【摘要】 目的 比较飞秒激光小切口角膜基质透镜取出术(SMILE)与角膜地形图引导下的飞秒激光辅助准分子激光原位角膜磨镶术(TOPO-LASIK)治疗高度近视散光的临床效果。方法 回顾性选取2020年5月至2022年11月在三二〇一医院自愿接受、选择矫正手术方式且近视散光均≤-2.50 D的患者81例(111眼),按照手术方式不同分为SMILE组(S组)48例(66眼)和TOPO-LASIK组(T组)33例(45眼)。两组患者术前、术后均行视力、显然验光、角膜地形图等检查。比较两组术前的验光结果；采用Alpins方法进行矢量分析，比较两组术后1周及术后6个月的疗效。结果 T组手术前平均等效球镜(SE)高于S组，差异有统计学意义(P<0.05),但两组的散光柱镜度及轴位比较，差异均无统计学意义(P>0.05)。术后1周以及术后6个月，S组和T组的平均裸眼视力(UDVA)均有显著改善，但组间比较差异无统计学意义(P>0.05);术后1周，S组的球镜与柱镜度均高于T组，柱镜轴位低于T组，差异均有统计学意义(P<0.05)。术后6个月，S组球镜度高于T组，柱镜轴位低于T组，差异均有统计学意义(P<0.05),但S组和T组的SE、柱镜值比较，差异均无统计学意义(P>0.05)。S组的术后1周差向量(DV)矢量值及术后6个月DV矢量值及CI值均显著低于T组，差异均有统计学意义(P<0.05)。S组和T组术后6个月的DV的矢量平均值分别为0.14 Ax 165、0.91 Ax 84,CI分别为0.95、1.28,差异均有统计学意义(P<0.05)。结论 SMILE和角膜地形图引导下的飞秒激光辅助准分子激光原位角膜磨镶术两种术式在矫正高度散光方面均安全、有效，但SMILE在矫正高度散光时存在欠矫倾向。更多还原

【Abstract】 Objective To compare the clinical effect of small incision lenticule extraction(SMILE) and topography-guided laser in situ keratomileusis(TOPO-LASIK) for the treatment of high myopic astigmatism. Methods Patients with myopic astigmatism less than 2.50 D who were examined in 3201 Hospital from May 2020 to November 2022 were enrolled and divided into SMILE group(group S, 48 cases, 66 eyes) and TOPO-LASIK group(group T, 33 cases, 45 eyes) retrospective. Visual acuity, apparent refraction and corneal topography were examined before and after operation. The results of preoperative optometry were compared between the two groups. Alpins vector analysis was used to compare the efficacy of the two groups at 1 week and 6 months after operation. Results The average equivalent spherical mirror(SE) before surgery in group T was higher than that in group S, and the difference was statistically significant(P<0.05). However, there were no statistically significant differences in the astigmatism column mirror degree and axial position between the two groups(P>0.05). At 1 week and 6 months after surgery, the average naked eye visual acuity(UDVA) of group S and group T significantly improved, but there was no statistically significant difference between the groups(P>0.05). At 1 week after surgery, the spherical and columnar degrees in group S were higher than those in group T, and the axial position of the columnar mirror was lower than that in group T, and the differences were statistically significant(P<0.05). At 6 months after surgery, the spherical mirror degree of group S was higher than that of group T, and the axial position of the column mirror was lower than that of group T, and the differences were statistically significant(P<0.05). However, there were no statistically significant differences in SE and column mirror values between group S and group T(P>0.05). The difference vector(DV) vector value at 1 week after surgery and the DV vector value and CI value at 6 months after surgery in group S were significantly lower than those in group T, and the differences were statistically significant(P<0.05). The vector mean values of DV in group S and group T at 6 months after surgery were 0.14 Ax 165 and 0.91 Ax 84, respectively, with CI of 0.95 and 1.28, and the differences were statistically significant(P<0.05). Conclusion Both SMILE and TOPO-LASIK are safe and effective for the correction of high astigmatism, However, SMILE has a tendency of undercorrection when correcting high astigmatism.更多还原