口服维生素D3治疗飞秒激光辅助LASIK术后干眼

目的：探讨口服维生素D3对飞秒激光辅助准分子激光原位角膜磨镶术（FS-LASIK）后干眼的治疗效 果。方法：前瞻性临床研究。选择2019 年1 ─12 月在柳州市工人医院接受FS-LASIK且术后1 个月有 明显干眼的患者90例（90眼）。所有患者被随机分为2组：研究组45例（45眼），连续12周服用维生素 D3 2 000 IU/d；对照组45例（45眼），不口服任何药物。分别在用药前及用药后第1、3、6个月测定患 者的眼表疾病指数（OSDI）、泪液破裂时间（TBUT）、Schirmer Ⅰ试验、泪河高度，血清维生素D3水平 以及对比敏感度情况。采用Kolmogorov-Smirnov、LSD-t检验和独立样本t检验进行统计分析。结果： 服药后1 个月，研究组OSDI评分均值明显低于对照组，差异有统计学意义（t=4.32，P=0.007）。研究 组的TBUT（t=3.02，P=0.027）和Schirmer Ⅰ试验值（t=2.78，P=0.030）均高于对照组。服药后3个月， 研究组OSDI（t=2.50，P=0.010）、TBUT（t=2.32，P=0.031）和Schirmer Ⅰ试验值（t=3.25，P=0.026）均优于对照组，差异均具有统计学意义。服药后6个月，2组患者OSDI（t=2.31，P=0.025）、TBUT（t=2.30， P=0.039）和Schirmer Ⅰ试验值（t=3.03，P=0.028）差异均具有统计学意义，研究组恢复更好。研究组患者血清维生素D3 水平与OSDI评分呈负相关（r=-0.90，P<0.001），与Schirmer Ⅰ试验值（r=0.88， P<0.001）、TBUT评分（r=0.89，P<0.001）和TMH（r=0.80，P<0.001）呈正相关。服药后6个月时，研究组患者的明视对比敏感度和暗视对比敏感度均优于对照组（3 cpd：t =2.40，P=0.04；6 cpd： t=2.16， P=0.04；12 cpd：t =2.23，P=0.04；18 cpd：t =2.37，P=0.04）。结论：维生素D3不仅改善了术后干眼症状及泪膜稳定性，而且可以改善FS-LASIK术后的视觉质量。

Efficacy of Oral Vitamin D3 Supplementation for Dry Eye after Femtosecond Laser-Assisted LASIK

Objective: To assess the effect of oral vitamin D3 supplementation for dry eye after femtosecond laserassisted LASIK (FS-LASIK). Methods: In this prospective study, 90 patients who underwent FSLASIK surgery in Liuzhou Workers' Hospital from January to December 2019 and who had obvious dry eyes one month after the operation were selected. The subjects were randomly divided into two groups: An experimental group (n=45) that received vitamin D3 2 000 IU/d continuously for 12 weeks after the operation and a control group (n=45) that did not take vitamin D3 orally. The ocular surface disease index (OSDI), tear break up time (TBUT) and Shirmer Ⅰ test were used to evaluate patients preoperatively and1, 3 and 6 months after treatment. Serum vitamin D level was also measured. Kolmogorov-Smirnov, LSD-t test and independent sample t test were used for statistics analysis. Results: One month after treatment, the mean OSDI score of the experimental group was significantly lower than that of the control group (t=4.32, P=0.007). TBUT and Schirmer Ⅰ of the experimental group were higher than those of the control group. The OSDI (t=2.50, P=0.010), TBUT (t=2.32, P=0.031) and Schirmer Ⅰ test values (t=3.25, P=0.026) of the experimental group were significantly lower than those of the control group at 3 months after treatment. There were significant differences in OSDI (t=2.31, P=0.025), TBUT (t=2.30, P=0.039) and Schirmer Ⅰ test values (t=3.03, P=0.028) between the two groups at 6 months after treatment. Serum vitamin D3 level was negatively correlated with the OSDI score (r=-0.90, P<0.001), and positively correlated with the Schirmer Ⅰ test (r=0.88, P<0.001), TBUT score (r=0.89, P<0.001) and TMH (r=0.80, P<0.001). Conclusions: Vitamin D3 has positive effects on post-LASIK dry eye symptoms, tear quality and the ocular surface condition. Vitamin D3 also improved visual quality after FS-LASIK.