Wallerstein Avi, Gauvin Mathieu, Qi Susan Ruyu, Bashour Mounir, Cohen Mark
J Refract Surg. 2019 Jan 1;35(1):15-23. doi: 10.3928/1081597X-20181113-01.
To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism.
Retrospective analysis of 1,274 consecutive LASIK eyes treated on the topography-measured anterior corneal astigmatism axis compared to eyes treated on the conventional clinical manifest refractive astigmatism axis.
In eyes with a small axis discrepancy between anterior corneal astigmatism and refractive astigmatism of 5° to 20°, there was no significant difference in efficacy index, refractive astigmatism accuracy, and most Alpins vector analysis parameters. Both treatment modalities achieved 20/20 uncorrected distance visual acuity (UDVA) in 90% of eyes, with 95% having postoperative cylinder of 0.50 diopters (D) or less. In eyes with a large axis discrepancy between 21° and 45° treated on the anterior corneal astigmatism axis, outcomes were both statistically and clinically inferior. Fewer eyes achieved UDVA of 20/20 (88.9% vs 73.6%; P = .01) and fewer had a defocus equivalent of 0.25 (65.6% vs 52.7%), 0.50 (86.9% vs 80.0%), and 0.75 (97.5% vs 90.9%) D or less (P < .05 for all). Significantly more eyes achieved an angle of error greater than 15° (25.4% vs 8.1%; P = .004), had postoperative residual astigmatism of 0.75 D or less (18.2% vs 7.4%; P = .03), and needed an excimer laser re-treatment (11% vs 1.6%; P = .007).
Topography-guided myopic astigmatism LASIK treated on the topography-measured anterior corneal astigmatism axis resulted in inferior refractive and visual outcomes compared to treating on the clinical manifest refractive astigmatism axis. [J Refract Surg. 2019;35(1):15-23.].
研究在威视康角膜地形图引导下（爱尔康实验室公司，沃思堡，德克萨斯州）测量前角膜散光进行的准分子原位角膜磨镶术（LASIK），与按照临床测量的显性屈光性散光轴治疗原发性近视散光眼相比，是否能带来更好的屈光效果。
对1274只连续接受LASIK手术的眼睛进行回顾性分析，将按照角膜地形图测量的前角膜散光轴治疗的眼睛与按照传统临床显性屈光性散光轴治疗的眼睛进行比较。
在前角膜散光与屈光性散光之间轴差异较小（5°至20°）的眼睛中，疗效指数、屈光性散光准确性以及大多数阿尔平斯矢量分析参数均无显著差异。两种治疗方式在90%的眼睛中均达到了20/20的未矫正远视力（UDVA），95%的眼睛术后柱镜度数为0.50屈光度（D）或更低。在前角膜散光轴上治疗轴差异较大（21°至45°）的眼睛，其结果在统计学和临床上均较差。达到20/20 UDVA的眼睛更少（88.9%对73.6%；P = 0.01），等效离焦为0.25（65.6%对52.7%）、0.50（86.9%对80.0%）和0.75（97.5%对90.9%）D或更低的眼睛也更少（所有P均<0.05）。显著更多的眼睛达到了大于15°的误差角（25.4%对8.1%；P = 0.004），术后残余散光为0.75 D或更低（18.2%对7.4%；P = 0.03），并且需要准分子激光再次治疗（11%对1.6%；P = 0.007）。
与按照临床显性屈光性散光轴治疗相比，在角膜地形图测量的前角膜散光轴上进行角膜地形图引导的近视散光LASIK手术，屈光和视觉效果较差。[《屈光手术杂志》。2019；35(1):15 - 23。]
