眼部抗氧化劑活性對近視雷射手術之術後療效的影響程度分析

本研究旨在研究評估手術前之眼表面總抗氧化能力和抗壞血酸對於角膜透鏡摘除術此種近視雷射手術術後結果之影響。本研究為一項前瞻性非隨機對照試驗，招募了160 位接受過角膜透鏡摘除術的受試者眼睛。研究人員收集了角膜切口附近的淚液並測定總抗氧化能力和抗壞血酸的濃度。另外也取得包括術後視力、術後度數以及乾眼症相關指標在內的眼部檢查結果。關於統計方式，本研究採用獨立T檢定、單因子獨立變異數分析以及廣義線性混合模型。關於總抗氧化能力的研究結果部分，在手術後1個月，高總抗氧化能力組的裸視顯著較佳，而低總抗氧化能力組有較多的表淺性角膜炎。且低總抗氧化能力組的抗氧化劑減少趨勢更為顯著。於次族群分析中，低總抗氧化能力族群以及年長者與較差裸視顯著相關，而厚的中央角膜厚度與較好的裸視顯著相關。此外，低總抗氧化能力的患者與較高的表淺性角膜炎發生率顯著相關，而年長者與較低的表淺性角膜炎發生率顯著相關。在術後1個月時，乾眼症低抗壞血酸組表現出比非乾眼症和乾眼症高抗壞血酸組更差的裸視。且與另外兩組相比，乾眼症低抗壞血酸組的抗壞血酸減少量最大。於次族群分析中，乾眼症高抗壞血酸組具高度近視者與較差的術後裸視顯著相關，而乾眼症低抗壞血酸組具高度近視和大光學治療區者與較差的術後裸視有顯著相關。總之，在角膜透鏡摘除術前具有較低總抗氧化能力的個案與較差的術後裸視和較高的術後表淺性角膜炎風險有關。另外，同時具有乾眼症和低術前抗壞血酸狀態的個案在接受角膜透鏡摘除術後其裸視顯著較差。因此除了年齡，術前的眼表面抗氧化力或許可以考慮放入近視雷射的評估中以找出容易術後恢復不良的個案以及擬定術後照護計畫。

We aim to evaluate the effect of preoperative total antioxidant capacity (TAC) and ascorbic acid (AA) of ocular surface on the postoperative outcome of keratolenticule extraction (KLEx) surgery. A prospective non-randomized control trial was conducted, and 160 eyes that had undergone KLEx refractive surgery were enrolled. The tear films near corneal incisions were collected and the concentrations of TAC and AA were determined. The ocular parameters including the postoperative visual acuity, postoperative refractive status, and dry eye disease (DED)-related indexes were obtained. The independent T test, one-way ANOVA and generalized linear mixed model was adopted for analysis. One month after the KLEx surgery, the uncorrected distance visual acuity (UDVA) was significantly higher in the high TAC group, and low TAC group associated with superficial keratitis risk compared to high TAC group. The trends of TAC and ascorbic acid (AA) decrements were more significant in the low TAC group. Low TAC population and old age correlated to poor UDVA while the thick CCT correlated to better UDVA. Besides, the low TAC population correlated to higher superficial keratitis rate, while old age correlated to lower superficial keratitis rate. One month postoperatively, the DED-low AA group demonstrated a worse UDVA than the non-DED and DED-high AA groups. After the KLEx surgery, the amount of AA decrement was the largest in the DED-low AA group compared to another two groups. The high myopia related to worse postoperative UDVA in the DED-high AA group, and the high myopia and large OZ significantly correlated to worse postoperative UDVA in the DED-low AA group. In conclusion, the presence of low TAC expression correlated to worse UDVA and higher risk of superficial keratitis after KLEx. Besides, the concurrent DED and low baseline AA status correlates to worse postoperative UDVA in those received KLEx surgery. Consequently, except for age, the ocular surface antioxidant examination before refractive surgery may be suggested to find the high-risk population of impaired recovery and modify postoperative plan.