术前总抗氧化能力对角膜透镜摘除手术后短期结果的影响-动脉网

The effect of preoperative total antioxidant capacity on short-term outcomes after kerato-lenticule extraction surgery

Nature 等信源发布 2025-03-06 12:56

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可切换为仅中文

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Abstract

摘要

To evaluate influence of total antioxidant capacity expression (TAC) on outcome of kerato-lenticule extraction (KLEx). A prospective non-randomized trial was conducted and patients received KLEx were categorized via TAC concentration. A total of 56 and 36 eyes were enrolled into the low TAC and high TAC groups.

为评估总抗氧化能力表达（TAC）对角膜透镜摘除术（KLEx）结果的影响，进行了一项前瞻性非随机化试验，并通过TAC浓度对接受KLEx的患者进行分组。共有56只眼和36只眼分别被纳入低TAC组和高TAC组。

The main outcomes are the postoperative un-corrected visual acuity (UCVA), refraction and superficial keratitis between groups. The generalized liner model was applied for statistical analysis. One month after the KLEx surgery, the UCVA was significantly higher in the high TAC group (.

主要结果是术后未矫正视力（UCVA）、屈光度和组间的浅表性角膜炎。采用广义线性模型进行统计分析。KLEx手术后一个月，高TAC组的UCVA显著更高（。

= 0.028), and low TAC group associated with superficial keratitis risk compared to high TAC group (

= 0.028)，与高TAC组相比，低TAC组与浅表性角膜炎风险相关（

= 0.035). The trends of TAC and ascorbic acid (AA) decrements were more significant in the low TAC group (both

= 0.035）。TAC 和抗坏血酸 (AA) 的下降趋势在低 TAC 组中更为显著（均

< 0.05). Low TAC population and old age correlated to poor UCVA (both

<0.05）。低TAC人群和老年与较差的UCVA相关（两者均是）。

< 0.05) while the thick CCT correlated to better UCVA (

<0.05），而较厚的CCT与更好的UCVA相关联（

= 0.030). Besides, the low TAC population (

= 0.030)。此外，低TAC人群 (

= 0.032) correlated to higher superficial keratitis rate, while old age (

= 0.032) 与较高的浅表性角膜炎发生率相关，而老年 (

= 0.018) correlated to lower superficial keratitis rate. The presence of low TAC expression correlated to worse UCVA and higher risk of superficial keratitis after KLEx.

= 0.018）与较低的浅表性角膜炎发生率相关。低TAC表达的存在与更差的裸眼视力（UCVA）和KLEx后更高的浅表性角膜炎风险相关。

Introduction

简介

The keratorefractive surgeries had been applied for the correction of myopia, hyperopia, and astigmatism and several types of keratorefractive surgeries had been developed

角膜屈光手术已被用于矫正近视、远视和散光，并且已经开发出几种类型的角膜屈光手术。

. The current types of corneal refractive surgery include photorefractive keratectomy, laser in situ keratomileusis (LASIK, a flap was created by either specific blade or femtosecond laser and lifted then the excimer laser strike and evaporate the corneal stroma that account for the targeted refractive error), and the kerato-lenticule extraction (KLEx, a corneal lenticule that account for the targeted refractive error and a corneal incision were created by femtosecond laser then the corneal lenticule was removed from the incision by spatula and forceps).

当前的角膜屈光手术类型包括：准分子激光角膜切削术、激光原位角膜磨镶术（LASIK，通过特定刀片或飞秒激光创建并掀起一个角膜瓣，然后使用准分子激光照射并蒸发角膜基质以矫正目标屈光不正）、以及角膜透镜取出术（KLEx，通过飞秒激光创建一个对应目标屈光不正的角膜透镜和角膜切口，随后用刮匙和镊子从切口移除角膜透镜）。

, and the numbers of patients received KLEx surgery have increased in the past decades

，接受KLEx手术的患者数量在过去几十年中有所增加

. The visual and refractive results of KLEx surgery is fair in which more than 90% of patients received KLEx surgery achieved un-corrected visual acuity (UCVA) of 20/20 and refractive spherical equivalent within ± 1.00 diopter (D) from target values

KLEx手术的视觉和屈光结果良好，超过90%接受KLEx手术的患者达到了20/20的裸眼视力（UCVA），并且屈光球镜等效值在目标值的±1.00屈光度（D）范围内。

. Still, the corneal optical density was higher in KLex surgery than LASIK surgery during early postoperative intervals

然而，在术后早期，KLex手术的角膜光学密度比LASIK手术更高。

。

Although the safety of KLEx may be acceptable, certain postoperative complications of KLEx surgery can disturb visual outcome

虽然KLEx的安全性可以接受，但KLEx手术的某些术后并发症可能会干扰视觉效果。

. The postoperative corneal wound healing process is a major concern for keratorefractive surgeries and delayed corneal healing could lead to irritation and guarded visual acuity

术后角膜伤口愈合过程是角膜屈光手术的主要关注点，延迟的角膜愈合可能导致刺激和视力模糊。

. Besides, the dry eye disease (DED) is the most frequent postoperative complications of refractive surgeries including the KLEx surgery which can reduce the speed of visual recovery

此外，干眼病（DED）是包括KLEx手术在内的屈光手术术后最常见的并发症，会降低视力恢复的速度。

，

. Although the rate of severe DED was lower in KLEx surgery than LASIK surgery, the advanced DED can occur in individuals who have received KLEx surgery

虽然KLEx手术中严重DED的发生率较LASIK手术低，但接受KLEx手术的个体仍可能出现严重的DED。

. In the severe form of DED, the prominent superficial keratopathy and microbial keratitis may develop and the presence of visual impairment is not-uncommon

在重度DED中，常出现明显的浅表性角膜病和微生物性角膜炎，视力障碍的存在并不少见。

，

, thus the retardation of DED after KLEx surgery is crucial.

，因此在KLEx手术后DED的延迟至关重要。

The oxidative stress expression is a fundamental component in several systemic and ocular morbidities

氧化应激表达是多种全身性和眼部疾病的基本组成部分。

，

. The higher oxidative stress had been demonstrated as a major risk factor for the DED and ocular surface injury due to the intracellular stress signaling, ocular surface epithelial and goblet cell dysfunction, and the loss of tear film stability

较高的氧化应激已被证明是DED和眼表损伤的主要风险因素，这是由于细胞内应激信号传导、眼表上皮和杯状细胞功能障碍以及泪膜稳定性丧失所致。

. Moreover, the corneal alkali injury can be lessened by antioxidant including N-acetyl-L-cysteine and ascorbic acid (AA) usages, which may because the antioxidant can suppress the reactive oxygen species produced during the alkali injury of ocular surface and the following inflammation and harmful angiogenesis would decrease.

此外，包括N-乙酰-L-半胱氨酸和抗坏血酸（AA）在内的抗氧化剂的使用可以减轻角膜碱烧伤，这可能是因为抗氧化剂能够抑制眼表碱烧伤过程中产生的活性氧物质，随之而来的炎症和有害的血管生成也会减少。

，

. About the correlation between the ocular surgery and oxidative stress, the retinal surgery like the trans pars plana vitrectomy can contribute to elevated postoperative oxidative stress and increase the risk of developing glaucoma

关于眼部手术与氧化应激之间的相关性，像经平坦部玻璃体切除术这样的视网膜手术可能会导致术后氧化应激升高，并增加患青光眼的风险。

. Besides, the oxidative stress would be produced during the cataract surgery which may contribute to the corneal endothelial cell damage

此外，白内障手术过程中会产生氧化应激，这可能导致角膜内皮细胞损伤。

. Regarding the keratorefractive surgery, the elevated oxygen-derived free radicals and corresponding corneal injury were observed in the patients received LASIK surgery which can be alleviated by the application of antioxidant

关于角膜屈光手术，接受LASIK手术的患者中观察到氧自由基升高及相应的角膜损伤，应用抗氧化剂可减轻损伤。

。

Still, the correlation between preoperative antioxidant level and postoperative condition of KLEx surgery had not been elucidated. Because the oxidative stress associated with post-KLEx surgery complication like DED

仍然，术前抗氧化水平与KLE切除术后状况之间的相关性尚未阐明。因为与术后KLE切除手术并发症（如DED）相关的氧化应激问题。

，

, the preoperative antioxidant level may influence the postoperative condition of KLEx surgery. The KLEx surgery is a surgery that rapidly develop and renew nowadays

，术前抗氧化水平可能影响KLEx手术的术后状况。KLEx手术是一种如今快速发展和更新的手术。

, and the oxidative stress-related disease like DED may contribute to permanent ocular pain after refractive surgery which may influence the quality of life

，并且与氧化应激相关的疾病如DED可能会导致屈光手术后永久性眼部疼痛，这可能会影响生活质量。

. Thus, the potential factor that could reduce the postoperative outcome after KLEx surgery, including the oxidative stress-related etiology, should be evaluated to discover the high-risk population and establish possible management.

