目的：探讨角膜地形图引导的飞秒激光制瓣的准分子激光原位角膜磨镶术(FS-LASIK)与有晶状体眼后房型环曲面人工晶状体(TICL)植入术矫正近视合并中高度散光的临床疗效。

方法：选取2019-06/2021-06在河源爱尔眼科医院屈光中心就诊的近视合并中高度散光患者60例115眼，按手术方式分组，接受角膜地形图引导的FS-LASIK患者32例62眼纳入A组； 接受TICL植入术的患者28例53眼纳入B组。记录术前、术后3mo的裸眼视力(UCVA)、最佳矫正视力(BCVA)、球镜度、残余散光度，评估手术安全性和有效性，并利用Alpins矢量分析方法评估散光的矫正效果。

结果：术后3mo，两组患者安全性指数(1.163±0.167 vs 1.136±0.194)和有效性指数(1.145±0.159 vs 1.123±0.196)均无差异(P>0.05)，但散光矢量分析显示两组患者成功指数\〖0.125(0.091，0.200)vs 0.200(0.167，0.250)\〗、矫正指数\〖1.000(0.902，1.066)vs 0.834(0.783，0.869)\〗、变平指数\〖1.000(0.922，1.079)vs 0.835(0.795，0.870)\〗均有差异(P<0.01)。

结论：角膜地形图引导的FS-LASIK与TICL植入术均能安全、有效地矫正近视散光，角膜地形图引导的FS-LASIK手术矫正散光的效果优于TICL植入术。

METHODS: A total of 60 patients(115 eyes)with moderate to high astigmatism in myopia(115 eyes)from June 2019 to June 2021 and treated in the refractive center of Heyuan Aier Eye Hospital were enrolled in the study, then were divided into Group A and Group B according to the operations they would accept. There were 32 patients(62 eyes)in the Group A treated with corneal topography-guided FS-LASIK and 28 patients(53 eyes)in the Group B treated with TICL implantation. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical diopter and residual astigmatism were recorded preoperatively and postoperatively at 3mo, surgical safety and efficacy were evaluated, and the Alpins vector analysis was used to evaluate the astigmatism.

RESULTS: The postoperative at 3mo, there were no differences in the safety index(1.163±0.167 vs 1.136±0.194)and the efficacy index(1.145±0.159 vs 1.123±0.196)between the patients of the two groups(P>0.05). However, the astigmatism vector analysis showed that there were statistically differences in the index of success index \〖0.125(0.091, 0.200)vs 0.200(0.167, 0.250)\〗, the correction index \〖1.000(0.902, 1.066)vs 0.834(0.783, 0.869)\〗 and the flattening index \〖1.000(0.922, 1.079)vs 0.835(0.795, 0.870)\〗(P<0.01).

CONCLUSION:Corneal topography-guided FS-LASIK and TICL implantation were effective and safe in correcting myopia with moderate to high astigmatism, and corneal topography-guided FS-LASIK perform better than TICL implantation for the astigmatism correction.