Objective To investigate changes in tear dynamics and corneal sub-basal nerve fiber regeneration after laser in situ keratomileusis (LASIK) surgery with a femtosecond laser and a mechanical microkeratome.Methods In a prospective case-control study,40 eyes of 20 patients were treated with FEMTO LDV femtosecond laser LASIK surgery (F-LASIK group) or mechanical microkeratome LASIK surgery (M-LASIK group) respectively.Tear film break-up time (BUT),Schirmer I test with corneal fluorescein staining (FS) and in vivo confocal microscopy of corneal subbasal nerve fibers (CSNFs) were obtained preoperatively and 1 and 3 months after surgery.Images of the CSNFs were analyzed to evaluate nerve regeneration.Data were analyzed using repeated measures ANOVA,an independent samples t test,Mann-Whitney U test and Spearman correlation analysis.Results At 1 and 3 months after operation the average of BUT of F-LASIK group was significantly longer than that of M-LASIK group (t=-2.195,-2.174,P＜0.05).Schirmer I test results and the FS were comparable between the 2 groups.The nerve regeneration score was a little higher in F-LASIK group (1.03±0.63) than that in M-LASIK group (0.83±0.55) at 1 month after surgery,but there was no significant difference (Z=-1.400,P＞0.05).The nerve regeneration score in F-LASIK group (2.31±0.83) was significantly higher than that in M-LASIK group (1.93±0.80) at 3 months after surgery (Z=-2.100,P＜0.05).Significant positive correlations were found between Schirmer I test and the CSNFs regeneration score (r=0.231,P＜0.01),while there was no statistically significant associations between the CSNFs regeneration score and BUT (r=0.143,P＞0.05) or FS (r=-0.049,P＞0.05).Conclusion The recovery of tear dynamics and corneal subbasal nerve fibers is faster in FEMTO LDV LASIK than in traditional LASIK.Schirmer I test is increase with the CSNFs regeneration.%目的 比较M2机械角膜刀及FEMTO LDV飞秒激光制瓣准分子激光原位角膜磨镶术(LASIK)后泪液功能和角膜神经再生速度,为制定个性化手术方式提供依据.方法 前瞻性病例对照研究.纳入患者40例(80眼),机械角膜板层刀制瓣LASIK (M-LASIK)组和FEMTO LDV飞秒激光制瓣LASIK (F-LASIK)组各20例.观察术后1、3个月泪液功能的3项客观指标即泪膜破裂时间(BUT)、泪液分泌试验(Schirmer I试验)和角膜荧光素染色(FS)评分,并对患者进行角膜共聚焦显微镜检查,对角膜上皮下神经修复速度进行分析.对检查结果进行方差分析、独立样本t检验、Mann-Whitney U检验和Spearman相关分析.结果 术后1个月和3个月F-LASIK组BUT长于M-LASIK组,差异有统计学意义(t=-2.195、-2.174,P＜0.05)；2组间Schirmer I试验、FS评分差异无统计学意义.角膜上皮下神经纤维(CSNFs)再生速度评分,术后1个月时F-LASIK组为(1.03±0.63)分,M-LASIK组为(0.83±0.55)分,差异无统计学意义(Z=-1.400,P＞0.05)；3个月时分别为(2.31±0.83)分和(1.93±0.80)分,差异有统计学意义(Z=-2.100,P＜0.05).Schirmer I试验和CSNFs再生速度呈正相关(r=0.231,P＜0.01),而BUT(r=0.143,P＞0.05)和FS评分(r=-0.049,P＞0.05)与CSNFs再生速度无相关性.结论 飞秒激光制瓣LASIK术后泪液功能恢复较机械刀制瓣快,角膜瓣切缘处神经修复速度较机械刀制瓣LASIK快.基础泪液分泌量随着角膜上皮下神经修复速度加快而增加.
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