因此，应评估可能降低KLEx手术后术后效果的潜在因素，包括与氧化应激相关的病因，以发现高风险人群并制定可能的管理方案。

As a consequence, we aim to investigate the postoperative outcomes of KLEx surgery in patients with different preoperative total antioxidant capacity (TAC). The effects of other preoperative parameters on KLEx surgery results were also analyzed.

因此，我们旨在研究不同术前总抗氧化能力（TAC）的患者在接受KLEx手术后的结果。还分析了其他术前参数对KLEx手术结果的影响。

Materials and methods

材料与方法

Ethics statement

伦理声明

The present study obeyed the declaration of Helsinki in 1964 and related amendments. Moreover, the present study was approved by the Institutional Review Board at the Linkou Chang Gung Memorial Hospital (Project Code: 202200858B0A3). The written informed consents were completed by all the participants and our clinical trial was registered in the ClinicalTrial.gov (Registration Number: NCT05905237, actual study start date: July 12, 2022, estimated study completion date: September 6, 2024)..

本研究遵守1964年的《赫尔辛基宣言》及其相关修正案。此外，本研究获得了林口长庚纪念医院机构审查委员会的批准（项目编号：202200858B0A3）。所有参与者均签署了书面知情同意书，我们的临床试验已在ClinicalTrial.gov注册（注册号：NCT05905237，实际研究开始日期：2022年7月12日，预计研究完成日期：2024年9月6日）。

Selection process

选拔过程

A prospective non-randomized study was conducted in Nobel Eye Institute which is an ophthalmic institution specialized in cataract and refractive surgeries. The participants of this study was recruited during August 10, 2022 to September 24, 2022. The individuals included in the present study achieved our inclusion criteria: (1) age between 20 and 50 years, (2) myopic status for at least − 1.00 D, (3) receipt the KLEx surgery in Nobel Eye Institute, and (4) participant realized all details of the present project.

在诺贝尔眼科研究所进行了一项前瞻性非随机研究，该研究所是一家专注于白内障和屈光手术的眼科机构。本研究的参与者于2022年8月10日至2022年9月24日期间招募。纳入本研究的个体符合以下纳入标准：(1) 年龄在20至50岁之间，(2) 近视度数至少为-1.00 D，(3) 在诺贝尔眼科研究所接受KLEx手术，以及(4) 参与者了解本项目的全部细节。

Also, the following exclusion criteria was applied to assure the homogeneity of participants as fair as possible: (1) un-corrected visual acuity (UCVA) lower than hand motion level, (2) any forms of cataract, (3) both the clinical significant or subclinical keratoconus or any corneal ectasic diseases, (4) severe retinal disorder like proliferative diabetic retinopathy or retinal detachment, (5) any uncontrolled or end-stage glaucoma, (6) active corneal lesions, central corneal scars, and microbial keratitis, (7) advanced ptosis that cover the whole pupil, (8) optic neuritis and optic nerve atrophy, (9) unstable refractive status which fluctuated more than 0.5 D during the past one years, (10) pregnant status, and (11) active systemic inflammatory diseases such Sjogren syndrome and rheumatic arthritis.

此外，应用以下排除标准以尽可能保证参与者的同质性：(1) 未矫正视力（UCVA）低于手动水平，(2) 任何形式的白内障，(3) 临床显著或亚临床圆锥角膜或任何角膜扩张性疾病，(4) 严重视网膜疾病如增殖性糖尿病视网膜病变或视网膜脱离，(5) 任何未控制或终末期青光眼，(6) 活动性角膜病变、中央角膜瘢痕和微生物性角膜炎，(7) 覆盖整个瞳孔的重度上睑下垂，(8) 视神经炎和视神经萎缩，(9) 不稳定的屈光状态，在过去一年中波动超过0.5 D，(10) 怀孕状态，以及 (11) 活动性全身炎症性疾病如干燥综合征和类风湿性关节炎。

A total of 92 eyes from 46 participants that received KLEx were included in the present study. These patients were further divided into two groups according to the level of TAC which demonstrated in the following section..

本研究共纳入了46名接受KLEx治疗的参与者，共计92只眼睛。这些患者根据TAC水平进一步分为两组，具体内容见下文。

Surgical technique

手术技术

The KLEx surgeries in the present study were done by one experienced refractive specialist (C.-K.C.). The KLEx surgery was completed using one femtosecond laser lenticule extraction device (Visuamax 500, Carl Zeiss, Göschwitzer Str., Jena, Germany). The optic zone (OZ) was set as 5.5–6.9 mm based on the patients’ pupil size and ablation depth, and a 3.0 mm corneal was created at 105 degrees.

本研究中的KLEx手术由一位经验丰富的眼科屈光专家（C.-K.C.）完成。KLEx手术使用了一台飞秒激光透镜提取设备（Visuamax 500，Carl Zeiss，Göschwitzer Str.，Jena，德国）进行。光学区（OZ）根据患者的瞳孔大小和消融深度设置为5.5–6.9毫米，并在105度创建了一个3.0毫米的角膜切口。

After the coaxially sighted corneal light reflex was confirmed manually by microscope with the assistance of topography, the cornea was fixed by the suction ring of the femtosecond laser lenticule extraction device. Then the device emitted femtosecond laser which creates the lenticule around 23 s which based on the refraction-related lenticule thickness.

在通过显微镜手动确认角膜光反射与地形图辅助的同轴对准后，使用飞秒激光透镜提取设备的负压环固定角膜。随后，设备发射飞秒激光，在约23秒内根据与屈光相关的透镜厚度创建透镜。

After the creation of the corneal lenticule, a spatula was used to dissect the lenticule, and then the corneal lenticule was extracted by a forceps. After the KLEx surgery, the topical prednisolone and levofloxacin eyedrops were instilled four times per day for one week, then switched to topical sulfamethoxazole and fluorometholone eyedrops four times per day for another three weeks.

在角膜基质透镜创建后，使用铲刀来分离透镜，然后用镊子将角膜基质透镜取出。KLEx手术后，每天四次局部滴入泼尼松龙和左氧氟沙星眼药水，持续一周，然后改为每天四次局部滴入磺胺甲恶唑和氟美松眼药水，再持续三周。

Preservative-free artificial tear was instilled pro re nata with a baseline frequency of four times per day for at least 8 weeks..

无防腐剂的人工泪液根据需要随时滴用，每天基线频率为四次，持续至少8周。

Ophthalmic examination

眼科检查

All the patients received identical examinations in the Nobel Eye Institute. The pre-operative exams included the following items: UCVA, best corrected visual acuity (BCVA), intraocular pressure (IOP) value via pneumatic tonometry (NT-530, NIDEK, Gamagori, Aichi, Japan), cyclopegic refraction of sphere/cylinder power via autorefractor (KR-8900, Topcon, Itabashi-ku, Tokyo, Japan), corneal cylinder power and central corneal thickness (CCT) via tomographic device (Oculus Pentacam, OCULUS Optikgeräte GmbH, Münchholzhäuser, Wetzlar, Germany), and Schirmer II test.

所有患者都在诺贝尔眼科研究所接受了相同的检查。术前检查包括以下项目：裸眼视力（UCVA）、最佳矫正视力（BCVA）、通过气动眼压计（NT-530，NIDEK，日本爱知县蒲郡市）测量的眼内压（IOP）、通过自动验光仪（KR-8900，Topcon，日本东京板桥区）进行的睫状肌麻痹验光球镜/柱镜度数、通过断层扫描设备（Oculus Pentacam，OCULUS Optikgeräte GmbH，德国韦茨拉尔Münchholzhäuser）测量的角膜柱镜度数和中央角膜厚度（CCT），以及Schirmer II测试。

For the details of Schirmer II test, a Schirmer strip was applied after topical anesthesia, and the patients closed their eyes and waited for 5 min. The length of the wet portion of Schirmer strip was recorded after the removal of the Schirmer strip from the patients’ eye. The postoperative exams of KLEx surgery involved the UCVA (presented as value in Snellen chart), sphere power, cylinder power, CCT, and IOP in which same preoperative device was applied.

