目的:分析角膜地形图引导的准分子激光角膜切削术(TOSCA)治疗复杂屈光不正患者术中切削厚度。方法:选取在我院接受TOSCA治疗的复杂屈光不正患者23例42眼,等效球镜为-2.50～-13.50(平均-7.51±2.23)D。将其在实际工作中按TOSCA模式中计算出的切削厚度与按照其相同的切削直径的LASIK/LASEK模式计算的切削厚度进行对比。结果:术前平均裸眼视力0.11±0.19,最佳矫正视力0.98±0.16,术后6mo裸眼视力1.03±0.30,与术前裸眼视力比较差异有统计学意义(P<0.05),达到并保持在术前最佳矫正视力。术前平均等效球镜-7.51±2.23D,术后6mo的平均等效球镜-0.42±0.67D,控制在±0.50D以内,达到矫正近视的目的。按照TOSCA模式计算术中实际切削厚度为92.43±21.28μm,剩余厚度为409.17±25.47μm,而按照相同的切削直径和屈光度的传统的LASIK/LASEK模式中计算的切削厚度和剩余厚度分别为123.26±28.73,378.69±32.65μm,两种模式的切削厚度相差约30.83±21.86μm,差异有统计学意义(P<0.05)。结论:在治疗复杂屈光不正患者时,TOSCA手术模式的术中预测角膜切削厚度明显小于LASIK/LASEK手术模式,理论上提高了手术的安全性。

·AIM:To analyze cutting thickness on TOSCA treatment of complex refractive errors.·METHODS:Totally 42 eyes 23 patients who received TOSCA were selected in our hospital,they were complex refractive errors.The spherical equivalent degree was-2.50--13.50D with an average of-7.51±2.23D.Then the cutting thickness in TOSCA and LASIK/LASEK mode was compared.·RESULTS:The preoperative average UCVA was 0.11±0.19 and BCVA was 0.98±0.16,and at 6 months postoperatively the average UCVA was 1.03±0.30,it was significantly improved and statisticaly different compared with the preoperative UCVA(P<0.05),and it was not significantly different compared with the preoperative BSCVA(P>0.05).The preoperative average spherical equivalent was-7.51±2.23D,and at 6 months postoperatively the average spherical equivalent was-0.42± 0.67D,controlled within±0.50D to achieve the purpose of correction of myopia.The preoperative average cutting thickness and the remaining thickness respectively were 92.43±21.28μm and 409.17±25.47μm in TOSCA mode,and 123.26±28.73μm,378.69±32.65μm in LASIK/LASEK,it was statistically different(P<0.05).·CONCLUSION:TOSCA can save corneal thickness significantly on treatment of complex refractive compared with LASIK,and improve the safety of operation theoretically.·

R779.63