飞秒激光制瓣的LASIK与SMILE术后干眼参数的Meta分析

目的系统评价飞秒激光制瓣的LASIK（FS-LASIK）和飞秒激光小切口角膜基质透镜取出术（SMILE）治疗近视术后干眼参数的差异。方法Meta分析。检索PubMed、Web of Science、超星Medalink、中国生物医学文献数据库（CBM disc）、中国期刊全文数据库（CNKI）、万方数据库，对比较FS-LASIK和SMILE术后干眼参数的文献进行Meta分析。分析内容主要包括术前，术后1周、1个月、3个月及6个月的泪液分泌试验（SIT）、泪膜破裂时间（BUT）、眼表疾病指数（OSDI）。采用RevMan 5．0进行统计分析，计量资料的疗效分析以加权均数差（WMD）及95％CI表示。采用Cochrane风险评价工具进行文献质量评价。结果共有5篇文献符合纳入标准，共317例（477眼），其中235眼行FS-LASIK，242眼行SMILE。Meta分析结果显示：FS-LASIK和SMILE患者术前SIT（WMD=-0.20，95％CI：-1.16～0.76，P>0.05）、BUT（WMD=-0.10，95％CI：-0.88～0.68，P>0.05）差异无统计学意义；术后1周、1个月、3个月及6个月两者SIT差异均无统计学意义；术后1个月及6个月两者BUT差异有统计学意义（WMD=-0.65，95％CI：-1.10～-0.20，P<0.05；WMD=-1.09，95％CI：-1.77～-0.40，P<0.01），术后6个月两者OSDI差异有统计学意义（WMD=9.18，95％CI：4.65～13.71，P<0.05）。结论与FS-LASIK相比，SMILE术后干眼症状较轻，对眼表的干扰更小。

Meta-analysis of dry eye parameters after femtosecond LASIK and SMILE surgery

Objective To evaluate and compare dry eye parameters after femtosecond LASIK and SMILE surgery by conducting a systematic review of the literature. Methods This was a meta-analysis study. Using the Cochrane system evaluation method, a meta-analysis search of PubMed, Web of Science, superstar Medalink, Chinese biomedical literature database (CBM disc), CNKI and Wanfang database, was performed on dry eye parameters in the literature that featured FS-LASIK and SMILE surgery. Content analysis mainly included preoperative measurements and assessments were performed 1 week, 1 month, 3 months and 6 months postoperatively based on the Schirmer I test (SIT) without anesthesia , tear film break-up time ( BUT ) and the ocular surface disease index ( OSDI ) . RevMan 5.0 was used for statistical analysis; measurement data were statistically analyzed for curative effect with weighted mean differences (WMD) (95%CI). A quality assessment was evaluated by the Cochrane risk assessment tools. Results A total of five articles satisfied the inclusion criteria for this study , a total of 317 cases ( 477 eyes ): There are 235 eyes of FS-LASIK , 242 eyes of SMILE . Meta-analysis showed that there was no statistically significant difference between FS-LASIK and SMILE in patients with preoperative SIT (WMD=-0.20, 95%CI: -1.16~0.76, P>0.05) and BUT (WMD=-0.10, 95%CI: -0.88~0.68, P>0.05). One week, 1 month, 3 months and 6 months postoperatively, the SIT between FS-LASIK and SMILE was not statistically significant. However, at 1 month and 6 months postoperatively, the BUT between FS-LASIK and SMILE was statistically significant (WMD=-0.65, 95%CI: -1.10~-0.20, P<0.05; WMD=-1.09, 95%CI: -1.77~-0.40, P<0.01). Six months postoperatively, the OSDI between FS-LASIK and SMILE was statistically significant (WMD=9.18, 95%CI: 4.65~13.71, P<0.05). Conclusion Compared with FS-LASIK, dry eye symptoms after SMILE is lighter and smaller disturbance of ocular surface.