LASIK手术中眼球旋转的观察研究

The observation on cyclotorsion during laser in situ keratomileusis

目的:探讨LASIK手术中患者发生眼球旋转的特点和规律。方法:对203例(394眼)患者术前应用VISX波前像差仪进行虹膜照相检查,LASIK手术中利用VISXS4-IR系统进行虹膜定位检查,观察手术时与检查时的眼球旋转方向和角度。结果:虹膜定位的捕捉成功率为92.6%,394眼中共有346眼在术中发生了旋转。双眼均主要为外旋,其中,右眼中,36.5%发生了内旋、63.5%发生了外旋;左眼中,36.3%的发生了内旋、63.7%发生了外旋。右眼眼球旋转的最小角度为0.1°,最大角度为8.9°;左眼眼球旋转的最小角度为0.1°,最大角度为9.6°。平均眼球的旋转角度为(2.78±2.10)°。旋转大于5°的眼球为18.5%。结论:LASIK手术时,随着从坐位到仰卧位的改变,患者普遍存在着低中度的眼球旋转问题。该问题会对患者的术后效果产生一定的影响。精确地进行虹膜定位,将有助于提高散光和高阶像差患者的手术效果。

AIM： To discuss the characteristic of cyclotorsion occurring during wavefront measurement and laser refractive surgery. HETHODS： VISX WaveScan wavefront device was used to obtain the eyeball position images of 394 eyes （203 patients） before refractive laser surgery. Additionally, an infrared camera was mounted on the VISX Star ,S4-1R exdmer laser system to obtain another image immediately before the laser was fired. Then the two sets of images were compared to determine the degree of cydotorsion during the measurement and surgery. RESULTS： The success capture rate of iris registration was 92.6%. The cydotorsion occurred in 346 eyes during the laser in situ keratomileusis （LASIK） surgery. The predominant trend was excydotorsion （63.5% in right eyes and 63.7% in left eyes, respectively）. The total range of torsion in degrees was 0.1°-9.6° （mean 2.78°±2.10°）. Cydotorsion〉5° occurred in 18.5% of the eyes. CONCLUSION： The majority of eyes have a low-to-moderate-degree of cydotorsion with the change of orientation from seating to supine position. The accurate iris registration is essential for proper correction of astigmatism and higher order aberrations to achieve optimal visual outcomes.