【摘要】 目的 对全飞秒激光角膜基质透镜切除术（Flex）与飞秒激光制瓣的LASIK（FS-LASIK）术后3个月近视散光患者的角膜形态进行比较研究。方法 前瞻性病例对照研究。对2013年1-9月在北京同仁医院的近视散光患者165例（323眼）进行Flex（87例170眼）或FS-LASIK（78例153眼）手术，术后3个月时，对2组视力、屈光状态及角膜形态参数进行独立样本t检验。结果 Flex组和FS-LASIK组术后3个月时，logMAR UCVA分别为-0.10±0.08和-0.11±0.10，矫正视力分别为-0.11±0.07和 -0.12±0.07，均较术前BCVA（-0.07±0.03和-0.07±0.04）提高（t=4.083、5.594、3.458、6.440，P<0.01），2种手术方式之间差异均无统计学意义（t=-0.811、-1.864，P＞0.05）。Flex和FS-LASIK切削偏心量分别为（0.29±0.17）mm和（0.40±0.17）mm，二者差异有统计学意义（t=5.662，P＜0.01）。Flex切削偏心程度与术前等效球镜度不相关（r=0.122，P＞0.05）；FS-LASIK切削偏心程度与术前等效球镜度呈正相关（r=0.210，P<0.01）。Flex和FS-LASIK术后角膜表面规则指数（SRI）分别为0.34±0.25和0.22±0.21，二者比较差异有统计学意义（t=-4.627，P＜0.01）。结论 Flex术后切削偏心程度比FS-LASIK小，FS-LASIK术后角膜表面规则性比Flex更好，二者术后都可获得满意的视力。
【关键词】 飞秒激光角膜基质透镜切除术； 角膜磨镶术，激光原位，飞秒激光； 角膜地形图； 屈光手术
DOI：10.3760/cma.j.issn.1674-845X.2014.07.006
作者单位：100730 首都医科大学附属北京同仁医院 北京同仁眼科中心 北京市眼科学与视觉科学重点实验室
通信作者：周跃华，Email：yh0220@yahoo.com
Corneal topography comparisons with femtosecond lenticule extraction and femtosecond LASIK
Zheng Yan， Zhou Yuehua， Zhang Jing， Liu Qian， Li Ying， Wang Yue. Beijing Tongren Eye Center， Beijing Tongren Hospital， Capital Medical University， Beijing Ophthalmology & Visual Sciences Key Lab， Beijing 100730， China
Corresponding author：Zhou Yuehua，Email：yh0220@yahoo.com
【Abstract】 Objective To compare the corneal topography of patients with myopia and astigmatism 3 months after femtosecond lenticule extraction （Flex） and femtosecond laser in situ keratomileusis （FS-LASIK）. Methods In this prospective study， 323 myopic eyes of 165 patients with astigmatism who underwent Flex or FS-LASIK from January to September in 2013 in Beijing Tongren Hospital were examined. An independent samples t test was used to compare visual acuity， refraction and corneal topography measurements 3 months after surgery. Results Three months after surgery， uncorrected visual acuities （UCVA） of logMAR in Flex and FS-LASIK were -0.10±0.08 and -0.11±0.10 and best corrected visual acuities （BCVA） were -0.11±0.07 and -0.12±0.07. These measurements were better than the BCVAs before surgery， which were -0.07±0.03 and -0.07±0.04 （t=4.083， 5.594 and 3.458， 6.440， P<0.01）. No significant difference in postoperative UCVA was seen between Flex and FS-LASIK （t=-0.811， -1.864， P＞0.05）. The cutting decentration with Flex （0.29±0.17 mm） was smaller than with FS-LASIK （0.40±0.17 mm）， respectively （t=5.662， P＜0.01）. There was no correlation with spherical equivalent （SE） in Flex （r=0.122， P＞0.05）， but there was a positive correlation with SE in FS-LASIK （r=0.210， P<0.01）. The postoperative surface regularity index （SRI） of Flex was higher than that of FS-LASIK， 0.34±0.25 and 0.22±0.21， respectively （t=-4.627， P＜0.01）. Conclusion The cutting decentration of Flex is smaller than that of FS-LASIK， however the regularity of the corneal surface after FS-LASIK is better than that of Flex. Both techniques result in satisfactory visual acuity.
【Key words】 Femtosecond lenticule extraction； Keratomileusis，laser in situ，femtosecond laser； Topography； Refractive surgery
