目的：比较角膜波前像差引导的FS-LASIK手术治疗近视合并不同程度散光患者的术后疗效及角膜高阶像差的变化。

方法：回顾性病例研究。选取2020-04/10在昆明爱尔眼科医院初次行角膜波前像差引导的FS-LASIK手术治疗近视合并散光患者133例265眼。根据散光程度分为三组：低散光组：散光度≤1.0D共62例124眼，中散光组：散光度1.25～2.0D共54例107眼，高散光组：散光度≥2.25D共17例34眼。记录患者术前及术后3mo时的视力及屈光度，使用Pentacam三维角膜地形图测量患者角膜，记录角膜6mm直径范围的总高阶像差(均方根)、球差、水平彗差、垂直彗差、水平三叶草差、倾斜三叶草差，观察三组患者术后效果并比较手术前后角膜高阶像差的变化情况。

结果：三组患者术后视力的有效性指数均大于1.1，残余屈光度均在±0.30D以内，低散光组残余屈光度较其他两组最少(P<0.05)。术后3mo时三组患者的角膜总高阶像差、球差、垂直彗差较术前均增加(P<0.05)。高散光组术后的球差增量较其他两组最少(P<0.05)。

结论：角膜波前像差引导的FS-LASIK手术矫正近视合并不同程度的散光均安全有效，对于高散光患者效果确切，术前散光的严重程度并非术后角膜高阶像差增加的原因。

AIM: To compare the postoperative efficacy of corneal wavefront-guided femtosecond laser-assisted excimer in situ keratomileusis(FS-LASIK)in the treatment of myopia patients with different degrees of astigmatism and the changes of corneal higher order aberration.

METHODS: A total of 133 patients(265 eyes)with myopia and astigmatism were enrolled in this retrospective study. All of them underwent corneal wavefront-guided FS-LASIK surgery for the first time in Aier Eye Hospital(Kunming)from April to October 2020. The patients were divided into three groups according to the different astigmatism: Low astigmatism group: astigmatism ≤1.0D, 62 cases(124 eyes), medium astigmatism group: a total of 54 cases(107 eyes)with astigmatism was 1.25-2.0D, high astigmatism group: a total of 17 cases(34 eyes)with astigmatism ≥2.25D. Visual acuity and refraction were recorded before surgery and 3mo after the surgery and the cornea of the patients was measured by Pentacam three-dimensional corneal topography. Record total higher order aberrations(root mean square), spherical aberration, horizontal coma, vertical coma, horizontal clover and oblique clover in the 6mm diameter range of the cornea. The postoperative effects of the three groups of patients were observed and the changes of corneal high order aberration before and after surgery were compared.

RESULTS: The validity index of visual acuity in the three groups of patients was all greater than 1.1 and the residual diopter was all within ±0.30D. The residual diopter in the low astigmatism group was the least than that of the other two groups(P<0.05). At 3mo after surgery, the corneal total higher order aberration, spherical aberration and vertical coma of the three groups were all increased compared with those before surgery(P<0.05). The spherical aberration increase in the high astigmatism group was less than that in the other two groups(P<0.05).

CONCLUSION: Corneal wavefront-guided FS-LASIK surgery is safe and effective in the treatment of myopia with different degrees of astigmatism, and the effect is also accurate for patients with high astigmatism. The degree of of preoperative astigmatism is not responsible for increased corneal higher order aberration after the surgery.