目的:评估波前像差引导飞秒激光辅助LASIK(femtosecond laser assisted LASIK,FS-LASIK)治疗近视合并中高度散光患者术后高阶像差变化.方法:纳入我院于2016-07/2017-02收治的近视合并中度至高度散光患者50例88眼.术前51眼散光≥-1.50D且<-3.00D(中度散光),37眼散光≥-3.00D(高度散光),所有患者均接受波前像差引导FS-LASIK手术.术前和术后3 mo评估未矫正视力(uncorrected distance visual acuity,UDVA)、 矫正视力(corrected distance visual acuity,CDVA)、角膜曲率、角膜中心厚度(central corneal thickness,CCT)和部分高阶像差(higher order aberrations,HOAs).结果:术后3 mo所有术眼的UDVA均达到20/20以上,均较术前提高且差异有统计学意义(P<0.05),而CDVA和术前相比差异无统计学意义(P=0.36).术后85眼(97％)散光在-1.00D以下,70眼(80％)散光在-0.50D以下,差异有统计学意义(P<0.05).较术前相比,术后平均角膜曲率降低约为3.81±1.97D,CCT减少约78.66±37.22μm,差异有统计学意义(P<0.05).术后3mo彗差与三叶草较术前无明显变化(P=0.078、0.065);而球面像差、二次散光及高阶像差均方根(HOA-root mean square,HOA-RMS)术后较术前均有所增加,分别从术前的0.19±0.06、0.05±0.02和0.42±0.12增加至术后的0.32±0.17、0.26±0.08和0.78±0.28,差异有统计学意义(P<0.05).结论:波前像差引导FS-LASIK术后虽然产生部分高阶像,但依然是中高度散光患者进行角膜屈光手术的一个安全有效的选择.%AIM:To assess the changes in higher order aberrations after wavefront guided femtosecond laser assisted laser in situ keratomileusis ( FS-LASIK ) for moderate to high astigmatism.?METHODS: Eighty-eight eyes of 50 myopia patients with moderate to high astigmatism were included in this prospective study. There were 51 eyes with moderate astigmatism (≥-1. 50D and <-3. 00D) and 37 eyes with high astigmatism (≥-3. 00D). All patients underwent wavefront guided FS-LASIK. Uncorrected distance visual acuity ( UDVA ) , corrected distance visual acuity (CDVA), keratometry, central corneal thickness ( CCT)and higher order aberrations ( HOAs ) were evaluated before operation and 3mo postoperatively.?RESULTS:At the 3mo after operation, the mean UDVA of all eyes was above 20/20, better than before operation (P<0. 05), but CDVA remained unchanged (P=0. 36) and no eyes lost ≥2 lines of CDVA. Mean astigmstism of 85 eyes ( 97％) was reduced below - 1. 00D, mean astigmatism of 70 eyes ( 80％) was reduced below-0.50D(P<0. 05). The average corneal curvature was flatter by 3. 81 ± 1. 97D and CCT was reduced by 78. 66 ± 37. 22μm, postoperatively (P<0. 05). Coma and trefoil aberrations remained unchanged(P=0. 078, 0. 065). The spherical aberration, secondary astigmatism and the HOA root mean square ( RMS ) increased from 0. 19 ± 0. 06, 0.05±0. 02 and 0. 42±0. 12, preoperatively to 0. 32± 0. 17, 0. 26 ± 0. 08 and 0. 78 ± 0. 28 ( P < 0. 05 ), postoperatively.?CONCLUSION: Wavefront-guided FS-LASIK is a safe and effective option for the patients with moderate to high astigmstism although parts of HOAs increased.
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