虹膜识别技术在准分子激光原位角膜磨镶术治疗近视性散光中的临床研究

Iris recognize-guided LASIK with Zyoptix-System for correction of myopic astigmatism

目的评价虹膜识别技术应用于准分子激光原位角膜磨镶术（LASIK）治疗近视性散光的准确性、稳定性及可预测性。方法采用虹膜识别引导的LASIK治疗近视散光患者97例（183只眼），按术前柱镜度数分为3组：1组（-0．50～-1．00D）79只眼，2组（-1．25～-2．00D）70只眼，3组（-2．25～4．00D）34只眼；按术前柱镜轴向分为组A（循规散光）106只眼、组B（逆规散光）43只眼、组C（斜轴散光）34只眼。术前采集散瞳前后的虹膜数据和波阵面像差数据，经过虹膜识别后形成ate文件，将该数据同Orbsesn角膜地形图系统产生的ore文件相结合设计手术方案形成tls文件，导入准分子激光系统，激光器对平卧位时术眼再次进行虹膜识别，确定瞳孔中心偏移量和眼球旋转角度，在治疗时加以补偿，术中三维眼球自动跟踪系统监测眼球运动。观察手术前后不同时期的视力、散光度及轴向变化。结果术中检测出瞳孔中心总体的偏移量为X轴方向（0．41±98．90）μm、Y轴方向（109．15±141．35）μm、眼球旋转偏移角度0．83°±3．40°，术中对其加以补偿。术后6个月裸眼视力≥0．5者183只眼（100．0％），≥1．0者169只眼（92．3％），散光度由术前（-1．54±0．65）D减少为术后6个月的（-0．26±0．25）D，对术后各时间点的样本总体散光度进行单因素方差分析，差异有统计学意义（F=5．74，P〈0．01）。各组间两两比较采用SNK检验，术后1周与1、3、6个月比较差异有统计学意义（P〈0．05）；术后1、3、6个月之间差异无统计学意义（P=0．88）。术后6个月顺规散光下降为45只眼（24．6％），逆规散光下降为31只眼（16．6％），斜轴散光上升为38只眼（21．0％），术后6个月有69只眼（37．8％）成为无散光眼。结论虹膜识别引导的LASIK治疗近视散光效果良好，准确性及可预测性较高，是目前精确、先进、有效的散光治疗方法之一。

Objective To assess the safety, efficacy, predictability, stability, and changes in cylindrical degree and axis after iris recoguize-guided LASIK with the Zyoptix 4. 01 System for the correction of myopic astigmatism. Methods The present study was a prospective, nonrandomized, self-controlled trial. Iris recognize-guided LASIK with the Zyoptix 4.01 System （ Bausch ＆ Lomb ） was performed in 97 patients （ 183 eyes） with myopic astigmatism in a 6-month trial. Patients were divided into 3 group according to the pre-operative cylindrical degree： Group 1, -0. 50 to -1.00D, 79 eyes; Group 2, - 1.25 to -2. 00D, 70 eyes; Group 3, 2. 00 to 4. 00D, 34 eyes. They were also grouped by preoperative astigmatism axis： Group A, with the rule （WTR） astignlatism, 126 eyes; Group B, against the rule （ATR）, 34 eyes; Group C, oblique axis astigmatism, 23 eyes. After a Hansatome microkeratome cut, iris recognized wavefrent-based excimer ablation （Zyoptix 100 ） was performed. The degree and axis of astigmatism preoperative and at various times post-operatively （ 1 day, 1 month, 3 month and 6 months） were analyzed and compared. Results At 6 month post-operatively, uncorrected visual acuity （VA） was 1.0 or better in 92. 3% of the eyes, and 0. 5 or better in all eyes. No eye lost ≥1 lines of best spectacle-corrected VA （BSCVA） at 6 month post-operatively; 60 eyes gained 1 line of BSCVA, and 22 eyes gained 2 lines. The cylindrical degree of astigmatism decreased from （ - 1.54 ＋ 0. 65 ） D of pre-operation to （ - 0. 26 ＋ 0. 25 ） D （6 month, post-operatively）, the difference between these two groups was statistically significant. The uncorrected VA （UCVA） and the degree of astigmatism returned to normal in the first week and tended to be stable after 1 month. Six months after the operation, WTR astigmatism decreased froml06 eyes （peroperation） to 45 eyes （pest-operation）. ATR stigmatism decreased from 43 eyes （per-operation） to 31 eyes （post-operation）. Oblique astigmatism increased from 34 to 38 eyes. Sixty-nine eyes became non-astigmatism 6 months after the operation. Conclusion Iris recognize-guided LASIK using Zyoptix is an effective and safe procedure for the treatment of myopic astigmatism.