【摘要】 目的 探讨角膜屈光手术中静态眼球旋转（SCC）和动态眼球旋转（DCC）的方向和程度。方法 回顾性病例研究。选择2013年5-7月接受个体化角膜屈光手术的患者144例（281眼），术中应用阿玛仕准分子激光仪（型号500）进行激光切削，测量并比较按性别、眼别、手术方式、术前等效球镜度分组后组间的SCC及DCC差异。计数资料采用卡方检验，计量资料采用成组设计t检验进行分析。结果 平均SCC为3.34°±2.57°（0°~12°）。SCC成功率66.55%，飞秒LASIK手术（100例195眼）和Trans PRK手术（44例86眼）的SCC成功率分别为57.44%和87.21%，差异有统计学意义（χ2=23.76，P<0.01）。SCC成功的右眼中，60%发生逆时针旋转，SCC成功的左眼中，50%发生逆时针旋转。测得术中平均DCC幅度为2.30°±1.42°（0.00°~7.80°）。接受飞秒LASIK手术的患眼，平均DCC幅度为2.05°±1.26°，接受Trans PRK手术的患眼为2.88°±1.59°，差异有统计学意义（t=4.33，P<0.01）。术前等效球镜度≥-5.00 D的患眼，平均DCC幅度为2.51°±1.51°，术前等效球镜度<-5.00 D的患眼为2.00°±1.23°，差异有统计学意义（t=3.07，P<0.01）。结论 角膜屈光手术过程中，眼球会发生旋转。阿玛仕准分子激光仪能够准确有效地测量静态及动态眼球旋转，并进行补偿。
【关键词】 屈光外科手术； 眼球旋转； 静态眼球旋转； 动态眼球旋转
DOI：10.3760/cma.j.issn.1674-845X.2014.03.007
作者单位：200092 上海交通大学医学院附属新华医院眼科
通信作者：李海燕，Email：lhypumc@sina.com
Measurement of static and dynamic cyclotorsion during corneal refractive surgery using SCHWIND AMARIS
Yan Hui， Zhao Peiquan， Zhu Huang， Feng Jieyu， Li Xiangbo， Li Haiyan. Department of Ophthalmology， Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital， Shanghai 200092， China
Corresponding author：LI Haiyan，Email：lhypumc@sina.com
【Abstract】 Objective To investigate the direction and the amount of static cyclotorsion （SCC） and dynamic cyclotorsion （DCC） in ametropic patients during corneal refractive surgery. Methods Two hundred eighty-one eyes of 144 patients who had undergone SCHWIND AMARIS corneal refractive surgery from May 2013 to July 2013 were involved in the study. Ablation was performed using the SCHWIND AMARIS （Version： 500）. The magnitudes of static and dynamic cyclotorsion were recorded in the supine position during the operation by the SCHWIND AMARIS excimer laser system. SCC and DCC were compared by gender， eye， surgical technique and preoperative spherical equivalent. Enumeration data were compared with a χ2 test and measurement data with an intergroup t test. Results Prevalence rates were 66.55% for SCC， and the mean SCC value was 3.34°±2.57°（range 0° to 12°）. Prevalence rates for Femto-LASIK and Trans PRK were 57.44% and 87.21%， respectively. The difference was statistically significant （χ2=23.76， P<0.01）. Sixty percent of the successful SCC right eyes and 50% of the successful SCC left eyes with counterclockwise rotation. The mean DCC amplitude was 2.30°±1.42°（0.00°~7.80°）. The mean DCC amplitude was 2.05°±1.26° in eyes treated with Femto-LASIK and 2.88°±1.59° in eyes treated with Trans PRK. The difference was statistically significant （t=4.33， P<0.01）. The mean DCC amplitude was 2.51°±1.51° in eyes with a preoperative spherical equivalent of ≥-5.00 D and 2.00°±1.23° in eyes with a preoperative spherical equivalent of <-5.00 D. The difference was statistically significant （t=3.07， P<0.01）. Conclusion Significant cyclotorsion occurs during corneal refractive surgery. The SCHWIND AMARIS excimer laser system is a useful tool to measure static and dynamic cyclotorsion precisely and to compensate effectively.
【Key words】 Refractive surgical procedure； Cyclotorsion； Static cyclotorsion； Dynamic cyclotorsion