飞秒激光辅助白内障手术中弧形角膜切开术的有效性、稳定性及影响因素：一项系统评价与Meta分析
Effectiveness, Stability, and Influence Factors of Femtosecond Laser-Assisted Arcuate Keratotomy in Cataract Surgery: A Systematic Review and Meta-Analysis.
作者信息
Zhuo Baoxian, Shen Wenqian, Cai Lei, Ni Shuang, Shen Jiying, Yang Jin
机构信息
From the Department of Ophthalmology and the Eye Institute (B.Z., W.S., L.C., J.Y.), Eye and Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China; Key National Health Committee Laboratory of Myopia, and Laboratory of Myopia (B.Z., W.S., L.C., J.Y.), Chinese Academy of Medical Sciences, Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration (B.Z., W.S., L.C., J.Y.), Shanghai, China.
Department of Ophthalmology (S.N., J.S.), Shanghai Heping Eye Hospital, Shanghai, China.
出版信息
Am J Ophthalmol. 2025 Sep;277:33-44. doi: 10.1016/j.ajo.2025.04.037. Epub 2025 May 7.
PURPOSE
This study aimed to evaluate the effectiveness, stability, and influencing factors of femtosecond laser-assisted arcuate keratotomy (FSAK) performed during cataract surgery for correcting corneal astigmatism (CA).
METHODS
A systematic literature review was conducted to identify clinical trials adopting a pre-post study design. Data sources included electronic databases such as PubMed, Scopus, Web of Science, and Embase. Corneal astigmatism was assessed preoperatively and at multiple postoperative intervals: 1 month, 3 months, 6 months, and 1 year. Comparative analyses were conducted to determine the efficacy and stability over time. Subgroup analyses of CA reduction and absolute angle of error were performed based on potential influence factors including the type, depth, diameter, and platform of FSAK, magnitude and type of preoperative CA, and area of the study. Statistical analyses were performed using Review Manager 5.4.
DESIGN
Systematic review and meta-analysis.
RESULTS
Of the 40 articles initially identified, 20 met the final inclusion criteria. Follow-up durations ranged from 1 month to 2 years. Significant reduction in CA postoperative were observed at 1 month, 3 months, 6 months, and 1 year after surgery (mean difference [MD] = -0.55 D, -0.66 D, -0.43 D, and -0.67 D, respectively; all P < .02). CA between different postoperative time points were not significant (all P > .20). Subgroup analysis did not address the high heterogeneity. However, differences of CA reduction between subgroups based on type, depth, diameter, and platform of FSAK were significant. Penetrating FSAK, deeper incision, optical diameter at 8.5 mm were shown to introduce higher CA reduction (P = .005, .02, < .001, respectively). The effect achieved by different laser platforms were significantly different (P = .0002).
CONCLUSIONS
FSAK performed during cataract surgery effectively reduces corneal astigmatism, with stability observed from 1 month to 1 year postoperatively. The corrective performance is closely related to type, depth, diameter, and platform of FSAK. This study was supported by the National Natural Science Foundation of China (Grant No. 82171039 and No. 82301191).
REGISTRATION NUMBER
PROSPERO CRD 42024504481).
目的
本研究旨在评估白内障手术期间进行的飞秒激光辅助弧形角膜切开术（FSAK）矫正角膜散光（CA）的有效性、稳定性及影响因素。
方法
进行系统的文献综述，以确定采用前后对照研究设计的临床试验。数据来源包括电子数据库，如PubMed、Scopus、Web of Science和Embase。在术前及术后多个时间点（1个月、3个月、6个月和1年）评估角膜散光。进行比较分析以确定随时间的疗效和稳定性。基于FSAK的类型、深度、直径和平台、术前CA的大小和类型以及研究区域等潜在影响因素，对CA降低和绝对误差角进行亚组分析。使用Review Manager 5.4进行统计分析。
设计
系统评价和荟萃分析。
结果
最初识别的40篇文章中，20篇符合最终纳入标准。随访时间从1个月到2年不等。术后1个月、3个月、6个月和1年时观察到CA显著降低（平均差值[MD]分别为-0.55 D、-0.66 D、-0.43 D和-0.67 D；所有P < 0.02）。不同术后时间点之间的CA无显著差异（所有P > 0.20）。亚组分析未解决高异质性问题。然而，基于FSAK的类型、深度、直径和平台的亚组之间CA降低的差异显著。穿透性FSAK、更深的切口、8.5 mm的光学直径显示出更高的CA降低（分别为P = 0.005、0.02、< 0.001）。不同激光平台实现的效果显著不同（P = 0.0002）。
结论
白内障手术期间进行的FSAK有效降低角膜散光，术后1个月至1年观察到稳定性。矫正性能与FSAK的类型、深度、直径和平台密切相关。本研究得到中国国家自然科学基金（批准号82171039和82301191）的支持。
注册号
PROSPERO CRD 42024504481）
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