目的：比较飞秒激光小切口角膜基质透镜取出术(SMILE)术中旋转补偿对散光矫正的疗效。

方法：检索PubMed、Web of Science、EMBASE、Cochrane以及CNKI、VIP、CBM和Wan Fang Data数据库，纳入2010-01/2022-08试验组为SMILE术中进行旋转补偿； 对照组为SMILE术中不进行旋转补偿的临床对照研究。由两名研究员独立进行文献筛选、质量评价和数据提取后，使用Stata16.0软件对术后裸眼远视力(UDVA)、残余散光、矢量分析法用于衡量散光矫正效果的指标[包括误差角度的绝对值(|AE|)：手术矫正散光的轴向与预期的误差绝对值； 误差大小(ME)：手术矫正散光与预期的算数差值]和术后总高阶像差、球差、彗差进行Meta分析。

结果：最终纳入7篇文献，共846眼(试验组442眼，对照组404眼)，Meta分析结果显示，两组患者在残余散光≥1.00D的眼所占百分比(OR=0.17，95%CI：0.06～0.49，P<0.01)、|AE|(WMD=-1.56，95%CI：-2.68～-0.45，P<0.01)、彗差(WMD=0.06，95%CI：-0.08～-0.04，P<0.01)和总高阶像差(WMD=-0.04，95%CI：-0.06～-0.02，P<0.01)均有差异，但在术后UDVA(WMD=0.00，95%CI：-0.02～0.01，P=0.54)、残余散光度数(WMD=0.08，95%CI：-0.02～0.18，P=0.10)、ME(WMD=-0.01，95%CI：-0.14～0.12，P=0.85)及球差(WMD=0.03，95%CI：-0.07～0.13，P=0.52)均无差异。

结论： SMILE术中进行旋转补偿能有效减少散光矫正时因眼球旋转所致的角度误差、降低术后残余散光，在精确矫正散光的临床疗效上更具优势。

METHODS: PubMed, Web of Science, EMBASE, Cochrane and CNKI, VIP, CBM, and Wan Fang Data were searched for clinically controlled studies from January 2010 to August 2022, including an experimental group with cyclotorsion compensation during SMILE and a control group without cyclotorsion compensation during SMILE. After literature screening, quality evaluation, and data extraction by two researchers independently, the Meta-analysis of uncorrected distance visual acuity(UDVA), residual astigmatism, vector analysis indicators for measuring the astigmatism correction including absolute value of angle of error(|AE|)and magnitude error(ME), and post-operative total higher order aberrations, spherical aberration and coma was carried out with Stata 16.0 software.

RESULTS: Seven studies with a total of 846 eyes(442 in the experimental group, 404 in the control group)were finally included. The Meta-analysis showed that there were significant differences in the percentage of eyes with residual astigmatism ≥1.00D(OR=0.17, 95%CI: 0.06～0.49, P<0.01), |AE|(WMD=-1.56, 95%CI: -2.68～-0.45, P<0.01), the coma(WMD=0.06, 95%CI: -0.08～-0.04, P<0.01), and the total higher order aberrations(WMD=-0.04, 95%CI: -0.06～-0.02, P<0.01). However, there were no differences in the postoperative UDVA(WMD=0.00, 95%CI: -0.02～0.01, P=0.54), residual astigmatism(WMD=0.08, 95%CI: -0.02～0.18, P=0.10), ME(WMD=-0.01, 95%CI: -0.14～0.12, P=0.85), and the spherical aberration(WMD=0.03, 95%CI: -0.07～0.13, P=0.52).

CONCLUSION: Cyclotorsion compensation in SMILE can reduce the angular error caused by eye rotation during astigmatism correction. It also decreases postoperative residual astigmatism. Overall, the SMILE with cyclotorsion compensation is superior in clinical efficacy of the precise correction of astigmatism.