方法：前瞻性临床病例研究。连续收集2012-07/2013-12期间不规则角膜散光患者21例21眼，施行角膜地形图引导的去瓣Epi-LASIK术，观察术前及术后1，6mo患者裸眼视力、最佳矫正视力、对比敏感度，记录术后3d角膜上皮愈合面积、患者主观疼痛评分。

结果：术后1mo，裸眼视力(uncorrected visual acuity，UCVA)及最佳眼镜矫正视力(best spectacle-corrected visual acuity，BSCVA)较术前均显著提高(t=15.703，4.351，P<0.05)； 术后6mo，UCVA较术后1mo提高，差异有统计学意义(t=6.867，P<0.05)，术后6mo，BSCVA与术后1mo比较，差异无统计学意义(t=1.497，P=0.140)。平均等效球镜度与平均柱镜度分别由术前的-2.43±3.02，-1.86±2.23D，下降至术后6mo的-0.23±0.49，-0.46±1.03D(P<0.05)。术后1mo，4种空间频率对比敏感度与术前相比无统计学差异(P>0.05)，术后6mo，除了3c/d空间频率，其余3种空间频率对比敏感度与术前相比均明显提高(P<0.05)。患者术后3d角膜上皮愈合面积为92.46%±8.24%(80%～100%)，术后7d所有患者均100%愈合，平均上皮愈合时间为3.50±1.56d。术后3，7d主观疼痛评分分别为1.54±1.32，0.04±0.64。

结论：角膜地形图引导的去瓣Epi-LASIK可以安全、有效地矫正外伤性角膜散光； 改善患者的对比敏感度视力，提高患者的视觉质量。

METHODS: This prospective clinical study was comprised of 21 eyes of 21 patients with irregular corneal astigmatism caused by trauma, they were treated by off-flap Epi-LASIK from July 2012 to December 2013. The data included uncorrected visual acuity(UCVA), best spectacle-corrected visual acuity(BSCVA), contrast sensitivity 1, 6mo before and after surgery; the healing area percentage of corneal epithelia, the healing time of corneal epithelia and pain score at 3d after surgery.

RESULTS: Postoperative 1mo both UCVA and BSCVA were improved significantly than that before surgery(t=15.703, 4.351, P<0.05); Compared with the 1mo after surgery, UCVA at 6mo after surgery raised significantly(t=6.867, P <0.05). There was no statistical significance between 6 and 1mo after surgery about BSCVA(t=1.497, P=0.140). After surgery, mean spherical equivalent(SE)was reduced from -2.43±3.02D to -0.23±0.49D(P<0.05), and the mean cylinder was reduced from -1.86±2.23D to -0.46±1.03D(P<0.05). Postoperative 1mo,4 kinds of spatial frequency and contrast sensitivity had no significant difference compared with the preoperative(P>0.05). Postoperative 6mo except the 3c/d spatial frequency, the remaining 3 spatial frequency contrast sensitivity compared with those before operation were significantly improved(P<0.05). The healing area percentage of corneal epithelia was 92.46%±8.24%(80%-100%)at 3d after surgery; The healing time of corneal epithelia was 3.50±1.56d; Pain scores at 3 and 7d after surgery was 1.54±1.32 and 0.04±0.64, respectively.

CONCLUSION: Topography-guided off-flap Epi-LASIK is safe and effective in treating the patients with traumatic corneal irregular astigmatism. The operation can improve both the contrast sensitivity and the visual performance.