目的 探讨准分子激光原位角膜磨镶术(LASIK)术中光线亮度改变对眼球旋转角度和瞳孔中心的影响.方法 前瞻性病例系列研究.LASIK患者140例(268眼),术中通过调整激光机灯光亮度,以虹膜定位技术(VisxStar-S4-IR)分别测出高亮度和低亮度下眼球的旋转角度、瞳孔大小、瞳孔直径及瞳孔中心位置,并进行比较分析.在与基础眼位相比及亮度变化之间,眼球旋转方向在两眼的差异采用卡方检验;眼球旋转角度、瞳孔直径改变在两种亮度状态下的差异采用独立样本t检验.结果 灯光亮度改变后,268眼中有259眼(占96.6%)发生了眼球旋转,而且主要为外旋(180眼,69.5%),其中有26眼(占10.0%)眼球旋转方向发生改变.大部分眼(247眼,占95.4%)旋转角度≤2°,且与基础眼位比较,右眼与左眼低亮度下的旋转角度大于高亮度(t=2.375、2.146,P均＜0.05).在高亮度和低亮度下,患眼瞳孔直径分别为2.00～4.10 mm和2.40～5.80 mm,差异有统计学意义(t=2.1l,P＜0.05).在高亮度和低亮度下,与术前检查结果相比,约2/3眼的瞳孔中心均向鼻上方偏移,但两种光亮度之间瞳孔中心的偏移差异无统计学意义.结论 准分子激光屈光手术中,亮度的改变会引起眼球旋转和瞳孔中心位置的改变,从而影响手术矫正的准确性.%Objective Discuss the effect of luminance on cyclotorsion and pupil center during Laser in situ keratomileusis (LASIK). Methods Prospective case series study. One hundred and forty subjects (268 eyes) were selected to receive LASIK operation. During the operation, the brightness of laser lighter was adjusted, rotation angle of eyeballs, diameter and position of pupil centre under high brightness and low brightness was tested using Visx S4 IR examer laser chi-square test and independent samples t test was used. Results Two hundred and fifty-nine eyes (96.6%) rotated, and mainly (69.5%) was extorsion after brightness adjusted. Furthermore, direction-changing occurred in 26 eyes. The rotation angle in most eyes (247 eyes, counted 95.4%) were within 2°. Under the high brightness and dark brightness, pupil centre of most eyes shifting naso-upside, but the discrepancy under different brightness with no statistic difference. Conclusion During LASIK procedures, luminance brightness will cause cyclotorsion and position shifting of pupil centre, therefore, brightness will affect the accuracy of LASIK.
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