目的 通过测定准分子激光原位角膜磨镶术(LASIK)后患者泪液分泌量、泪膜破裂时间(BUT)、角膜知觉、角膜上皮下神经丛密度和泪液中神经生长因子(NGF)含量变化,评估角膜神经损伤恢复情况及泪液中NGF含量的变化趋势.方法 自身对照研究.选取沧州市中心医院LASIK手术患者102例(204眼),测定术前及术后1d、1个月、3个月时角膜泪液分泌量、BUT和泪液中NGF含量；测定术前及术后1d、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5个观测指标采用SPSS 13.0软件进行统计分析.结果 术前角膜泪液中NGF含量为(51.97±3.66)pg/ml,术后1 d为(225.29±33.64)pg/ml,1个月为(104.77±+2.19)pg/ml,均高于术前(t1 d=11.39,t1个月=5.79,P均＜0.05)；术后3个月时恢复到术前水平(t3 个月=0.47,P＞0.05).术前角膜泪液分泌量为(26.59±0.10)mm,术后1d为(12.12±1.03)mm,1个月为(17.24±0.77)mm,均低于术前(t1d=9.63,t1个月=8.52,P均＜0.05)；术后3个月时恢复到术前水平(t3个月=2.09,P＞0.05).术前BUT为(10.06±0.45)s,术后1d为(1.47±0.21)s,1个月为(4.71±0.23)s,均低于术前(t1 d=19.25,t1个月=10.00,P均＜0.05)；术后3个月时恢复到术前水平(t3个月=1.11,P＞0.05).术前角膜上皮下神经丛密度为(1582±175)μm,术后1d、1个月、3个月、6个月、1年分别为(208±32)μm、(254±31)μm、(588±65)μm、(634±79)μm、(938±119)μm,均低于术前(t1 d=7.71,t1个月=7.35,t3个月=5.48,t6个月=4.72,t1年=2.73,P均＜0.05)；术后2年时恢复到术前水平(t2年=0.15,P＞0.05).术前角膜知觉为(58.82±0.53)mm,术后1d、1个月、3个月、6个月分别为(0.59±0.40)mm、(15.59±2.67)mm、(41.18±1.44)mm、(51.36±0.83)mm,均低于术前(t1 d=79.20,t1个月=15.04,t3个月=7.44,t6个月=5.40,P均＜0.05)；术后1年时恢复到术前水平(t1年=1.14,P＞0.05).结论 LASIK术后泪液中NGF含量先增高后恢复到正常,角膜上皮下神经丛密度、角膜知觉、泪液分泌量和BUT先降低后恢复到正常;泪液中NGF含量、泪液分泌量和BUT术后3个月恢复正常,而角膜知觉术后1年时恢复正常,角膜上皮下神经丛密度术后2年时恢复正常.
目的 通過測定準分子激光原位角膜磨鑲術(LASIK)後患者淚液分泌量、淚膜破裂時間(BUT)、角膜知覺、角膜上皮下神經叢密度和淚液中神經生長因子(NGF)含量變化,評估角膜神經損傷恢複情況及淚液中NGF含量的變化趨勢.方法 自身對照研究.選取滄州市中心醫院LASIK手術患者102例(204眼),測定術前及術後1d、1箇月、3箇月時角膜淚液分泌量、BUT和淚液中NGF含量；測定術前及術後1d、1箇月、3箇月、6箇月、1年、2年時角膜上皮下神經叢密度和角膜知覺.對上述5箇觀測指標採用SPSS 13.0軟件進行統計分析.結果 術前角膜淚液中NGF含量為(51.97±3.66)pg/ml,術後1 d為(225.29±33.64)pg/ml,1箇月為(104.77±+2.19)pg/ml,均高于術前(t1 d=11.39,t1箇月=5.79,P均＜0.05)；術後3箇月時恢複到術前水平(t3 箇月=0.47,P＞0.05).術前角膜淚液分泌量為(26.59±0.10)mm,術後1d為(12.12±1.03)mm,1箇月為(17.24±0.77)mm,均低于術前(t1d=9.63,t1箇月=8.52,P均＜0.05)；術後3箇月時恢複到術前水平(t3箇月=2.09,P＞0.05).