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SPT-TransPRK术后早期干眼发生情况及相关因素分析

Incidence and associated factors of early postoperative dry eye disease after SPT-TransPRK

    摘要
  • 摘要:
    目的 观察智能脉冲技术辅助下经上皮准分子激光角膜切削术（SPT-TransPRK）后早期眼表指标变化及干眼发生情况，并分析其相关因素。
    方法 采用单中心前瞻性队列研究设计，纳入SPT-TransPRK术前无干眼患者52例（52眼），于术前及术后2周、1月、2月、3月随访，评估眼表疾病指数（OSDI）评分、首次非侵入性泪膜破裂时间（NIBUTf）、角膜荧光素染色评分（NEI评分）、SchirmerⅠ试验（SⅠT）、泪河高度（TMH）、眼红指数及睑板腺评分（meiboscore），分析术后干眼发生情况及其相关因素。
    结果 术后2周、1月、2月及3月干眼发生率分别为57.7%、36.5%、9.6%和9.6%。OSDI评分、NIBUTf及NEI评分在术后不同时间点间总体差异均有统计学意义（均P ＜ 0.05），SⅠT、TMH及眼红指数总体差异均无统计学意义（均P ＞ 0.05）。不同术前meiboscore组术后干眼发生率及多数眼表指标的变化差异均无统计学意义。术前OSDI评分升高与术后2周发生干眼独立相关（OR = 1.120，95%CI：1.001 ～ 1.253，P = 0.048），消融区直径增大与术后1月发生干眼独立相关（OR = 1.987，95%CI：1.100 ～ 3.590，P = 0.023）。消融区直径与术后1月OSDI评分呈正相关（rs = 0.325，P = 0.019）。
    结论 SPT-TransPRK术后干眼主要发生于术后早期，多数随时间逐渐缓解。术前OSDI评分和消融区直径对术后早期干眼发生具有一定提示价值。

     

    Abstract:
    Objective  To investigate early postoperative changes in ocular surface parameters and the incidence of dry eye disease (DED) after smart pulse technology-assisted transepithelial photorefractive keratectomy (SPT-TransPRK), and to analyze the associated factors.
    Methods This single-center prospective cohort study included 52 patients (52 eyes) without preoperative DED who underwent SPT-TransPRK. Assessments were performed preoperatively and at 2 weeks and 1, 2, and 3 months postoperatively, including the Ocular Surface Disease Index (OSDI) score, first noninvasive tear film breakup time (NIBUTf), corneal fluorescein staining score based on the National Eye Institute (NEI) scale, Schirmer Ⅰ test (SIT), tear meniscus height (TMH), ocular redness index, and meiboscore. The incidence of postoperative DED and its associated factors were analyzed.
    Results The incidences of DED at 2 weeks and 1, 2, and 3 months postoperatively were 57.7%, 36.5%, 9.6%, and 9.6%, respectively. Significant overall differences across follow-up time points were observed in the OSDI score, NIBUTf, and NEI score (all P ＜ 0.05), whereas no significant overall differences were observed in SIT, TMH, or the ocular redness index (all P ＞ 0.05). Postoperative DED incidence and changes in most ocular surface parameters did not differ significantly between groups stratified by preoperative meiboscore. A higher preoperative OSDI score was independently associated with DED at 2 weeks postoperatively (OR = 1.120, 95%CI: 1.001-1.253, P = 0.048), whereas a larger ablation zone diameter was independently associated with DED at 1 month postoperatively (OR = 1.987, 95%CI: 1.100-3.590, P = 0.023). Ablation zone diameter was positively correlated with the OSDI score at 1 month postoperatively (rs = 0.325, P = 0.019).
    Conclusion DED after SPT-TransPRK occurred predominantly in the early postoperative period and gradually resolved in most patients. The preoperative OSDI score and ablation zone diameter may help identify patients at risk of early postoperative DED.

     

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