目的：探讨飞秒激光与机械板层刀制瓣准分子激光角膜磨镶术(LASIK)对眼表的影响，研究制瓣方法不同对术后眼表的影响。

方法：本研究纳入对象选择2016-01/2017-01于我院眼科进行屈光手术治疗的218例436眼近视患者，进行病历资料回顾性分析，所有患者均采用LASIK术治疗，术后主诉有不同程度的眼干、异物感及不适症状。将采用机械板层刀制瓣的61例122眼患者设为对照组，观察组采用飞秒激光制瓣的157例314眼设为观察组。比较两组患眼术前、术后1wk，1、3mo干眼症状评分，角膜荧光素染色(FL)评分、泪膜破裂时间(BUT)以及基础泪液分泌试验(SⅠt)。

结果：两组患者术前干眼症状评分差异无统计学意义(P>0.05)，手术前后两组患者干眼症状评分比较差异有统计学意义(P<0.05)，术后1wk，对照组干眼症状评分大于观察组，两组患者干眼症状评分差异有统计学意义(P<0.05)，术后1、3mo，两组干眼症状评分差异无统计学意义(P>0.05)。术前两组患者BUT比较差异无统计学意义(P>0.05)，两组患者手术前后BUT差异有统计学意义(P<0.05)，对照组术后BUT显著低于观察组，差异有统计学意义(P<0.05)。术前两组患者FL评分比较差异无统计学意义(P>0.05)，两组患者手术前后FL评分差异有统计学意义(P<0.05)，对照组术后1wk，1mo FL评分显著高于观察组，差异有统计学意义(P<0.05)，术后3mo两组患者FL评分差异无统计学意义(P>0.05)。术前两组患者SⅠt比较，差异无统计学意义(P>0.05)，两组患者手术前后SⅠt评分差异有统计学意义(P<0.05)，对照组术后1wk，1mo SⅠt显著低于观察组，差异有统计学意义(P<0.05)，术后3mo两组患者SⅠt比较，差异无统计学意义(P>0.05)。两组患者术后均无严重的并发症发生。

结论：飞秒激光较机械板层刀制瓣LASIK对眼表影响更小，干眼症症状更轻，影响时间更短。

METHODS: This study included 218 cases(436 eyes)myopia patients from January 2016 to January 2017 in our hospital for refractive surgery, their medical records were retrospectively analyzed. They all underwent LASIK surgery treatment and complained of different degree of dry eye postoperatively, foreign body sensation and discomfort. Mechanical microkeratome was used in 61 cases(122 eyes)of patients and they were as control group, with femtosecond laser, 157 cases(314 eyes)were set as observation group. We compared dry eye symptom scores, corneal fluorescein staining(FL)score, break-up time(BUT)and basic tear secretion test(SⅠt)between the two groups preoperatively and postoperatively 1wk, 1, and 3mo.

RESULTS: Before surgery, dry eye symptoms scoring of two groups had no statistically significant difference(P>0.05); the scores of the two groups were significantly different before and after surgery(P<0.05); postoperatively 1wk, dry eye symptoms score of control group was greater than that of the observation group with significant difference(P<0.05), the sores at 1 and 3mo after surgery were not different between the two groups(P>0.05). There was no significant differenc on the preoperative BUT between the two groups(P>0.05). BUT before and after surgery was significantly different of both groups(P<0.05). BUT of control group was significantly lower than that of observation group postoperatively(P<0.05). Before surgery, FL score of two groups had no statistically significant difference(P>0.05); the scores of the two groups were significantly different before and after surgery(P<0.05); postoperatively 1wk and 1mo, FL score of control group was greater than that of the observation group with significant difference(P<0.05), the sores at 3mo after surgery were not different between the two groups(P>0.05). Before surgery, SⅠt of two groups had no statistically significant difference(P>0.05); the scores of the two groups were significantly different before and after surgery(P<0.05); postoperatively 1wk and 1mo, SⅠt of control group was lower than that of the observation group with significant difference(P<0.05); SⅠt at 3mo after surgery were not different between the two groups(P>0.05). Two groups of patients had no serious postoperative complications occurred.

CONCLUSION: Compared with the mechanical microkeratome for creating corneal flap, LASIK with femtosecond laser for creating corneal flap has less effect on ocular surface and has mild symptoms of dry eye, the effect time is also shortened.