眼球静态旋转对LASIK矫治散光的影响

Study static rotation after the LASIK treatment for myopic astigmatism

目的评估眼球静态旋转对准分子激光原位角膜磨镶术（LASIK）治疗散光的影响。方法回顾性系列病例研究。2010年5—11月柱镜≥-0．75D的近视散光患者118例（184眼），根据患者对手术的自愿选择原则分为两组：实验组为接受虹膜定位联合波前像差引导的LASIK术后患者65例（97眼），对照组为传统LASIK术后患者53例（87眼）。观察实验组静态旋转度数。比较术后1d，1个月，3个月裸眼视力，残余球镜，残余散光。计数资料采用书方检验，计量资料采用成组t检验。结果平均静态旋转角度为（3．58±2.31）°，最大为9.3°。术后3个月，实验组裸眼视力达到或超过术前最佳矫正视力有92眼（95％），对照组74眼（85％），两组差异有统计学意义（x2=5．56，P〈0．05）；实验组与对照组平均球镜度数分别为（＋0．03±0．57）D和（＋0．27±0．69）D，平均柱镜度数为（-0．42±0．28）D和（-0．63±0．37）D，两组差异有统计学意义（t=-2．65、4．43，P均〈0．01）；术后3个月，实验组M，J0，J45均显著低于对照组，差异有统计学意义（t=4．43、-2．49、2．01；P均〈0．051；实验组与对照组球镜在±0．50D范围内者分别为67％及52％．柱镜为69％及48％，差异有统计学意义（x2=4．67，P〈0．05；x2=9．08，P〈0．01）。结论LASIK手术治疗前会发生明显的眼球旋转，通过矫正静态旋转能够有效地改善散光的治疗。

Objective To evaluate static rotation for astigmatism after treatment with laser in situ keratomileusis （LASIK）. Methods It was a retrospective case series study. A total of 118 patients （184 eyes） with preoperative astigmatism ≥0.75 D from May 2010 to November 2010 were enrolled and proceeded clinic research. According to the patients＇ choice of the operation, the patients were divided into two groups： 65 patients （97 eyes） in the experimental group were performed the wavefront-guided LASIK with iris recognition and 53 patients （87 eyes） in control group were performed conventional LASIK. Static rotation was assessed in the experimental group groups. The main parameters were uncorrected visual acuity and the amount of residual sphere and cylinder 1 day and l and 3 months postoperatively. Enumeration data were compared with X2 test and measurement data with intergroup t test. Results Mean static rotation was （3.58±2.31）°, maximum was 9.3°. At 3 months postoperatively, uncorrected visual acuity of 92 eyes （95%） in the experimental group and 74 eyes （85%） in the control group was better than preoperative best-corrected visual acuity, there was a statistical difference （X2=5.56, P〈0.05）. The mean sphere was （＋0.03±0.57）D in the experimental group and （＋0.27±0.69）D in the control group, and mean cylinder was （-0.42±0.28）D and （-0.63±0.37）D, respectively,there were statistical differences （t=-2.65, 4.43, all P〈0.01）. At 3 months postoperatively, M, J0, J45 in the experimental group were significantly lower than that in the control group （t=4.43, -2.49, 2.01; all P〈0.05）. Predictability was 67% and 52% within ＋0.50 D for sphere and 69% and 48% for cylinder in the experimental and control groups, respectively, there were statistical differences （X2=4.67, P〈0.05; Xz=9.08, P〈0.01）. Conclusion Significant eyclotorsion occurs after LASIK treatment. By correcting the cylinder axis, the efficacy of cylinder correction can be improved.