術前BUT為(10.06±0.45)s,術後1d為(1.47±0.21)s,1箇月為(4.71±0.23)s,均低于術前(t1 d=19.25,t1箇月=10.00,P均＜0.05)；術後3箇月時恢複到術前水平(t3箇月=1.11,P＞0.05).術前角膜上皮下神經叢密度為(1582±175)μm,術後1d、1箇月、3箇月、6箇月、1年分彆為(208±32)μm、(254±31)μm、(588±65)μm、(634±79)μm、(938±119)μm,均低于術前(t1 d=7.71,t1箇月=7.35,t3箇月=5.48,t6箇月=4.72,t1年=2.73,P均＜0.05)；術後2年時恢複到術前水平(t2年=0.15,P＞0.05).術前角膜知覺為(58.82±0.53)mm,術後1d、1箇月、3箇月、6箇月分彆為(0.59±0.40)mm、(15.59±2.67)mm、(41.18±1.44)mm、(51.36±0.83)mm,均低于術前(t1 d=79.20,t1箇月=15.04,t3箇月=7.44,t6箇月=5.40,P均＜0.05)；術後1年時恢複到術前水平(t1年=1.14,P＞0.05).結論 LASIK術後淚液中NGF含量先增高後恢複到正常,角膜上皮下神經叢密度、角膜知覺、淚液分泌量和BUT先降低後恢複到正常;淚液中NGF含量、淚液分泌量和BUT術後3箇月恢複正常,而角膜知覺術後1年時恢複正常,角膜上皮下神經叢密度術後2年時恢複正常.
목적 통과측정준분자격광원위각막마양술(LASIK)후환자루액분비량、루막파렬시간(BUT)、각막지각、각막상피하신경총밀도화루액중신경생장인자(NGF)함량변화,평고각막신경손상회복정황급루액중NGF함량적변화추세.방법 자신대조연구.선취창주시중심의원LASIK수술환자102례(204안),측정술전급술후1d、1개월、3개월시각막루액분비량、BUT화루액중NGF함량；측정술전급술후1d、1개월、3개월、6개월、1년、2년시각막상피하신경총밀도화각막지각.대상술5개관측지표채용SPSS 13.0연건진행통계분석.결과 술전각막루액중NGF함량위(51.97±3.66)pg/ml,술후1 d위(225.29±33.64)pg/ml,1개월위(104.77±+2.19)pg/ml,균고우술전(t1 d=11.39,t1개월=5.79,P균＜0.05)；술후3개월시회복도술전수평(t3 개월=0.47,P＞0.05).술전각막루액분비량위(26.59±0.10)mm,술후1d위(12.12±1.03)mm,1개월위(17.24±0.77)mm,균저우술전(t1d=9.63,t1개월=8.52,P균＜0.05)；술후3개월시회복도술전수평(t3개월=2.09,P＞0.05).술전BUT위(10.06±0.45)s,술후1d위(1.47±0.21)s,1개월위(4.71±0.23)s,균저우술전(t1 d=19.25,t1개월=10.00,P균＜0.05)；술후3개월시회복도술전수평(t3개월=1.11,P＞0.05).술전각막상피하신경총밀도위(1582±175)μm,술후1d、1개월、3개월、6개월、1년분별위(208±32)μm、(254±31)μm、(588±65)μm、(634±79)μm、(938±119)μm,균저우술전(t1 d=7.71,t1개월=7.35,t3개월=5.48,t6개월=4.72,t1년=2.73,P균＜0.05)；술후2년시회복도술전수평(t2년=0.15,P＞0.05).술전각막지각위(58.82±0.53)mm,술후1d、1개월、3개월、6개월분별위(0.59±0.40)mm、(15.59±2.67)mm、(41.18±1.44)mm、(51.36±0.83)mm,균저우술전(t1 d=79.20,t1개월=15.04,t3개월=7.44,t6개월=5.40,P균＜0.05)；술후1년시회복도술전수평(t1년=1.14,P＞0.05).결론 LASIK술후루액중NGF함량선증고후회복도정상,각막상피하신경총밀도、각막지각、루액분비량화BUT선강저후회복도정상;루액중NGF함량、루액분비량화BUT술후3개월회복정상,이각막지각술후1년시회복정상,각막상피하신경총밀도술후2년시회복정상.
