Arba-Mosquera Samuel, de Ortueta Diego
J Refract Surg. 2016 Feb;32(2):78-83. doi: 10.3928/1081597X-20151119-04.
To investigate refractive outcomes and induction of corneal higher order aberrations (HOAs) in eyes with large pupil to corneal vertex offset that underwent LASIK for hyperopia using an aberration-neutral profile with corneal vertex centration and asymmetric offset.
In this retrospective consecutive review, 26 patients (46 eyes) who underwent LASIK performed by one surgeon using the AMARIS 750S excimer laser platform and Carriazo-Pendular microkeratome (both from SCHWIND eye-tech-solutions, Kleinostheim, Germany) for flap creation were retrospectively analyzed. Only eyes targeted for plano and with a pupil to corneal vertex offset greater than 200 µm were included. The preoperative metrics were correlated with the outcomes at 3 and 6 months postoperatively.
The mean spherical equivalent was +3.43 ± 1.30 diopters (D) preoperatively and +0.21 ± 0.61 D at last postoperative visit (P < .0001). Mean refractive astigmatism was 1.09 ± 1.06 D preoperatively, and 0.39 ± 0.43 D at last postoperative visit. Postoperative uncorrected distance visual acuity of 20/25 or better was achieved in 74%, 65%, and 79% of eyes at 1, 3, and 6 months, respectively, compared to 85% corrected distance visual acuity of 20/25 or better preoperatively. Statistically significant correlation was observed between preoperative and postoperative aberration values for vertical trefoil (P < .0005), vertical coma (P < .0005), oblique tetrafoil (P < .0001), secondary cardinal astigmatism (P < .05), cardinal tetrafoil (P < .05), and secondary vertical trefoil (P < .05).
LASIK for high levels of hyperopia using corneal vertex centration with asymmetric offset was safe and predictable. Maintaining postoperative keratometry less than 49.00 D after hyperopic LASIK and centering on corneal vertex may reduce the induction of coma compared to other profiles or centration strategies.
研究采用像差中和剖面、角膜顶点对中及不对称偏移的方法，对瞳孔至角膜顶点偏移较大的远视眼行准分子原位角膜磨镶术（LASIK）后的屈光效果及角膜高阶像差（HOAs）的诱导情况。
在这项回顾性连续研究中，对26例患者（46只眼）进行了回顾性分析，这些患者均由同一位外科医生使用AMARIS 750S准分子激光平台和卡里亚佐-摆动式微型角膜刀（均来自德国施温德眼科技术解决方案公司，克莱诺施泰姆）制作角膜瓣并实施LASIK手术。仅纳入目标屈光度为平光且瞳孔至角膜顶点偏移大于200μm的眼睛。将术前指标与术后3个月和6个月的结果进行相关性分析。
术前平均球镜等效度为+3.43±1.30屈光度（D），末次随访时为+0.21±0.61 D（P<.0001）。术前平均屈光性散光为1.09±1.06 D，末次随访时为0.39±0.43 D。术后1个月、3个月和6个月时，分别有74%、65%和79%的眼睛未矫正远视力达到20/25或更好，而术前矫正远视力达到20/25或更好的比例为85%。垂直三叶像差（P<.0005）､垂直彗差（P<.0005）､斜向四叶像差（P<.0001）､二级主散光（P<.05）､主四叶像差（P<.05）和二级垂直三叶像差（P<.05）的术前和术后像差值之间存在统计学显著相关性。
采用角膜顶点对中及不对称偏移的方法对高度远视眼行LASIK手术是安全且可预测的。与其他剖面或对中策略相比，远视性LASIK术后保持角膜曲率计测量值小于49.00 D并以角膜顶点为中心，可能会减少彗差的诱导。
