摘要目的 通过测定LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉变化,评估2种手术方式对角膜神经损伤的情况.方法 前瞻性临床病例研究.选取河北省沧州市中心医院LASIK手术患者102例(204眼),LASEK手术患者34例(68眼).测定2组术前,术后1周、1个月、3个月、6个月、1年、2年时角膜上皮下神经丛密度和角膜知觉,对上述2个指标采用重复测量方差分析进行比较.结果 术前LASIK组角膜上皮下神经丛密度和角膜知觉分别为(1 582±175)μm、(58.82±0.53)mm.术后1周[(208±32)μm]、1个月[(254 ±32) μm]、3个月[(588±65)μm]、6个月[(648 ±65) μm]、1年[(938±119)μm]时角膜上皮下神经丛密度均较术前降低(F=7.13,P＜0.05);术后2年时恢复到术前水平(t=0.147,P＞0.05).术后1周[(0.59±0.40)mm]、1个月[(15.59±2.67)mm]、3个月[(41.18±3.44)mm]、6个月[(52.88±2.58)mm]时角膜知觉均较术前降低(F=78.13,P＜0.05);术后1年时恢复到术前水平(t=1.144,P＞0.05).术前LASEK组角膜上皮下神经丛密度和角膜知觉分别为(1 406±195)μm、(58.82±0.53)mm.术后1周[(182±33)μm]、1个月[(538±83)μm]、3个月[(784±74)μm]、6个月[(1024±74)μm]时角膜上皮下神经丛密度均较术前降低(F=34.51,P＜0.05);术后1年时恢复到术前水平(t=1.906,P＞0.05);术后1周[(1.18±0.53)mm]、1个月[(38.82±3.11)mm]、3个月[(55.29±1.00)mm]时角膜知觉均较术前降低(F=361.98,P＜0.05);术后6个月时恢复到术前水平(t=0.899,P＞0.05).LASEK组在术后1个月、3个月、6个月时角膜知觉恢复优于LASIK组,其余时间点差异无统计学意义.LASEK组在术后6个月和1年时角膜上皮下神经丛密度恢复优于LASIK组,其余时间点差异无统计学意义.结论 LASIK和LASEK术后角膜上皮下神经丛密度、角膜知觉均较术前降低;LASEK术后角膜上皮下神经丛密度、角膜知觉恢复均优于LASIK.

abstractsObjective To study corneal nerve damage by observing the corneal subepithelial nerve plexus density and corneal sensitivity after LASIK and LASEK.Methods In this prospective clinical study,102 LASIK (204 eyes) and 34 LASEK (68 eyes) postoperative patients from the Central Hospital of Cangzhou City were enrolled.Nerve plexus density under corneal epithelium basal cells and corneal sensitivity were examined in both groups 1 day preoperatively and 1 week,1 month,3 months,6 months,1 year,and 2 years after the surgery.Repeat measured ANOVA was used to statistically analyze and compare the above two indicators.Results The LASIK group:corneal subepithelial nerve plexus density was 1 582±175 μm preoperatively and 208±32 μm at 1 week,254±32 μm at 1 month,588±65 μm at 3 months,648±65 μm at 6 months,and 938±119 μm at 1 year.All measurements had decreased significantly after surgery (F=7.13,P＜0.05).However,the measurements had almost returned to preoperative levels 2 years after surgery (t=0.147,P＞0.05).Corneal sensitivity was 58.82±0.53 mm preoperatively and 0.59±0.40 mm at 1 week,15.59±2.67 mm at 1 month,41.18±3.44 mm at 3 months and 52.88±2.58 mm at 6 months.All measurements had decreased significantly after the surgery (F=78.13,P＜0.05).However,the measurements had almostreturned to preoperative levels at 1 year after surgery (t=1.144,P＞0.05).The LASEK group:corneal subepithelial nerve plexus density was 1 406±195 μm preoperatively and was 182±33 μm at 1 week,538±83 μm at 1 month,784±74 μm at 3 months,and 1 024±74 μm at 6 months.All measurements had decreased significantly after surgery (F=34.51,P＜0.05).However,the measurements had almost returned to preoperative levels at 1 year after surgery (t=1.906,P＞0.05).Corneal sensitivity was 58.82±0.53 mm preoperatively and 1.18±0.53 mm at 1 week,38.82±3.11 mm at 1 month,and 55.29±1.00 mm at 3 months.All measurements had decreased significantly after the surgery (F=361.98,P＜0.05).However,measurements had almost returned to preoperative levels 6 months after surgery (t=0.899,P＞0.05).When the two types of surgeries were compared,recovery of corneal sensation in the LASEK group was better at 1 month,3 months,and 6 months postoperatively than recovery in the LASIK group.Recovery of corneal density in the subepithelial nerve plexus was better in the LASEK group at 6 months and 1 year than recovery in the LASIK group.However,the differences at the time points were not statistically significant.Conclusion The density of the corneal subepithelial nerve plexus and corneal sensitivity are lower in both the LASEK and LASIK groups compared to preoperative levels.After surgery,recovery of both the subepithelial nerve plexus density and corneal sensitivity are better in the LASEK group than in the LASIK group.