Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PurposeHigh myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery.MethodsWe included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery.ResultsThe study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively).ConclusionsModerately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.     

穿透性角膜移植治疗LASIK术后继发圆锥角膜

目的 观察穿透性角膜移植治疗准分子激光原位角膜磨削术(Laserin situkeratomileusis,LASIK)术后继发圆锥角膜的效果.方法 对6例LASIK术后确诊为继发圆锥角膜的患者进行穿透性角膜移植术,选用直径7～7.5mm植片,与植床等大.术后随访1～5年,观察和评价其疗效.结果 本研究6例患者LASIK术前角膜厚度平均为394.9μm.术后圆锥发生时间(13±3.4)个月,穿透性角膜移植术后,中央角膜厚度平均为504.7μm,视力明显增进,随访期内未见圆锥角膜复发.讨论我们建议,进行LASIK对术中切削时,角膜基质床的厚度不应小于270μm,角膜总厚度不应小于400μm.对LASIK术后继发圆锥角膜患者行穿透性角膜移植术,植床直径与角膜植片等大,术后再选择性拆除缝线,将有助于降低术后免疫排斥反应发生率和圆锥复发,减少手术源性散光,提高视力.     

穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入手术

目的探讨穿透性角膜移植术后白内障行超声乳化吸出和人工晶体植入方法及疗效。方法应用超声乳化仪为22只眼穿透性角膜移植术后白内障行白内障吸出和人工晶体植入手术。术后观察视力、角膜内皮变化和角膜移植片透明度。结果视力：12只眼0．1～0．4（54．5％），8只眼0．5～0.9（364％），2只眼＜01（9．1％）；角膜内皮细胞平均损失率17．76％；术后角膜移植片全部透明。结论本方法治疗角膜移植术后白内障，其术后视力恢复快，角膜内皮细胞损失少，可维持角膜移植片的透明。     

穿透性角膜移植散光多因素分析及其控制

目的：探讨穿透性角膜移植（PK）术中减少术后散光的有效方法。方法：应用不同环钻（Barron放射真实环钻及Storz环钻）及手术技术对两组患者共24例施行PK,术后6月、12月及15月（拆线后3个月）检查视力、最佳矫正视力,术后12月检测屈光性散光及角膜地形图散光。结果：术后6月、12月及15月,Barron组视力、最佳矫正视力显著高于Storz组,术后12个月,检测角膜地形图散光及屈光性散光,Barron组较Storz显著减少。结论：能提供供体、受体组织高质量钻切的优质环钻是控制PK散光的关键,手术技术（缝线技术、缝线调整技术）及术中的各个环节均影响术后散光程度。     

The Recovery of Optical Quality after Laser Vision Correction

Purpose

To evaluate the optical quality after laser in situ keratomileusis (LASIK) or serial photorefractive keratectomy (PRK) using a double-pass system and to follow the recovery of optical quality after laser vision correction.

Methods

This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system.

Results

This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity.

Conclusions

Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.     

Keratophakia and Keratomileusis: Comparison of Pathologic Features in Penetrating Keratoplasty Specimens

Two patients, one who had had two keratophakia procedures, and another who had had a keratophakia, followed by a keratomileusis procedure both eventually required a penetrating keratoplasty. In the keratoplasty specimen bearing an intrastromal lenticle from a keratophakia procedure performed nine months earlier, no viable keratocytes were found in the in situ lenticle. The lenticle’s stroma stained paler with methylene blue and toluidine blue than the host’s surrounding stroma, probably due to the absence of proteoglycan synthesis. The interface scar between the lenticle and the host’s stroma displayed metabolically active keratocytes, amorphous basement membrane-like material, banded basement membrane material or long-spacing collagen of 1000 Å periodicity, microfibrillar collagen of 100 Å diameter, and, only in focal areas, more mature-appearing collagen of 200 Å diameter. In the keratomileusis-bearing penetrating keratoplasty specimen, complete repopulation of the keratomileusis’ stroma by the host’s keratocytes had been accomplished after seven months. The absence of any significant tinctorial differences between the keratomileusis’ stroma and the host’s stroma indicated that these keratocytes were functioning and able to produce proteoglycans. The interface scar between the keratomileusis’ stroma and the host’s stroma was similar to that in the keratophakia specimen, except for the lesser presence of mature collagen of 200 Å diameter. An explanation is not clearly obvious for the more rapid keratocytic repopulation of the keratomileusis’ stroma in comparison with the lenticle’s stroma in keratophakia. Both patients had successful penetrating keratoplasties, with postoperative visual acuities of 20/40 and 20/20, owing to the fact that the earlier corneal surgeries had not compromised the integrity of the anterior chamber structures.     

