掃描共焦顯微鏡對飛秒激光小切口基質透鏡取出術后角膜帽神經修復的動態觀察. 中華實驗眼科雜志, 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. 買志彬, 劉蘇冰, 聶曉麗, 等. 飛秒激光和微型角膜刀制瓣 LASIK 術后共焦顯微鏡檢查比較. 中華實驗眼科雜志, 2012, 30(7): 633-637.
9. 魏升升, 王雁, 耿維莉, 等. 飛秒激光 LASIK 術后早期不同部位角膜敏感性變化研究. 中國實用眼科雜志, 2012, 30(4): 397-401.
10. 危平輝, 王雁, 李華, 等. 飛秒激光小切口角膜基質透鏡取出術光學區大小對角膜生物力學特性影響的研究. 中華眼科雜志, 2017, 53(3): 182-187.
11. 徐婧, 李瑩, 余晨穎, 等. 角膜板層刀和飛秒激光制瓣準分子激光原位角膜磨鑲術后淚液功能及角膜神經再生速度的比較. 中華眼視光學與視覺科學雜志, 2013, 15(7): 396-400.
12. 張豐菊, 孫明甡. 飛秒激光輔助 LASIK 與飛秒激光小切口角膜基質透鏡取出術孰優孰劣. 中華眼科雜志, 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. 梁剛, 張豐菊. 飛秒激光小切口角膜基質透鏡取出術在眼科臨床應用的新進展. 中華眼科雜志, 2016, 52(1): 68-72.
15. 邢星, 李世洋, 趙愛紅, 等. 飛秒激光小切口角膜基質透鏡取出術與準分子激光原位角膜磨鑲術治療近視對角膜內皮細胞密度影響的比較. 眼科新進展, 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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