目的：评估波前像差引导飞秒激光辅助LASIK(femtosecond laser assisted LASIK， FS-LASIK)治疗近视合并中高度散光患者术后高阶像差变化。

方法：纳入我院于2016-07/2017-02收治的近视合并中度至高度散光患者50例88眼。术前51眼散光≥-1.50D且<-3.00D(中度散光)，37眼散光≥-3.00D(高度散光)，所有患者均接受波前像差引导FS-LASIK手术。术前和术后3mo评估未矫正视力(uncorrected distance visual acuity， UDVA)、矫正视力(corrected distance visual acuity， CDVA)、角膜曲率、角膜中心厚度(central corneal thickness， CCT)和部分高阶像差(higher order aberrations， HOAs)。

结果：术后3mo所有术眼的UDVA均达到20/20以上，均较术前提高且差异有统计学意义(P<0.05)，而 CDVA和术前相比差异无统计学意义(P=0.36)。术后85眼(97%)散光在-1.00D以下，70眼(80%)散光在-0.50D以下，差异有统计学意义(P<0.05)。较术前相比，术后平均角膜曲率降低约为3.81±1.97D，CCT减少约78.66±37.22μm，差异有统计学意义(P<0.05)。术后3mo彗差与三叶草较术前无明显变化(P=0.078、0.065)； 而球面像差、二次散光及高阶像差均方根(HOA-root mean square， HOA-RMS)术后较术前均有所增加，分别从术前的0.19±0.06、0.05±0.02 和0.42±0.12增加至术后的0.32±0.17、0.26±0.08 和0.78±0.28，差异有统计学意义(P<0.05)。

结论：波前像差引导FS-LASIK术后虽然产生部分高阶像，但依然是中高度散光患者进行角膜屈光手术的一个安全有效的选择。

METHODS: Eighty-eight eyes of 50 myopia patients with moderate to high astigmatism were included in this prospective study. There were 51 eyes with moderate astigmatism(≥-1.50D and <-3.00D)and 37 eyes with high astigmatism(≥-3.00D). All patients underwent wavefront guided FS-LASIK. Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), keratometry, central corneal thickness(CCT)and higher order aberrations(HOAs)were evaluated before operation and 3mo postoperatively.

RESULTS: At the 3mo after operation, the mean UDVA of all eyes was above 20/20, better than before operation(P<0.05), but CDVA remained unchanged(P=0.36)and no eyes lost ≥2 lines of CDVA. Mean astigmstism of 85 eyes(97%)was reduced below -1.00D, mean astigmatism of 70 eyes(80%)was reduced below -0.50D(P<0.05). The average corneal curvature was flatter by 3.81±1.97D and CCT was reduced by 78.66±37.22μm, postoperatively(P<0.05). Coma and trefoil aberrations remained unchanged(P=0.078, 0.065). The spherical aberration, secondary astigmatism and the HOA root mean square(RMS)increased from 0.19±0.06, 0.05±0.02 and 0.42±0.12, preoperatively to 0.32±0.17, 0.26±0.08 and 0.78±0.28(P<0.05), postoperatively.

CONCLUSION: Wavefront-guided FS-LASIK is a safe and effective option for the patients with moderate to high astigmstism although parts of HOAs increased.