School of Medicine， Nanjing University， Department of Ophthalmology， Nanjing General Hospital of Nanjing Military Command of PLA， Nanjing 210002， China
Objective To investigate the changes in dry eye parameters after small incision lenticule extraction （SMILE）， femtosecond LASIK （FS-LASIK） and off-flap epipolis LASIK （Epi-LASIK）， and to investigate the effect of the type of surgery on tear film. Methods In this prospective case-control study， 66 eyes of 33 patients underwent SMILE， 48 eyes of 24 patients underwent FS-LASIK， and 61 eyes of 31 patients underwent Epi-LASIK. Tear meniscus height （TMH） measured by anterior segment optical coherence tomography （OCT）， break-up time （BUT） and Schirmer I test （SIT） were evaluated preoperatively， and at 1 week and 1， 3， and 6 months postoperatively. Differences in preoperative general information and dry eye parameters among the different groups were performed using a one-way ANOVA. Repeat measures ANOVA was used for preoperative and postoperative comparisons within the same group. Results The TMH results presented no significant decrease at all postoperative time points in the SMILE group （F=1.225， P>0.05）. The TMH results in the FS-LASIK group decreased significantly within 1 month after surgery and returned to preoperative levels at 3 months postoperatively （F=3.806， P<0.05）. The TMH results in the Epi-LASIK group decreased significantly within 3 months after surgery and did not return to preoperative levels until 6 months postoperatively （F=4.564， P<0.05）. There were significant differences in the TMH among the 3 groups after surgery （F=4.749， 8.173， 3.850， 2.830， P<0.05）. The BUT values in the SMILE and FS-LASIK groups decreased significantly within 3 months after surgery， and recovered to their preoperative levels at 6 months postoperatively （F=2.860， 3.590， P<0.05）. The BUT values at the postoperative time points were obviously lower than preoperative levels in the Epi-LASIK group （F=12.800， P<0.01）. Differences in the BUT values among the 3 groups were not statistically significant preoperatively and at 1 week and 1 month postoperatively （F=0.966， 0.115， 0.991， P>0.05） except for postoperative 3 and 6 months （F=4.448， 6.634， P<0.05）. The SIT values in the SMILE and FS-LASIK groups decreased significantly within 1 month after surgery， and recovered to their preoperative levels at 3 months postoperatively （F=14.160， 13.323， P<0.01）. The SIT values in the EPi-LASIK group recovered to their preoperative levels at 6 months postoperatively （F=10.085， P<0.01）. There were no statistically significant differences in SIT at all postoperative time points among the 3 groups （F=0.005， 2.210， 1.054， P>0.05） except 3 months postoperatively （F=10.021， P<0.01）. Conclusion The three refractive surgery techniques can result in different degrees of short-term dry eye. The dry eye parameters are best in the SMILE group and have the fastest recovery.
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