关于Schirmer II测试的详细信息，是在局部麻醉后应用Schirmer试纸条，患者闭眼等待5分钟。从患者眼中取出Schirmer试纸条后，记录试纸条湿润部分的长度。KLEx手术的术后检查包括裸眼视力（以Snellen图表的值表示）、球镜度数、柱镜度数、中央角膜厚度和眼内压，其中使用了与术前相同的设备。

Moreover, the ophthalmologist evaluated the corneal surface via slit-lamp biomicroscope with fluorescein stain and decided whether postoperative superficial keratitis presented. The presence of superficial keratitis was regarded as grade 3 (prominent central puntate keratitis) to 5 (diffuse puntate keratitis at the whole cornea) according to Oxford Scheme.

此外，眼科医生通过裂隙灯生物显微镜结合荧光素染色评估了角膜表面，并判断术后是否出现浅表性角膜炎。根据牛津方案，浅表性角膜炎的存在被评定为3级（显著的中央点状角膜炎）至5级（全角膜弥漫性点状角膜炎）。

. The data before the surgery, one week after the surgery, and one month after the surgery were obtained and put in the statistical analyses.

手术前、手术后一周和手术后一个月的数据被收集并用于统计分析。

Antioxidant agent determination

抗氧化剂测定

The TAC and AA concentrations were collected and analyzed with the similar methods illustrated in the previous publications

TAC和AA浓度的收集和分析采用了先前出版物中所述的类似方法。

，

. The tear film of each patient was obtained via the Schirmer strip in three time points: (1) preoperatively, (2) one week postoperatively, and (3) one month postoperatively. The tear film samples were taken near the incision of KLEx surgery which means the superior-temporal site (around 11 clock hours) from right eye and superior-nasal site (near 1 clock hour) from left eye.

每位患者的泪膜通过Schirmer试纸在三个时间点获取：（1）术前，（2）术后一周，以及（3）术后一个月。泪膜样本取自靠近KLEx手术切口的位置，即右眼的上颞侧部位（约11点钟方向）和左眼的上鼻侧部位（接近1点钟方向）。

The Schirmer strip was put near the limbal region of corneal incision in KLEx for 5 min, and the tear film sample in the Schirmer strip was transported in liquid nitrogen (− 196 °C) and stored in a refrigerator at -80 °C. The assessments of TAC and AA concentrations were performed via the colorimetric OxiSelect™ Ascorbic Acid Assay Kit (FRASC, Cell Biolabs, Inc., San Diego, CA, USA), which examined the reduction of ferric ions by the application of ascorbic oxidase.

在KLEx中，将Schirmer试纸条放置在角膜切口边缘区域附近5分钟，试纸条中的泪膜样本通过液氮（-196°C）运输，并储存在-80°C的冰箱中。总抗氧化能力（TAC）和抗坏血酸（AA）浓度的评估使用比色法OxiSelect™抗坏血酸测定试剂盒（FRASC，Cell Biolabs公司，美国加利福尼亚州圣地亚哥），该试剂盒通过应用抗坏血酸氧化酶检测铁离子的还原情况。

Before analysis, tear film samples that restored in refrigerator at − 80 °C were thawed to about 4 °C, and 35 µL of each tear film sample was diluted by the assay buffer of OxiSelect™ to a one-twentieth concentration. After the dilution, colorimetric assessments were completed within the light ranges of 540–600 nm wavelength via the absorbance microplate reader (Sunrise™ Tecan, Switzerland).

在分析之前，将保存在-80°C冰箱中的泪膜样品解冻至约4°C，并使用OxiSelect™的测定缓冲液将每个泪膜样品35微升稀释至1/20的浓度。稀释后，通过吸光度微孔板读取器（Sunrise™ Tecan，瑞士）在540-600纳米波长的光范围内完成比色评估。

Finally, the expressions of TAC and AA were checked via the utilization of colorimetric OxiselectTM Ascorbic Acid Assay Kit. Concerning the unit of antioxidant, the quantification of both TAC and AA concentrations was described in units of millimoles per liter (µmol/L or µM). To ensure the accuracy of tear film samples, all tear film samples were examined for three times and the average value of the examinations were used in the subsequent analysis..

最后，通过使用比色OxiselectTM抗坏血酸测定试剂盒检测了TAC和AA的表达。关于抗氧化剂的单位，TAC和AA浓度的量化均以毫摩尔每升（µmol/L或µM）为单位进行描述。为确保泪膜样品的准确性，所有泪膜样品均进行了三次检测，并采用检测结果的平均值用于后续分析。

Statistical analysis

统计分析

The SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA) was conducted for all analyses mentioned in the present study. The Shapiro–Wilk test was applied to check the normal distribution of the whole KLEx population and normal distribution was confirmed (

本研究中提到的所有分析均使用SPSS 20.0版（SPSS公司，美国伊利诺伊州芝加哥）进行。应用Shapiro-Wilk检验检查整个KLEx群体的正态分布，并确认其呈正态分布（

> 0.05). The whole KLEx population was then divided into the low TAC group (56 eyes) and high TAC group (36 eyes) according to the TAC concentration of 820µM which is the mean TAC value of all participants. The descriptive analysis was adopted to present the baseline data of the low TAC and high TAC groups, and the independent T test and Fisher’s exact test were applied to compare the difference of baseline data between the two groups according to the types of data.

> 0.05）。然后，根据所有参与者TAC浓度的平均值820µM，将整个KLEx人群分为低TAC组（56只眼）和高TAC组（36只眼）。采用描述性分析呈现低TAC组和高TAC组的基线数据，并根据数据类型使用独立样本T检验和Fisher精确检验比较两组间基线数据的差异。

Then the independent T test and Fisher’s exact test were also utilized to compare the postoperative data between the two groups. After that, the trend of TAC and AA changes after the KLEx surgery between the two groups were analyzed via the generalized estimate equation, which can adjusted the influence of repeated measurements for some parameters like age and sex, with the adjustment of age, sex, preoperative refraction, corneal cylinder, IOP, CCT, results of Schirmer test, OZ and lenticule thickness.

随后，还使用了独立样本T检验和Fisher精确检验来比较两组之间的术后数据。之后，通过广义估计方程分析了两组在KLEx手术后TAC和AA变化的趋势，该方程能够调整某些参数（如年龄和性别）的重复测量影响，并对年龄、性别、术前屈光度、角膜散光、眼压、中央角膜厚度、Schirmer试验结果、光学区大小和透镜厚度进行了校正。

The adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI) of TAC and AA changes in high TAC group compared to low TAC group was yielded. In the next steps, the generalized linear model was applied to analyze the correlation between preoperative factors and UCVA one month postoperatively and the postoperative superficial keratitis.

得出了高TAC组与低TAC组相比，TAC和AA变化的调整后比值比（aOR）及其相应的95%置信区间（CI）。在接下来的步骤中，应用广义线性模型分析了术前因素与术后一个月的UCVA及术后浅表性角膜炎之间的相关性。

The generalized linear model also adjusted the effect of age, sex, preoperative refraction, corneal cylinder, IOP, CCT, Schirmer test results, and surgical parameters then aOR with 95% CI were produced. Also, the generalized linear model was applied to evaluate the correlation between old age and both TAC and AA concentrations.

广义线性模型还调整了年龄、性别、术前屈光度、角膜散光、眼压 (IOP)、角膜中心厚度 (CCT)、Schirmer 试验结果和手术参数的影响，然后生成了调整后的比值比 (aOR) 及其 95% 置信区间 (CI)。此外，广义线性模型还用于评估老年与总抗氧化能力 (TAC) 和抗坏血酸 (AA) 浓度之间的相关性。

A .

A。

value lower than 0.05 was defined as statistical significance and the

低于0.05的值被定义为具有统计学意义，并且

value lower than 0.001 was presented as

值低于0.001表示为

< 0.001.

< 0.001。

Results

结果

The baseline features between the low TAC and high TAC groups are demonstrated in Table

低TAC组和高TAC组之间的基线特征在表中展示。

. The mean age was 32.33 ± 7.26 years and 34.12 ± 6.28 years in the low TAC and high TAC groups, respectively, without significant difference (

低TAC组和高TAC组的平均年龄分别为32.33±7.26岁和34.12±6.28岁，无显著差异（

= 0.241). Similarly, the sex distribution (male to female) was 8:20 and 7:11 in the low TAC and high TAC groups, respectively. The difference of sex distributions between the two groups was non-significant (

= 0.241）。同样，低TAC组和高TAC组的性别分布（男性对女性）分别为8:20和7:11。两组之间的性别分布差异无统计学意义（

= 0.246). The other baseline features including IOP, systemic diseases, presence of DED, preoperative refractions, topographic indexes, Schirmer test results and surgical parameters showed similar values between the two groups (all

= 0.246）。其他基线特征，包括眼压 (IOP)、系统性疾病、DED 的存在、术前屈光度、地形指数、Schirmer 试验结果和手术参数，两组之间均显示出相似的值（全部

> 0.05) (Table

> 0.05) （表

）。

Table 1 The preoperative features of the whole study population.

