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目的：研究准分子激光屈光性角膜术（ＰＲＫ与ＬＡＳＩＫ）前后泪膜的变化。方法：选择８７ 眼近视眼患者分两组进行ＰＲＫ和ＬＡＳＩＫ术，分别观察患眼术前和术后３ 天、１０ 天、１ 月、３ 月及６ 月（ＬＡＳＩＫ组未查） 的主观感觉、上皮缺损情况、泪膜形态、非侵犯性泪膜破裂时间（ＮＩＢＵＴ） 和侵犯性泪膜破裂时间（ＢＵＴ） ，并对结果作统计学分析。结果：①ＰＲＫ 组有１８ 眼感觉较术前干燥，ＬＡＳＩＫ 组无一例出现症状，两组相比有显著性差异（ Ｐ＜ ０ ．０１） 。②术后３ 天、１０ 天ＰＲＫ组术后上皮缺损者明显多于ＬＡＳＩＫ组，两组相比有显著性差异（ Ｐ＜０．０１） 。③两组各眼术前、术后的泪膜形态均无改变。④ＰＲＫ组ＢＵＴ术后３ 天、１０ 天、１ 月较术前明显缩短，有显著性差异（Ｐ＜０．０１）；ＬＡＳＩＫ 组术前、术后各期相比均无显著性差异（ Ｐ＞ ０．０５）。结论：ＰＲＫ可影响泪膜的稳定性，但随着角膜的愈合而逐渐恢复，ＬＡＳＩＫ由于保留了角膜上皮的完整性而不影响其稳定性。角膜上皮层结构的改变是引起泪膜稳定性下降的主要原因。
Objective: To study the changes of tear film before and after laser keratomileusis (PRK and LASIK). Methods: Eighty - seven eyes of patients with myopia underwent PRK and LASIK. The subjective sensations were observed before and 3 days, 10 days, 1 month, 3 months and 6 months after operation (not detected in LASIK group) Epithelial defect, tear film morphology, noninvasive tear film break-up time (NIBUT) and invasive tear film break-up time (BUT), and the results were statistically analyzed. RESULTS: ① There were 18 eyes in PRK group, which were more dry than those in preoperative and none in LASIK group. There were significant differences between the two groups (P <0.01). ② The number of postoperative epithelial defects in PRK group was significantly higher than that in LASIK group at 3 days and 10 days after operation (P <0.01). ③ There was no change in tear film morphology before and after surgery in both groups. ④ The BK, BK and BK levels in the PRK group were significantly decreased at 3 days, 10 days and 1 month after operation compared with that before operation (P <0.01). There was no significant difference between preoperative and postoperative LASIK groups (P> 0.05). Conclusion: PRK can affect the stability of tear film, but gradually recover with the healing of cornea. LASIK does not affect the stability of corneal epithelium because of its integrity. Changes in the structure of the corneal epithelium is the main reason for the drop in tear film stability.