【摘要】 目的:应用Fourier分析法评价鹰视酷眼准分子激光仪行前弹力层下激光角膜磨镶术(OUP-SBK)和飞秒制瓣准分子激光原位角膜磨镶术(飞秒LASIK)治疗中高度近视患者散光的准确性,并统计各组的正常值范围。方法:回顾性病例分组研究2012年1月至2012年3月在温州医学院眼视光医院行准分子激光手术的患者,满足散光度数≥-0.5 D,近视度数≥-3.0 D的近视散光患者271例(542眼),其中OUP-SBK组159例(318眼),飞秒LASIK组112例(224眼)。按术前等效球镜度数各自分为中度近视及高度近视两组。分别收集各组术前及术后3～6个月间最早的一次随访数据,包括主觉验光度数、角膜地形图、最佳矫正视力。应用Fourier分析法分别计算术前总散光(TJ0,TJ45),角膜散光(CJ0,CJ45)以及术后总散光(RJ0,RJ45)进行散光矫正准确性分析。统计学方法采用成组t检验及Pearson检验。结果:①残余散光:OUP-SBK术后中度近视组RJ0=(0.012±0.161)D,RJ45=(-0.012±0.128)D;高度近视组术后RJ0=(0.026±0.239)D,RJ45=(-0.029±0.194)D,两组差异无统计学意义(P=0.697,0.402)。飞秒LASIK术后中度近视组RJ0=(0.053±0.248)D,RJ45=(-0.039±0.186)D;高度近视组RJ0=(0.042±0.267)D,RJ45=(-0.044±0.261)D,两组差异无统计学意义(P=0.784,0.308)。②散光矫正率:OUP-SBK术后中度近视组CRJ0=97.98%(84.66%～111.30%),CRJ45=702.20%(-337.03%～1741.43%),两者差异有统计学意义(P<0.01);高度近视组术后CRJ0=86.52%(60.20%～94.84%),CRJ45=83.24%(-760.92%～927.40%),两者差异有统计学意义(P<0.01)。飞秒LASIK术后中度近视组CRJ0=90.96%(81.65%～100.27%),CRJ45=1 035.98%(191.04%～1 880.92%),两者差异有统计学意义(P<0.01);高度近视组CRJ0=85.61%(72.70%～98.51%),CRJ45=346.00%(-1 288.68%～1 980.69%),两者差异有统计学意义(P<0.01)。③术后散光相关性分析:OUP-SBK组高度近视组RJ45与TJ45相关性有统计学意义(r=0.361,P<0.01)。飞秒LASIK术后中度近视组RJ0与CJ0(r=0.393,P<0.01),RJ0与TJ0(r=0.596,P<0.01),RJ45与TJ0(r=0.396,P<0.01)相关性均有统计学意义。结论:①鹰视酷眼准分子激光行OUP-SBK或飞秒LASIK手术矫正中高度近视患者的顺规散光具有较高的准确性;②手术对顺规散光患者垂轴成分的矫正准确性高于对斜轴散光成分的矫正准确性;③手术矫正中高度近视患者的顺规散光准确性相近。更多还原

【Abstract】 Objective: To evaluate the accuracy of Cool Excimer Laser System for myopic astigmatism in One Use-Plus Sub-Bowman’s keratomileusis(OUP-SBK) and Femtosecond Laser In Situ Keratomileusis(FSLASIK) with Fourier Analysis and develop a customized nomogram for astigmatic patients.Methods: Retrospectively reviewed the charts of 542 eyes(OUP-SBK: 318 eyes;FS-LASIK: 224 eyes),who had excimer laser surgery in Eye Hospital of Wenzhou Medical College during Jan 2012 to March 2012,with an inclusion criteria as: WTR astigmatism ≥-0.5 D,myopia >-3 D.The moderate and high myopia groups were divided respectively according to baseline myopia.Preoperative and 3 to 6 months postoperative examinations included: refraction,corneal topography,pachymetry,best spectacles corrected visual acuity(BSCVA).Fourier Analysis was used to transform preoperative astigmatism to T J0 and TJ45;preoperative corneal astigmatism to CJ0 and CJ45;postoperative residual astigmatism to RJ0 and RJ45.Group t test and Pearson test were used for statistical analysis.Results:① Residual Astigmatism.OUP-SBK moderate myopia group: R J0 =(0.012 ± 0.161)D,RJ45=-(0.012 ±0.128)D;OUP-SBK high myopia group: R J0 =(0.026 ± 0.239)D,RJ45=(-0.029 ± 0.194)D,the difference between moderate and high myopia group was not statistically significant(P=0.697,0.402).Femtosecond LASIK moderate myopia group: R J0 =(0.053 ± 0.248)D,R J45 =(-0.039 ± 0.186)D;femtosecond LASIK high myopia group: R J0 =(0.042 ± 0.267)D,R J45 =(0.044 ± 0.261)D,the difference between moderate and high myopia group was not statistically significant(P=0.784,0.308).② Astigmatism Correction Rate.OUP-SBK moderate myopia group: CR J0 = 97.98%(84.66%~111.30%),CR J45 = 702.20%(-337.03%~1741.43%),the difference between them was statistically significant(P<0.01);high myopia group: CR J0 = 86.52%(60.20%~94.84%),CR J45 = 83.24%(-760.92%~ 927.40%),the difference was statistically significant(P<0.01).FS-LASIK moderate myopia group: CR J0 = 90.96%(81.65%~100.27%),CR J45 =1 035.98%(191.04%~1 880.92%),the difference them was statistically significant(P<0.01);high myopia group: CR J0 = 85.61%(72.70%~98.51%),CR J45 = 346.00%(-1288.68%~1980.69%),the difference was statistically significant(P<0.01).③ Correlation Analysis.OUPSBK high myopia group: R J45 was related to T J45 with statistically significant correlation(r=0.361,P<0.01).Femtosecond LASIK moderate myopia group R J0 and C J0(r=0.393,P<0.01),R J0 and T J0(r=0.596,P<0.01),R J45 and T J0(r=0.396,P<0.01) had statistically significant correlation respectively.Conclusion: ① Cool Excimer Laser System for myopic astigmatism with OUP-SBK or femtosecond LASIK has great accuracy;② It’s better at correction Cartesian astigmatism than oblique astigmatism;③ The accuracy in correcting astigmatism of moderate myopia patients is close to that of high myopia patients.更多还原