表1 整个研究人群的术前特征。

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全尺寸表格

The initial concentrations of TAC and AA were 1199.03 ± 205.48µM and 597.00 ± 143.03µM in the high TAC group which were significantly higher than the 359.20 ± 148.83µM and 219.32 ± 95.17µM in the low TAC group (both

高TAC组中TAC和AA的初始浓度分别为1199.03 ± 205.48µM和597.00 ± 143.03µM，显著高于低TAC组的359.20 ± 148.83µM和219.32 ± 95.17µM（两者均

< 0.001). After the follow-up period of one month, the change of TAC were − 384.14 ± 81.87µM (32.04%) in the high TAC group and − 229.50 ± 69.14µM (63.89%) in the low TAC group, respectively (Fig.

<0.001）。在一个月的随访期后，高TAC组和低TAC组的TAC变化分别为-384.14 ± 81.87 µM（32.04%）和-229.50 ± 69.14 µM（63.89%）（图。

). Besides, the change of AA were − 65.45 ± 43.86µM (10.96%) in the high TAC group and − 83.40 ± 58.54µM (38.03%) in the low TAC group, respectively (Fig.

). 此外，高TAC组和低TAC组中AA的变化分别为− 65.45 ± 43.86µM（10.96%）和− 83.40 ± 58.54µM（38.03%），如图所示（Fig.

). The trends of TAC (aOR: 3.368, 95% CI: 1.158–9.793,

). TAC 的趋势 (aOR: 3.368, 95% CI: 1.158–9.793,

< 0.001) and AA (aOR: 2.049, 95% CI: 1.646–5.260,

<0.001）和AA（aOR：2.049，95% CI：1.646–5.260，

< 0.001) decrements were more significant in the low TAC group compared to high TAC group.

<0.001）低TAC组的下降比高TAC组更显著。

Fig. 1

图1

The trend of total antioxidant capacity change between the two groups. TAC: total antioxidant capacity. *Denotes significant difference of TAC decrement between the two groups after adjusting age, sex, preoperative refraction, corneal cylinder, IOP, CCT, Schirmer test results, OZ and lenticule thickness..

两组之间总抗氧化能力变化的趋势。TAC：总抗氧化能力。*表示在调整年龄、性别、术前屈光度、角膜散光、眼压、角膜中心厚度、Schirmer试验结果、光学区和透镜厚度后，两组间TAC降低值的显著差异。

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Fig. 2

图2

The trend of ascorbic acid change between the two groups. AA: ascorbic acid. *Denotes significant difference of AA decrement between the two groups after adjusting age, sex, preoperative refraction, corneal cylinder, IOP, CCT, Schirmer test results, OZ and lenticule thickness.

两组之间抗坏血酸变化趋势。AA：抗坏血酸。*表示在调整年龄、性别、术前屈光度、角膜散光、眼压、角膜中央厚度、Schirmer试验结果、光学区和透镜厚度后，两组间AA减少量的显著差异。

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One week after the KLEx surgery, the amount of UCVA, sphere, cylinder and IOP illustrated similar values between the two groups (all

KLEx手术一周后，两组之间的UCVA、球镜、柱镜和眼压的数值相似（全部

> 0.05). One month after the KLEx surgery, however, the UCVA was significantly higher in the high TAC group (1.00 ± 0.02) than the low TAC group (0.94 ± 0.15) (

> 0.05）。然而，在KLEx手术一个月后，高TAC组的UCVA（1.00 ± 0.02）显著高于低TAC组（0.94 ± 0.15）（

= 0.028) while the difference of sphere, cylinder and IOP remain insignificant between the two groups (all

= 0.028)，而两组之间的球镜、柱镜和眼压差异仍然不显著（所有

> 0.05) (Table

> 0.05) （表

). On the other hand, the CCT value after KLEx surgery demonstrated insignificant difference between the two groups (

）。另一方面，KLEx手术后的CCT值显示两组之间无显著差异（

= 0.353), while the low TAC group associated with more cases with superficial keratitis compared to high TAC group (

= 0.353)，而低TAC组相较于高TAC组与更多浅表性角膜炎病例相关联（

= 0.035) (Table

= 0.035)（表

）。

Table 2 The postoperative outcomes between the two groups.

表 2 两组之间的术后结果。

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About the predictors for UCVA one month postoperatively, the low TAC population (aOR: 0.948, 95% CI: 0.906–0.992,

关于术后一个月UCVA的预测因素，低TAC人群（aOR：0.948，95% CI：0.906–0.992，

= 0.022), old age (aOR: 0.995, 95% CI: 0.992–0.999,

= 0.022)，老年（aOR：0.995，95% CI：0.992–0.999，

= 0.009) correlated to poor UCVA while the thick CCT (aOR: 1.003, 95% CI: 1.001–1.005,

= 0.009）与较差的UCVA相关，而较厚的CCT（aOR：1.003，95% CI：1.001–1.005，

= 0.030) correlated to better UCVA. The other preoperative parameters showed no significant association to UCVA one month postoperatively (all

= 0.030）与更好的UCVA相关。其他术前参数显示与术后一个月的UCVA无显著关联（所有

> 0.05) (Table

> 0.05)（表

). Concerning the predictors for the development of postoperative superficial keratitis, the low TAC population (aOR: 2.897, 95% CI: 1.075–7.058,

关于术后浅表性角膜炎发展的预测因素，低TAC人群（aOR：2.897，95% CI：1.075–7.058，

= 0.032) correlated to higher rate of postoperative superficial keratitis, while old age (aOR: 0.763, 95% CI: 0.609–0.956,

= 0.032) 与术后浅表性角膜炎的较高发生率相关，而高龄 (aOR: 0.763, 95% CI: 0.609–0.956,

= 0.018) correlated to lower rate of postoperative superficial keratitis. The other indexes did not influence the incidence of postoperative superficial keratitis (all

= 0.018）与较低的术后浅表性角膜炎发生率相关。其他指标对术后浅表性角膜炎的发生率没有影响（所有

> 0.05) (Table

> 0.05) （表

). The old age was not significantly related to the TAC and AA concentrations (both

）。老年与TAC和AA浓度无显著相关性（两者均是如此）

> 0.05).

> 0.05)。

Table 3 The relationship of each parameter to postoperative un-corrected visual acuity.

表3 各参数与术后未矫正视力的关系。

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全尺寸表格

Table 4 The relationship of each parameter to postoperative superficial keratitis.

表4 各参数与术后浅表性角膜炎的关系。

Full size table

全尺寸表格

Discussion

讨论

Briefly, the patients with low initial TAC demonstrated a worse UCVA and higher rate of superficial keratitis than the patients with high initial TAC after KLEx surgery. Moreover, the trend of TAC and AA decrements were more prominent in the patients with low TAC levels compared to those with high TAC levels.

简而言之，初始总抗氧化能力（TAC）较低的患者在KLEx手术后比初始TAC较高的患者表现出更差的裸眼视力（UCVA）和更高的浅表性角膜炎发生率。此外，与TAC水平较高的患者相比，TAC水平较低的患者TAC和抗坏血酸（AA）下降的趋势更为显著。

On the other hand, the old age and thick CCT is positively and negatively correlated to worse postoperative UCVA while old age associated with fewer episodes of superficial keratitis after the KLEx surgery..

另一方面，年龄较大和较厚的CCT与术后UCVA较差呈正相关和负相关，而年龄较大与KLex手术后较少发生表层角膜炎相关。

In the present study, the low baseline TAC correlated to the worse UCVA one month after the KLEx surgery compared to the individuals with high baseline TAC level. In previous publication, the worse UCVA that warranted enhancement after KLEx surgery could associate with intraoperative suction loss, high preoperative myopia and high preoperative astigmatism.

在本研究中，与基线TAC水平较高的个体相比，基线TAC较低的个体在KLEx手术一个月后UCVA更差。在以往的文献中，KLEx手术后需要增强的较差UCVA可能与术中吸力丧失、高术前近视和高术前散光有关。

. Moreover, both the preoperative and postoperative DED correlated to a worse visual quality after keratorefractive surgeries

此外，术前和术后DED均与角膜屈光手术后视力质量下降相关。

. Nevertheless, the molecular predictor for the visual outcome after KLEx surgery had not been established. To our knowledge, our results may be a preliminary experience to demonstrate the positive correlation between low baseline TAC and poor postoperative visual outcome. Furthermore, this correlation was re-checked by the generalized linear model which incorporates the effect of age, sex, preoperative refractive status and the tear secretion function.