The Impact of Learning Curve on Flap Thickness Outcome in Femtosecond Laser-assisted Laser In Situ Keratomileusis Performed with New LenSx Dual Platform

PurposeTo evaluate the effect of learning curve on flap thickness (FT) outcome in femtosecond (FS) laser-assisted laser in situ keratomileusis (LASIK) operation for myopia performed with recently introduced LenSx dual platform using curved applanation cone.MethodsSeventy eyes of 36 patients with myopia or myopic astigmatism operated with FS laser-assisted LASIK with recently introduced LenSx dual platform were evaluated in this retrospective study. Operations were divided into two groups: first 20 operations (20 eyes of 10 patients) and next 50 operations (50 eyes of 26 patients). Data on patient demographics, preoperative and postoperative keratometric and aberrometric parameters, and FT related outcome, including mean central FT, mean total FT, intra-FT range, and FT homogeneity were compared in study groups.ResultsExcept for significantly lower preoperative steepest keratometry values in the next 50 operations versus first 20 operations (p = 0.033), no significant difference was noted between study groups in terms of preoperative and postoperative parameters. When compared to first 20 operations, next 50 operations were associated with significantly higher values for mean central FT (median, 123 μm vs. 114 μm; p = 0.007) and mean total FT (median, 123 μm vs. 113 μm; p = 0.015), whereas significantly lower intra-FT range (median, 4.0 μm vs. 4.5 μm; p = 0.003).ConclusionsIn conclusion, our findings related to FS laser-assisted LASIK surgery for myopia with new LenSx dual platform using curved applanation cone revealed significant impact of learning curve on the corneal FT outcome in terms of closer FT to the intended value and lower intra-flap range.     

Comparison of Clinical Outcomes of Same-size Grafting between Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

Purpose

To compare the clinical outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) with same-size grafts in patients with keratoconus.

Methods

Medical records of 16 eyes from 15 patients treated from June 2005 through April 2011 were retrospectively reviewed. Patients with contact lens intolerance or who were poor candidates for contact lens fitting due to advanced cone underwent keratoplasty. The transplantations consisted of 11 DALK and 5 PKP with same-size grafting for keratoconus. Best-corrected visual acuity (BCVA), refractive error, corneal topographic profiling, and clinical course were compared between DALK and PKP groups.

Results

The follow-up period was 30 ± 17 months in the DALK group and 45 ± 20 months in the PKP group (p = 0.145). At final follow-up, the DALK and PKP groups achieved a BCVA (logarithm of the minimum angle of resolution) of 0.34 and 0.52, respectively (p = 0.980). Postoperative refractive error and mean simulated keratometric index showed myopic astigmatism in both groups without any statistical difference. Corneal irregularity index measured at 5 mm in the DALK group was less than that of the PKP group at 1-year follow-up (p = 0.021); however, at final follow-up, there was no longer a statistically significant difference. Endothelial cell counts were lower in the PKP group than in the DALK group at final follow-up (p = 0.021).

Conclusions

The optical outcomes of DALK with same-size grafts for keratoconus are comparable to those of PKP. Endothelial cell counts are more stable in DALK compared to PKP.     