Objective To study corneal nerve damage and changes in the quantity of nerve growth factor (NGF) in tears by observing the NGF in tears,corneal subepithelial nerve plexus density,corneal sensation,tear secretion and tear film stability (BUT) after laser in situ keratomileusis (LASIK) surgery.Methods Two hundred and four eyes of 102 postoperative patients were examined in this self-controlled study.Tear secretion quantity,BUT and the NGF level in tears were measured preoperatively and 1 day,1 month and 3 months after surgery.Nerve plexus density under the corneal epithelium and corneal sensation were measured preoperatively and 1 day,1 month,3 months,6 months,1 year and 2 years after surgery.All data were analyzed.Results The NGF level in tears in preoperative patients was 51.97±3.66 pg/ml and was 225.29±33.64 pg/ml 1 day after surgery and 104.77±+2.19 pg/ml 1 month after surgery,both of which were higher compared to the the preoperative measurement (t1 day=11.39,t1 month=5.79,both P＜0.05).The NGF quantity at 3 months after surgery had reverted to the preoperative level (t3 months=0.47,P＞0.05).Tear secretion quantity in preoperative patients was 26.59±0.10 mm,and was 12.12±1.03 mm 1 day after surgery and 17.24±0.77 mm 1 month after surgery,both of which were lower compared to the preoperative level (t1 day=9.63,t1 month=8.52,both P＜0.05).Tear secretion quantity at 3 months after the operation had reverted to the preoperative level (t3 months=2.09,P＞0.05).BUT in preoperative patients was 10.06±0.45 s,and was 1.47±0.21 s 1 day after surgery and 4.71±0.23 s 1 month after surgery,both of which were reduced compared to the preoperative level (t1ay=19.25,t1month=10.00,both P＜0.05).BUT at 3 months after surgery had reverted to the preoperative level (t3 months=1.11,P＞0.05).Corneal subepithelial nerve plexus density in preoperative patients was 1582±175 μm and was 208±32 μm at one day,254±31 μm at 1 month,588±65 μm at 3 months,634±79 μm at 6 months and 938±119 μm at 1 year,all of which were significantly decreased after surgery compared to the preoperative level (t1 day=7.71,t1 month=7.35,t3 months=5.48,t6 months=4.72,t1 year=2.73,all P＜0.05).Corneal subepithelial nerve plexus density 2 years after surgery had basically reverted to the preoperative level and the difference was not statistically significant (t=0.15,P＞0.05).Corneal sensation in preoperative patients was 58.82±0.53 mm and was 0.59±0.40 mm at 1 day,15.59±2.67 mm at 1 month,41.18±1.4 mm at 3 months and 51.36±0.83 mm at 6 months,all of which were significantly decreased after surgery compared to the preoperative level (t1 day=79.20,t1 months=15.04,t3 months=7.44,t6 months=5.40,all P＜0.05).Corneal subepithelial nerve plexus density at 1 year after the operation had basically reverted to the preoperative level and the difference was not statistically significant (t1 year=1.14,P＞0.05).Conclusion After LASIK surgery,the NGF quantity in tears increased and then recovered gradually to the preoperative level.Corneal subepithelial nerve plexus density,tear secretion quantity,BUT and corneal sensation initially decreased and then recovered gradually to preoperative levels.NGF quantity in tears,tear secretion quantity and BUT had recovered by 3 months after surgery.Corneal sensation recovered to the preoperative level by 1 year after surgery while nerve plexus density under the corneal epithelium basal cells recovered to the preoperative level by 2 years after surgery.