然而，对于KLEx手术后视力结果的分子预测因子尚未建立。据我们所知，我们的研究结果可能是一个初步的经验，证明了低基线TAC与术后视力结果不佳之间的正相关性。此外，这种相关性通过广义线性模型进行了重新验证，该模型结合了年龄、性别、术前屈光状态和泪液分泌功能的影响。

As a consequence, the low baseline TAC may serves as independent risk factor for the poor UCVA after KLEx surgery. The laser application during KLEx surgery would contribute to postoperative inflammation in the corneal stroma which resulted from the thermal effect.

因此，较低的基线TAC可能作为KLEx手术后UCVA不佳的独立风险因素。KLEx手术中激光的应用可能会因热效应导致角膜基质术后炎症。

. In previous study, the inflammation in the anterior segment of eye are associated with higher levels of oxidative stress

之前的研究表明，眼前段的炎症与较高的氧化应激水平有关。

. On the other side, the persistent ocular surface inflammation, oxidative stress and subsequent DED after kertorefractive surgeries could impair the postoperative visual recovery

另一方面，角膜屈光手术后持续的眼表炎症、氧化应激及随后的DED可能会影响术后视力恢复。

. We speculate that the individuals with lower baseline TAC concentrations may experience a prolonged course of high oxidative stress status because the low antioxidant capacity cannot promptly compensate the oxidative stress produced by KLEx. Accordingly, the postoperative visual recovery would be slower in the population with low baseline TAC..

我们推测，基线TAC浓度较低的个体可能会经历较长的高氧化应激状态过程，因为低抗氧化能力无法迅速补偿KLEx产生的氧化应激。因此，基线TAC较低的人群术后视觉恢复会较慢。

In addition to the worse postoperative UCVA, the individuals with lower baseline TAC also presented with higher incidence of postoperative superficial keratitis than the high baseline TAC population. The development of superficial keratitis is a not-uncommon, but not universal, complication after the performance of refractive surgeries.

除了术后UCVA更差之外，基线TAC较低的个体术后浅表性角膜炎的发生率也高于基线TAC较高的人群。浅表性角膜炎的发展是屈光手术后并非不常见、但也不是普遍的并发症。

，

. In previous literature, the incidence of superficial keratitis or corneal epithelial defect was lower in the KLEx surgery than the LASIK surgery

在以往的文献中，KLEx手术中浅表性角膜炎或角膜上皮缺损的发生率低于LASIK手术。

. In the present study, we highlight the possible molecular predictor for the formation of postoperative superficial keratitis. Similar to the UCVA-related analysis, we also applied generalized linear regression that adjusted the effect of several confounders for postoperative DED/corneal damage. Although the preoperative DED may contribute to postoperative corneal defects.

在本研究中，我们强调了术后浅层角膜炎形成的可能分子预测因子。与UCVA相关分析类似，我们也应用了广义线性回归，并对术后DED/角膜损伤的多种混杂因素进行了调整。尽管术前DED可能导致术后角膜缺陷。

, the preoperative tear secretion function between the two groups were similar and we adjusted the effect of preoperative DED in the multivariable analysis. Thus the low baseline TAC concentration could also be an independent risk factor for the development of post-KLEx superficial keratitis. The oxidative stress can lead to various ocular surface disorders including the anterior segment and posterior segment of eye.

，两组间的术前泪液分泌功能相似，并且我们在多变量分析中调整了术前DED的影响。因此，低基线TAC浓度也可能成为KLEx术后浅表性角膜炎发生的独立风险因素。氧化应激可导致多种眼表疾病，包括眼前节和眼后节。

. The higher oxidative stress was observed in the individuals with DED which resulted from the deficiency of tear film and the antioxidant it contains

DED患者由于泪膜及其所含抗氧化剂的缺乏，导致更高的氧化应激。

. On the other side, the corneal injury like the alkali-induced corneal erosion is accompany with higher level of oxidative stress

另一方面，像碱性物质引起的角膜糜烂等角膜损伤伴随着更高水平的氧化应激。

, and the usage of antioxidant can reduced such corneal damage

，使用抗氧化剂可以减少这种角膜损伤。

. Because the KLEx and other keratorefractive surgeries could induce the oxidative stress elevation

因为KLEx和其他角膜屈光手术可能会导致氧化应激升高

，

, the delayed reduction of oxidative stress in those with lower baseline TAC expression could insult the corneal surface more easily than those with adequate baseline TAC.

，基线TAC表达较低的人群中氧化应激的延迟减轻可能比基线TAC充足的人群更容易损害角膜表面。

About the trend of antioxidant changes between the low TAC and high TAC groups, the percentage of TAC decrement was significantly higher in the low TAC group than that in the high TAC group which confirmed by the generalized estimate equation. In previous studies, the postoperative oxidative stress could be elevated after keratorefractive surgeries.

关于低TAC组和高TAC组之间抗氧化变化趋势，低TAC组的TAC减少百分比显著高于高TAC组，这通过广义估计方程得到了证实。在以往的研究中，角膜屈光手术后术后的氧化应激可能会升高。

，

, thus it is reasonable that the prominent reduction of TAC between the KLEx in the present study. Our result imply that the patients with higher TAC concentration were under better protection for oxidative stress-related event like the KLEx surgery, and the residual TAC may be adequate for the oxidative stress resulted from postoperative DED which may persisted up to 6–12 months.

，因此本研究中KLEx之间TAC显著降低是合理的。我们的结果暗示，TAC浓度较高的患者对于像KLEx手术这样的氧化应激相关事件有更好的保护作用，而残留的TAC可能足以应对术后DED引起的氧化应激，这种应激可能会持续6到12个月。

. On the other hand, the overall AA decrements in the both group were even lesser than the TAC loss. The possible explanation for this results is that the TAC consists of multiple antioxidants on ocular surface

另一方面，两组的整体AA减少甚至小于TAC的损失。对此结果的可能解释是，TAC由眼表的多种抗氧化剂组成。

，

, and some of these antioxidants may be consumed firstly to compensate the oxidative stress induced by keratorefractive surgeries thus the concentration of AA did not decrease prominently as other antioxidant. Nevertheless, further study is warranted to verify this hypothesis.

，其中一些抗氧化剂可能首先被消耗以补偿由角膜屈光手术引起的氧化应激，因此抗坏血酸的浓度并未像其他抗氧化剂一样显著下降。然而，仍需要进一步研究来验证这一假设。

Concerning the other parameters that associate with the worse postoperative UCVA and the presence of postoperative superficial keratitis, the old age positively correlates to worse postoperative UCVA and lower risk of postoperative superficial keratitis. In the previous study discussing the postoperative outcome of KLEx, the age was a significantly risk factor for the poor postoperative visual acuity.

关于与其他参数相关的术后UCVA较差以及术后浅表性角膜炎的存在，年龄较大与术后UCVA较差呈正相关，而术后浅表性角膜炎的风险较低。在之前关于KLEx术后结果的研究中，年龄是术后视力不佳的显著风险因素。

，

. Moreover, the old age would delay the visual recovery in both our clinical experience and an earlier publication

此外，根据我们的临床经验和早期的出版物，年龄较大可能会延迟视力的恢复。

. Because the follow-up period in the present study was only one month, the patients with old age may not fully recovered and presented with worse postoperative visual acuity. Interestingly, the patients with old age presented with lower risk of developing postoperative superficial keratitis which is contrast to previous concept that the older patients related to higher incidence of DED and corneal damage.

由于本研究的随访期仅为一个月，老年患者可能未完全恢复，并表现出较差的术后视力。有趣的是，老年患者术后发生浅表性角膜炎的风险较低，这与以往认为老年患者干眼症和角膜损伤发生率较高的观念相反。

. The possible reason is that the individuals with older age used the smart phone with lower frequency compared to their younger counterpart

可能的原因是，与年轻人群体相比，年龄较大的个体使用智能手机的频率较低。

, thus avoid a prominent risk factor for DED and possible superficial keratitis development. On the other hand, the thick preoperative CCT correlates to better postoperative UCVA after the adjustment of preoperative sphere and cylinder powers, which means the protective effect of thick CCT on postoperative UCVA was independent of lenticule thickness.

，从而避免了DED的一个显著风险因素及可能的浅表性角膜炎的发展。另一方面，术前较厚的CCT在调整术前球镜和柱镜度数后与术后更好的UCVA相关，这意味着厚CCT对术后UCVA的保护作用独立于透镜厚度。

Since postoperative irregular astigmatism and corneal ectasia often occurred in those with thin cornea.

