目的:评价角膜地形图引导的个体化切削术治疗复杂屈光不正的临床疗效。方法:选择接受TOSCA治疗的复杂屈光不正患者共59例113眼。其中近视度数相对高角膜厚度相对薄67眼,角膜形态不规则8眼,角膜散光大33眼,PRK/LASIK术后偏心切削6眼,PRK/LASIK术后再近视5眼。术前等效球镜为平均-1.25～-13.88(平均-6.87±2.86)D。观察术后裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best-corrected visual acuity,BCVA)、等效球镜、角膜曲率、角膜厚度、高阶像差及偏中心切削等。结果:UCVA术前为0.13±0.12,术后6mo为0.94±0.22,差异有统计学意义(P<0.05)。术后6mo时的平均等效球镜为(-0.45±0.48)D,在±0.5D以内。角膜曲率术前为(43.01±1.56)D,术后6mo为(37.99±1.69)D,术后与术前比较显著降低,差异有统计学意义(P<0.05)。术中平均切削厚度为(88.30±28.86)μm,比按照其相同屈光度和切削直径的传统LASIK/LASEK手术的切削厚度(117.93±32.72)μm节约了约(27.77±23.24)μm,差异无统计学意义(P>0.05)。术前总高阶像差、水平彗差、垂直彗差及球差值分别为0.50±0.23,0.10±0.08,0.14±0.12,0.12±0.09,术后6mo时分别为0.68±0.25,0.21±0.22,0.32±0.18,0.38±0.14,差异有统计学意义(P<0.05)。术前6例因PRK和LASIK术后造成的偏中心切削,其偏中心切削距离均>1.0(平均1.33±0.45)mm,术后偏中心切削平均为(0.49±0.22)mm,差异有统计学意义(P<0.05)。结论:TOSCA治疗复杂屈光不正术后有较好的安全性、有效性和预测性,且可以在一定程度上节约角膜厚度。

AIM:To evaluate the clinical efficacy of TOSCA treatment of complex refractive errors. METHODS:Totally 59 patients 113 eyes who received TOSCA were selected.There were complex refractive errors,such as 67 eyes of the high degree of corneal thickness comparative thin,8 eyes of irregular corneal shapes,33 eyes of corneal astigmatism large,6 eyes of eccentric ablation after PRK/LASIK,5 eyes of re-myopia after PRK/LASIK.The spherical equivalent degree was -1.25 - -13.88D with an average of -6.87±2.86D.The uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),spherical equivalent,keratomrtry of corneal curvature,the thickness of corneal,wavefront aberration and eccentric ablation were evaluated postoperatively. RESULTS:The UCVA was 0.13±0.12 preoperatively and 0.94±0.22 6 months postoperatively,there was statistical difference(P<0.05).The average spherical equivalent was -0.45±0.48D6 months postoperatively,it was within±0.5D.The preoperative keratomrtry of corneal curvature was 43.01±1.56D,and 37.99±1.69D 6 months postoperatively,there was statistical difference(P<0.05) between preoperation and postoperation.The preoperative average cutting thickness was 88.30±28.86μm and 117.93±32.72μm in LASIK/LASEK,the former saved about 27.77±23.24μm,there was no statistical difference between two groups(P<0.05).The total high order aberration,the level of coma,vertical coma and spherical aberration were 0.50±0.23,0.10±0.08,0.14±0.12,0.12±0.09 preoperatively,and 0.68±0.25,0.21±0.22,0.32±0.18,0.38±0.14 6 months postoperativly,there was statistical differen between them(P<0.05).The eccentric ablation of 6 eyes was more than 1.0mm with an average of 1.33±0.45mm because of PRK/LASIK preoperatively, its average was 0.49±0.22mm postoperatively,there was statistical difference between preoperation and postoperation (P<0.05). CONCLUSION:In the treatment of complex refractive errors,TOSCA have better safety,effectiveness and predictability,and can save corneal thickness significantly to some extent.

R779.63