Objective To assess the safety,efficacy,stability and changes in cylindrical degree and axis after real-time iris recognition guided LASIK with femtosecond laser flap creation for the correction of myopic astigmatism.Methods Retrospective case series.This observational case study comprised 136 patients (249 eyes) with myopic astigmatism in a 6-month trial.Patients were divided into 3 groups according to the pre-operative cylindrical degree:Group 1,-0.75 to-1.25 D,106 eyes;Group 2,-1.50 to-2.25 D,89 eyes and Group 3,-2.50 to-5.00 D,54 eyes.They were also grouped by pre-operative astigmatism axis:Group A,with the rule astigmatism (WTRA),156 eyes; Group B,against the rule astigmatism (ATRA),64 eyes;Group C,oblique axis astigmatism,29 eyes.After femtosecond laser flap created,real-time iris recognized excimer ablation was performed.The naked visual acuity,the bestcorrected visual acuity,the degree and axis of astigmatism were analyzed and compared at 1,3 and 6 months postoperatively.Results Static iris recognition detected that eye cyclotorsional misalignment was 2.37° ± 2.16°,dynamic iris recognition detected that the intraoperative cyclotorsional misalignment range was 0-4.3°.Six months after operation,the naked visual acuity was 0.5 or better in 100％ cases.No eye lost ≥ 1 line of best spectacle-corrected visual acuity (BSCVA).Six months after operation,the naked vision of 227 eyes surpassed the BSCVA,and 87 eyes gained 1 line of BSCVA.The degree of astigmatism decreased from (-1.72 ± 0.77) D (pre-operation) to (-0.29 ± 0.25) D (post-operation).Six months after operation,WTRA from 157 eyes (pre-operation) decreased to 43 eyes (post-operation),ATRA from 63 eyes (pre-operation) decreased to 28 eyes (post-operation),oblique astigmatism increased from 29 eyes to 34 eyes and 144 eyes became non-astigmatism.Conclusions The real-time iris recognition guided LASIK with femtosecond laser flap creation can compensate deviation from eye cyclotorsion,decrease iatrogenic astigmatism,and provides more precise treatment for the degree and axis of astigmatism.It is an effective and safe procedure for the treatment of myopic astigmatism.%目的 探讨实时虹膜识别引导的飞秒激光制瓣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、安全性.方法 回顾性系列病例研究.接受实时虹膜识别引导飞秒激光制瓣LASIK的近视性散光患者136例(249只眼),按术前柱镜度数分为3个组:低度组106只眼(-0.75～-1.25 D),中度组89只眼(-1.50～-2.25 D),高度组54只眼(-2.50～-5.00 D);同时按术前柱镜轴向分为3个组,柱镜轴向在180°±22.5°之间的近视性散光为顺规组(156只眼)；轴向在90°±22.5°之间的近视性散光为逆规组(64只眼)；轴向在45°±22.5°之间的近视性散光为斜轴组(29只眼).手术前应用波阵面像差仪进行小瞳孔下虹膜摄像,将数据导人准分子激光仪,掀瓣前进行静态虹膜识别,掀瓣后激光切削时以25 Hz眼球旋转跟踪频率进行动态虹膜识别,观察患者术后1、3、6个月的裸眼视力、最佳矫正视力、散光度、散光轴向的变化.配对设计均数采用配对t检验,多组均数比较采用单因素方差分析,计数资料采用卡方检验,多个构成比比较采用R×C表卡方检验.结果 静态虹膜识别检测出眼球旋转偏移角度为2.37°±2.16°,动态虹膜识别检测出眼球旋转变化范围为0～4.3°,术中对其加以补偿.术后6个月时,裸眼视力均≥0.5,术后最佳矫正视力均未丢失,术中术后均未产生严重并发症；裸眼视力≥术前最佳矫正视力的患者227只眼(91.16％),裸眼视力≥术前最佳矫正视力l行以上的患者87只眼(34.94％)；散光度数由术前(-1.72±0.77)D减少为术后(-0.29±0.25)D(F=2.16,P＞0.05).低、中、高度组术后1个月散光度数分别为(-0.23±0.21)、(-0.31±0.27)、(-0.37 ±0.34)D,均较术前明显降低(t=7.35,7.74,6.52；P＜0.01).术后6个月时,顺规散光下降为43只眼(17.27％),逆规散光下降为28只眼(11.25％),斜轴散光上升为34只眼(13.65％),144只眼(57.83％)成为无散光眼,与术后1个月相比,差异无统计学意义(x2 =1.28,P＞0.05).结论 实时虹膜识别引导的飞秒激光制瓣LASIK能够有效校正患者平卧后和手术中眼球的旋转偏差,使散光度数和轴向的治疗更加精确,同时能够减少术后散光的产生.
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