由于术后不规则散光和角膜扩张经常发生在那些角膜较薄的患者身上。

, the lower risk of mild postoperative irregular astigmatism in patients with think CCT may lead to better postoperative vision.

，CCT较薄的患者术后出现轻度不规则散光的风险较低，这可能会带来更好的术后视力。

There are some limitations in the present study. Firstly, the case numbers of the present study is relative few in which only a total of 92 eyes was enrolled. Although the normality of the study population was confirmed by Shapiro–Wilk test, the relative small study population may lead to statistical bias and reduce the reproducibility and generalizability of our results.

本研究存在一些局限性。首先，本研究的病例数相对较少，仅纳入了共计92只眼。尽管通过Shapiro-Wilk检验确认了研究人群的正态性，但相对较小的样本量可能导致统计偏差，并降低结果的可重复性和普适性。

Secondly, we only demonstrate the statistical association between preoperative TAC and postoperative UCVA while the causal relationship and the exactly mechanism was not examined and confirmed, so the significance and importance of our findings may not be high. Besides, the one month follow-up period of the present study is short, and subsequent visual and corneal recovery cannot be accessed.

其次，我们仅展示了术前TAC与术后UCVA之间的统计学关联，而未考察和确认其因果关系及确切机制，因此我们研究结果的意义和重要性可能不高。此外，本研究的一个月随访期较短，无法评估随后的视力和角膜恢复情况。

Moreover, the site of tear film collection was not the exact site of laser strike during the KLEx surgery: the femtosecond laser strike on the corneal surface and stroma while we took the tear film sample at the surface of conjunctiva-limbus junction. Thus, the reduction of TAC and AA may not directly resulted from the application of KLEx surgery and would be influenced by the condition of ocular surface.

此外，泪膜收集的部位并非KLEx手术中激光照射的确切部位：飞秒激光照射在角膜表面和基质上，而我们在结膜-角膜缘交界处的表面采集了泪膜样本。因此，TAC和AA的减少可能并非直接由KLEx手术的应用引起，而是会受到眼表状况的影响。

Finally, the numbers and expressions of reactive oxygen species were not measured in the present study and the exact mechanism of antioxidant reduction could remain unclear, and the pH measurement and densitometry exam were also not performed..

最后，本研究未测量活性氧物质的数量和表达，抗氧化能力下降的确切机制可能仍不清楚，并且也未进行 pH 值测量和密度测定检查。

In conclusion, the individuals with lower TAC correlates to worse UCVA and high risk of superficial keratitis after KLEx surgery after adjusting multiple covariates. Furthermore, the percentage of TAC and AA decrements were more significant in the low-TAC population. Consequently, the topical or systemic antioxidant supplement might be suggested for the individuals with low baseline TAC who scheduled for KLEx surgery.

总之，经多变量调整后，TAC水平较低的个体在KLEx手术后与更差的UCVA和较高的浅表性角膜炎风险相关。此外，TAC和AA下降的百分比在低TAC人群中更为显著。因此，对于计划接受KLEx手术且基线TAC较低的个体，可能会建议局部或全身补充抗氧化剂。

Further large-scale prospective study to evaluate whether the preoperative application of antioxidant in the low-TAC population can preserve the postoperative visual recovery and corneal integrity after KLEx surgery is mandatory..

进一步的大规模前瞻性研究是必要的，以评估在低TAC人群中术前应用抗氧化剂是否能够保留KLEx手术后的术后视力恢复和角膜完整性。

Data availability

数据可用性

The data used in this study is available from the corresponding author upon reasonable request.

本研究中使用的数据可根据合理要求从通讯作者处获取。

Abbreviations

缩略语

KLEx:

Kerato-lenticule extraction

角膜晶状体提取

UCVA:

Un-corrected visual acuity

未矫正视力

Diopter

屈光度

DED:

Dry eye disease

干眼症

AA:

Ascorbic acid

抗坏血酸

TAC:

Total antioxidant capacity

总抗氧化能力

OZ:

奥兹：

Optic zone

光学区

IOP:

Intraocular pressure

眼内压

CCT:

闭合冷却塔：

Central corneal thickness

中央角膜厚度

AXL:

Axial length

眼轴长度

ACD:

ACD：

Anterior chamber depth

前房深度

LT:

Lens thickness

镜片厚度

aOR:

Adjusted odds ratio

调整后的比值比

CI:

持续集成：

95% Confidence interval

95% 置信区间

Number

数字

SD:

标准差（Standard Deviation）：

Standard deviation

标准差

References

参考文献

Ang, M. et al. Refractive surgery beyond 2020.

Ang, M. 等。2020年后的屈光手术。

Eye (London)

眼睛（伦敦）

。

, 362–382.

，362-382。

https://doi.org/10.1038/s41433-020-1096-5

(2021).

（2021）。

Article

文章

MATH

数学

Google Scholar

谷歌学术

Nair, S., Kaur, M., Sharma, N. & Titiyal, J. S. Refractive surgery and dry eye: An update.

Nair, S., Kaur, M., Sharma, N. & Titiyal, J. S. 屈光手术与干眼症：最新进展。

Indian J. Ophthalmol.

印度眼科杂志

, 1105–1114.

，1105-1114。

https://doi.org/10.4103/ijo.Ijo_3406_22

(2023).

（2023）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术索

Kim, T. I. et al. Refractive surgery.

金，T. I. 等。屈光手术。

Lancet

柳叶刀

393

, 2085–2098.

，2085-2098。

https://doi.org/10.1016/s0140-6736(18)33209-4

(2019).

（2019）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术搜索

Zhang, Y., Shen, Q., Jia, Y., Zhou, D. & Zhou, J. Clinical outcomes of SMILE and FS-LASIK used to treat myopia: A meta-analysis.

张毅、沈琪、贾莹、周丹、周静。《SMILE与FS-LASIK治疗近视的临床结果：一项荟萃分析》。

J. Refract. Surg.

《屈光手术杂志》

, 256–265.

，256-265。

https://doi.org/10.3928/1081597x-20151111-06

(2016).

（2016）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Alio, D. et al. Evolution of corneal thickness and optical density after laser in situ keratomileusis versus small incision lenticule extraction for myopia correction.

阿里奥，D. 等。激光原位角膜磨镶术与小切口透镜提取术矫正近视后角膜厚度和光学密度的演变。

Br. J. Ophthalmol.

英国眼科杂志

105

, 1656–1660.

，1656-1660。

https://doi.org/10.1136/bjophthalmol-2020-316601

(2021).

（2021）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Moshirfar, M. et al. Small-incision lenticule extraction.

莫希尔法尔，M. 等。小切口透镜提取。

J. Cataract Refract. Surg.

白内障屈光手术杂志

, 652–665.

，652-665。

https://doi.org/10.1016/j.jcrs.2015.02.006

(2015).

（2015）。

Article

文章

PubMed

Google Scholar

谷歌学术

Wilson, S. E. Biology of keratorefractive surgery- PRK, PTK, LASIK, SMILE, inlays and other refractive procedures.

威尔逊，S. E. 角膜屈光手术的生物学原理——PRK、PTK、LASIK、SMILE、角膜嵌入术及其他屈光手术。

Exp. Eye Res.

实验眼科研究

198

, 108136.

，108136。

https://doi.org/10.1016/j.exer.2020.108136

(2020).

（2020）。

Article

文章

ADS

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术索

Shehadeh-Mashor, R. et al. Risk factors for dry eye after refractive surgery.

Shehadeh-Mashor, R. 等。屈光手术后干眼的风险因素。

Cornea

角膜

, 1495–1499.

，1495-1499。

https://doi.org/10.1097/ico.0000000000002152

(2019).

（2019）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

D’Souza, S. et al. Algorithmic approach to diagnosis and management of post-refractive surgery dry eye disease.

D’Souza, S. 等。屈光手术后干眼病诊断与管理的算法方法。

Indian J. Ophthalmol.

印度眼科杂志

, 2888–2894.

，2888-2894。

https://doi.org/10.4103/ijo.IJO_1957_20

(2020).

（2020）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Wong, A. H. Y. et al. Dry eyes after SMILE.

黄，A. H. Y. 等。SMILE术后干眼。

Asia Pac. J. Ophthalmol. (Phila)

亚太眼科杂志（费城）

。

, 397–405.

，397-405。

https://doi.org/10.1097/01.APO.0000580136.80338.d0

(2019).

（2019）。

Article

文章

PubMed

Google Scholar

谷歌学术

Sotozono, C., Ueta, M. & Yokoi, N. Severe dry eye with combined mechanisms is involved in the ocular sequelae of SJS/TEN at the chronic stage.

Sotozono, C., Ueta, M. & Yokoi, N. 在SJS/TEN慢性阶段，多种机制共同作用的严重干眼症与其眼部后遗症有关。

Invest. Ophthalmol. Vis. Sci.

投资。眼科。视力。科学。

, Des80–des86.

，Des80–des86。

https://doi.org/10.1167/iovs.18-24019

(2018).

（2018）。

Article

文章

PubMed

Google Scholar

谷歌学术

Vallabh, N. A., Romano, V. & Willoughby, C. E. Mitochondrial dysfunction and oxidative stress in corneal disease.

瓦拉布，N. A.，罗曼诺，V.，威洛比，C. E. 线粒体功能障碍和氧化应激在角膜疾病中的作用。

Mitochondrion

线粒体

, 103–113.

，103-113。

https://doi.org/10.1016/j.mito.2017.05.009

(2017).

（2017）。

Article

文章

PubMed

Google Scholar

谷歌学术

Kaluzhny, Y. et al. Oxidative stress in corneal injuries of different origin: Utilization of 3D human corneal epithelial tissue model.

Kaluzhny, Y. 等。不同来源的角膜损伤中的氧化应激：利用3D人角膜上皮组织模型。

Exp. Eye Res.

实验眼科研究

190

, 107867.

，107867。

https://doi.org/10.1016/j.exer.2019.107867

(2020).

（2020）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Seen, S. & Tong, L. Dry eye disease and oxidative stress.

Seen, S. & Tong, L. 干眼病与氧化应激。

Acta Ophthalmol.

眼科杂志

, e412–e420.

，e412–e420。

https://doi.org/10.1111/aos.13526

(2018).

（2018）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Kubota, M. et al. Hydrogen and N-acetyl-L-cysteine rescue oxidative stress-induced angiogenesis in a mouse corneal alkali-burn model.

久保田，M. 等。氢气和N-乙酰-L-半胱氨酸在小鼠角膜碱烧伤模型中挽救氧化应激诱导的血管生成。

Invest. Ophthalmol. Vis. Sci.

投资。眼科。视力。科学。

, 427–433.

，427-433。

https://doi.org/10.1167/iovs.10-6167

(2011).

（2011）。

Article

文章

PubMed

Google Scholar

谷歌学术搜索

Pfister, R. R. & Paterson, C. A. Ascorbic acid in the treatment of alkali burns of the eye.

Pfister, R. R. & Paterson, C. A. 抗坏血酸在眼部碱烧伤治疗中的应用。

Ophthalmology

眼科

, 1050–1057.

，1050-1057。

https://doi.org/10.1016/s0161-6420(80)35126-9

(1980).

（1980）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Siegfried, C. J. & Shui, Y. B. Intraocular oxygen and antioxidant status: New insights on the effect of vitrectomy and Glaucoma pathogenesis.

西格弗里德，C. J. & 水，Y. B. 眼内氧与抗氧化状态：关于玻璃体切除术和青光眼发病机制影响的新见解。

Am. J. Ophthalmol.

美国眼科杂志

203

, 12–25.

，12-25。

https://doi.org/10.1016/j.ajo.2019.02.008

(2019).

（2019）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术索

Han, S. B. et al. Effects of different capsulotomy and fragmentation energy levels on the generation of oxidative stress following femtosecond laser-assisted cataract surgery.

韩，S. B. 等。不同囊切开和碎裂能量水平对飞秒激光辅助白内障手术后氧化应激产生的影响。

Biomolecules

生物分子

。

https://doi.org/10.3390/biom14030318

(2024).

（2024）。

Smirennaia, E., Kourenkov, V., Chesnokova, N. B. & Kuznetsova, T. R. Antioxidant activity of tear fluid and antioxidant therapy in myopic patients after laser in situ keratomileusis.

斯米尔娜娅，E.，库伦科夫，V.，切斯诺科娃，N. B.，库兹涅佐娃，T. R. 近视患者激光原位角膜磨镶术后泪液的抗氧化活性及抗氧化治疗。

J. Refract. Surg.

屈光手术杂志

, S364–365.

，S364-365。

https://doi.org/10.3928/1081-597x-20020502-17

(2002).

（2002）。

Article

文章

PubMed

Google Scholar

谷歌学术索

Vanathi, M. Kerato-lenticule extraction (KLex) surgeries: Current perspectives.

Vanathi, M. 角膜晶状体提取（KLex）手术：当前视角。

Indian J. Ophthalmol.

印度眼科杂志

, 459–460.

，459-460页。

https://doi.org/10.4103/ijo.Ijo_675_24

(2024).

（2024）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Zhao, L. et al. Efficacy of topical 0.05% cyclosporine A and 0.1% sodium hyaluronate in post-refractive surgery chronic dry eye patients with ocular pain.

赵，L. 等。0.05%环孢素A和0.1%透明质酸钠局部用药对屈光手术后慢性干眼症伴眼部疼痛患者的疗效。

BMC Ophthalmol.

BMC眼科。

, 28.

，28。

https://doi.org/10.1186/s12886-024-03294-z

(2024).

（2024）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Bron, A. J., Evans, V. E. & Smith, J. A. Grading of corneal and conjunctival staining in the context of other dry eye tests.

Bron, A. J., Evans, V. E. & Smith, J. A. 在其他干眼测试背景下对角膜和结膜染色的分级。

Cornea

角膜

, 640–650.

，640-650。

https://doi.org/10.1097/00003226-200310000-00008

(2003).

（2003）。

Article

文章

PubMed

Google Scholar

谷歌学术

Chen, H. C. et al. Differences in change of post-operative antioxidant levels between laser-assisted lenticule extraction and femtosecond laser in situ keratomileusis.

陈，H. C. 等。激光辅助透镜提取术与飞秒激光原位角膜磨镶术术后抗氧化水平变化的差异。

J. Cell. Mol. Med.

细胞与分子医学杂志

, e18069.

，e18069。

https://doi.org/10.1111/jcmm.18069

(2024).

（2024）。

Article

文章

PubMed

Google Scholar

谷歌学术

Tsao, Y. T. et al. An assessment of cataract severity based on antioxidant status and ascorbic acid levels in aqueous humor.

曹, Y. T. 等。基于抗氧化状态和房水中抗坏血酸水平的白内障严重程度评估。

Antioxid. (Basel)

抗氧化剂（巴塞尔）

。

https://doi.org/10.3390/antiox11020397

(2022).

（2022）。

Hsueh, Y. J. et al. Ascorbic acid ameliorates corneal endothelial dysfunction and enhances cell proliferation via the noncanonical GLUT1-ERK axis.

薛，Y. J. 等。抗坏血酸通过非经典的GLUT1-ERK轴改善角膜内皮功能障碍并促进细胞增殖。

Biomed. Pharmacother.

生物医学与药物治疗

144

, 112306.

，112306。

https://doi.org/10.1016/j.biopha.2021.112306

(2021).

（2021）。

Article

文章

PubMed

Google Scholar

谷歌学术索

Liu, Y. C., Rosman, M. & Mehta, J. S. Enhancement after small-incision lenticule extraction: Incidence, risk factors, and outcomes.

刘, Y. C., 罗斯曼, M. & 梅塔, J. S. 小切口透镜提取术后增强：发生率、风险因素和结果。

Ophthalmology

眼科

124

, 813–821.

，813-821。

https://doi.org/10.1016/j.ophtha.2017.01.053

(2017).

（2017）。

Article

文章

PubMed

Google Scholar

谷歌学术

Zhao, P. F. et al. Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia.

赵鹏飞等。评价接受角膜屈光手术矫正近视患者的术前干眼情况。

Int. J. Ophthalmol.

国际眼科杂志

, 1047–1051.

，1047-1051。

https://doi.org/10.18240/ijo.2021.07.13

(2021).

（2021）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

de Medeiros, F. W. et al. Effect of femtosecond laser energy level on corneal stromal cell death and inflammation.

德梅迪罗斯，F. W. 等。飞秒激光能量水平对角膜基质细胞死亡和炎症的影响。

J. Refract. Surg.

屈光手术杂志

, 869–874.

，869-874。

https://doi.org/10.3928/1081597x-20090917-08

(2009).

（2009）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Dammak, A. et al. Oxidative stress in the anterior ocular diseases: Diagnostic and treatment.

Dammak, A. 等。眼前节疾病中的氧化应激：诊断与治疗。

Biomedicines

生物医学

https://doi.org/10.3390/biomedicines11020292

(2023).

（2023）。

Sharma, B. et al. Impact of corneal refractive surgery on the precorneal tear film.

夏尔马，B. 等。角膜屈光手术对泪膜前层的影响。

Indian J. Ophthalmol.

印度眼科杂志

, 2804–2812.

，2804-2812。

https://doi.org/10.4103/ijo.IJO_2296_19

(2020).

（2020）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Ang, R. T., Dartt, D. A. & Tsubota, K. Dry eye after refractive surgery.

Ang, R. T., Dartt, D. A. & Tsubota, K. 屈光手术后的干眼症。

Curr. Opin. Ophthalmol.

眼科临床意见

, 318–322.

，318-322。

https://doi.org/10.1097/00055735-200108000-00013

(2001).

（2001）。

Article

文章

PubMed

Google Scholar

谷歌学术

Huh, D., Kay, K. M. & Kim, W. J. Superficial punctate keratopathy after laser in situ keratomileusis.

huh, D., Kay, K. M. & Kim, W. J. 激光原位角膜磨镶术后的表层点状角膜病变。

J. Refract. Surg.

《屈光手术杂志》

, 835–836.

，835-836页。

https://doi.org/10.3928/1081-597x-20041101-13

(2004).

（2004）。

Article

文章

PubMed

Google Scholar

谷歌学术

Moshirfar, M. et al. A literature review of the incidence, management, and prognosis of corneal Epithelial-Related complications after Laser-Assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE).

Moshirfar, M. 等。激光原位角膜磨镶术 (LASIK)、准分子激光角膜切削术 (PRK) 和小切口透镜摘除术 (SMILE) 后角膜上皮相关并发症的发生率、管理及预后的文献综述。

Cureus

治愈

, e43926.

，e43926。

https://doi.org/10.7759/cureus.43926

(2023).

（2023）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Schechter, B. & Mah, F. Optimization of the ocular surface through treatment of ocular surface disease before ophthalmic surgery: A narrative review.

Schechter, B. & Mah, F. 通过在眼科手术前治疗眼表疾病优化眼表：叙述性综述。

Ophthalmol. Therapy

眼科治疗

。

, 1001–1015.

，1001–1015。

https://doi.org/10.1007/s40123-022-00505-y

(2022).

（2022）。

Article

文章

Google Scholar

谷歌学术

Hsueh, Y. J. et al. The pathomechanism, antioxidant biomarkers, and treatment of oxidative stress-related eye diseases.

薛，Y. J. 等。氧化应激相关眼病的病理机制、抗氧化生物标志物及治疗。

Int. J. Mol. Sci.

国际分子科学杂志

https://doi.org/10.3390/ijms23031255

(2022).

（2022）。

Cejkova, J. et al. Suppression of alkali-induced oxidative injury in the cornea by mesenchymal stem cells growing on nanofiber scaffolds and transferred onto the damaged corneal surface.

Cejkova, J. 等。生长在纳米纤维支架上的间充质干细胞对碱性诱导的角膜氧化损伤的抑制作用，并将其移植到受损的角膜表面。

Exp. Eye Res.

实验眼科研究

116

, 312–323.

，312-323。

https://doi.org/10.1016/j.exer.2013.10.002

(2013).

（2013）。

Article

文章

PubMed

Google Scholar

谷歌学术

Chen, Y., Mehta, G. & Vasiliou, V. Antioxidant defenses in the ocular surface.

陈，Y.，米塔，G.，瓦西里乌，V. 眼表的抗氧化防御。

Ocul. Surf.

眼表

, 176–185.

，176-185。

https://doi.org/10.1016/s1542-0124(12)70185-4

(2009).

（2009）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Primavera, L., Canto-Cerdan, M., Alio, J. L. & Alio Del Barrio, J. L. Influence of age on small incision lenticule extraction outcomes.

普里马韦拉，L.，坎托-塞尔丹，M.，阿里奥，J. L.，阿里奥·德尔·巴里奥，J. L. 年龄对小切口透镜提取术结果的影响。

Br. J. Ophthalmol.

英国眼科杂志

106

, 341–348.

，341-348。

https://doi.org/10.1136/bjophthalmol-2020-316865

(2022).

（2022）。

Article

文章

PubMed

Google Scholar

谷歌学术

Kitazawa, K. et al. Impact of aging on the pathophysiology of dry eye disease: A systematic review and meta-analysis.

北泽，K. 等。衰老对干眼病病理生理学的影响：系统评价与荟萃分析。

Ocul. Surf.

眼表

, 108–118.

，108-118。

https://doi.org/10.1016/j.jtos.2022.06.004

(2022).

（2022）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Christensen, M. A. et al. Direct measurements of smartphone screen-time: Relationships with demographics and sleep.

克里斯滕森，M. A. 等。智能手机屏幕时间的直接测量：与人口统计学和睡眠的关系。

PLoS ONE

。

, e0165331.

，e0165331。

https://doi.org/10.1371/journal.pone.0165331

(2016).

（2016）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Santhiago, M. R., Giacomin, N. T., Smadja, D. & Bechara, S. J. Ectasia risk factors in refractive surgery.

桑蒂亚戈，M. R.，贾科明，N. T.，斯马杰，D.，贝查拉，S. J. 屈光手术中的扩张风险因素。

Clin. Ophthalmol.

临床眼科

, 713–720.

，713-720。

https://doi.org/10.2147/opth.S51313

(2016).

（2016）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Download references

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Acknowledgements

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None.

无。

Author information

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Author notes

作者笔记

Chia-Yi Lee, Hung-Chi Chen and Shun-Fa Yang contributed equally to this work.

李佳宜、陈宏基和杨顺发对本研究贡献相同。

Authors and Affiliations

作者与所属机构

Institute of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan

台湾台中市中山医学大学医学研究所，402

Chia-Yi Lee & Shun-Fa Yang

李佳怡和杨顺发

Nobel Eye Institute, Taipei, 115, Taiwan

诺贝尔眼科中心，台北，115，台湾

Chia-Yi Lee & Chao-Kai Chang

李佳怡 & 常朝凯

Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, 412, Taiwan

台湾台中市大里区仁爱医院眼科，412

Chia-Yi Lee

李佳宜

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, 333, Taiwan

台湾桃园市长庚纪念医院林口分院眼科部，邮编333

Hung-Chi Chen & Yi-Jen Hsueh

陈鸿基 & 薛义仁

Department of Medicine, Chang Gung University College of Medicine, Taoyuan, 333, Taiwan

台湾桃园长庚大学医学院医学系，333

Hung-Chi Chen

陈鸿志

Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, 333, Taiwan

台湾林口长庚纪念医院组织工程中心，邮编333

Hung-Chi Chen & Yi-Jen Hsueh

陈宏基和薛义仁

Department of Medical Research, Chung Shan Medical University Hospital, Taichung, 402, Taiwan

台湾台中市中山医学大学附属医院医学研究中心，402

Shun-Fa Yang & Jing-Yang Huang

杨顺发黄景阳

Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, 300, Taiwan

台湾新竹市元培科技大学视光学系，邮编300

Chao-Kai Chang

常超凯

Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan

诺贝尔眼科中心，台湾台北市中正区公园路13-5号，邮编100008

Chao-Kai Chang

常超凯

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Chia-Yi Lee

李佳宜

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Hung-Chi Chen

陈鸿志

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杨顺发

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薛义仁

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Contributions

贡献

C.-K.C.: conceptualization. C.-Y.L., H.-C.C., and S.-F.Y.: methodology. C.-K.C. and Y.-J.H.: data curation. C.-K.C.: software. CKC and J.-Y.H.: formal analysis. C.-Y.L., H.-C.C., and S.-F.Y.: writing—original draft preparation. C.-K.C.: writing—review and editing. C.-K.C.: validation. C.-K.C.: visualization.

C.-K.C.：概念化。C.-Y.L.、H.-C.C. 和 S.-F.Y.：方法论。C.-K.C. 和 Y.-J.H.：数据整理。C.-K.C.：软件。C.-K.C. 和 J.-Y.H.：形式分析。C.-Y.L.、H.-C.C. 和 S.-F.Y.：撰写—原稿准备。C.-K.C.：撰写—审阅与编辑。C.-K.C.：验证。C.-K.C.：可视化。

C.-K.C.: supervision. All authors reviewed and agreed the submission version of our manuscript..

C.-K.C.：监督。所有作者都审阅并同意了我们手稿的提交版本。

Corresponding author

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Chao-Kai Chang

常超凯

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Lee, CY., Chen, HC., Yang, SF.

李, CY., 陈, HC., 杨, SF.