LASIK interface-captured foreign bodies after mild traumatic corneal scratch without flap displacement

A 38-year-old woman developed diffusely distributed opacities with crystalline materials in the laser in situ keratomileusis (LASIK) interface of her eye after she was scratched by a sprig during mountain climbing. No sign of flap displacement was noted. Despite two days of topical and systemic antibiotics therapy, the corneal infiltration with interface opacities persisted. The following day, the distribution of the crystalline materials had rotated in a counterclockwise direction. Flap lifting and foreign body removal using sufficient irrigation were performed. One month after surgery, the patient's postoperative uncorrected visual acuity was 0.8 with cleared interface. No signs of epithelial ingrowth or flap striae were noted. Mild traumatic corneal scratching without flap displacement may threaten the integrity of the LASIK interface. If foreign bodies are suspected to be the cause of inflammation, early flap lifting with irrigation is imperative for successful treatment.     

LASIK术后角膜上皮植入的发生及处理

目的探讨LASIK术后角膜上皮植入的发生、影响因素、处理方法和效果.方法回顾性分析由同一位医生所行LASIK术后随访6个月以上并有完整记录的所有病例.结果共633例病人1 240只眼,其中61眼曾行二次LASIK手术.有10人10眼(0.81%)发生角膜上皮植入.其中,1眼为二次手术后发生(1.6%);6眼有戴接触镜史;5眼术中发生瓣或上皮异常游离瓣1眼、上皮缺损2眼、上皮松解2眼;6眼术后1天时发现荧光素染色阳性(5眼)或角膜瓣皱折(1眼);9眼上皮植入发生于角膜瓣的边缘,4眼见于原上皮缺损或易脱落方向.除1眼待术外,其余9眼(5眼药物治疗,4眼手术治疗)的最终裸眼视力为0.72±0.32(0.02～1.0),最佳矫正视力为0.93二0.1(0.8～1.0),球镜为-0.31±0.97D(-2.25～1.5D),柱镜为0.61±0.50D(0～1.25D),无异物感、眩光、荧光素着染等,上皮植入消失5眼,变小1眼,静止3眼.结论术者应通过提高手术操作技能和完善各手术步骤尽可能地减少此并发症的发生.发现后恰当处理,可获得很好效果.     

复性近视散光LASIK术后角膜散光的动态分析

目的　观察、分析准分子激光角膜原位磨镶术 (LaserinSituKeratomileusis,LASIK)治疗复性近视散光手术前后角膜地形图的变化规律 ,研究LASIK术对角膜各区散光度及散光轴的影响。方法　对 6 5例复性近视散光患者 (12 6眼 )行LASIK手术 ,术前、术后 1月、 3月、 6月分别行角膜地形图检查。将患者按散光程度不同分为两组 ,观察、比较两组手术前后不同时期角膜不同区的散光度及散光轴的变化规律。结果　复性近视散光患者LASIK术后角膜散光度降低以 3mm区最为明显 ,而 5mm、 7mm区表现为散光轻度增加 ,术后 3～ 6月恢复至与术前差异无显著意义 (P >0 0 5 )。角膜 3mm区散光部分欠矫与非角膜散光因素呈正相关系 :角膜 3mm区散光欠矫度 (D) =1 196×非角膜散光因素 +1 117;角膜各区之间散光轴位差异无显著意义 (P >0 0 5 ) ,术前、术后不同时期差异均无显著意义 (P >0 0 5 )。结论　复性近视散光LASIK术后角膜散光以 3mm区散光值减少明显 ,且散光高度组减少更明显 ,而 5mm、 7mm区早期散光轻度增加 ,术后 3～ 6月逐渐恢复至术前水平。角膜 3mm区散光部分欠矫与非角膜散光因素密切相关。手术前后角膜各区散光轴均保持良好的一致性。     

大龄近视患者准分子激光原位角膜磨镶术分析

目的　探讨大龄近视患者LASIK疗效、特点及需要加以关注的问题。方法　对 88例(16 4眼 )大龄 (年龄≥ 4 0岁 )近视患者进行LASIK治疗 ,并对术前屈光度、预矫屈光度、手术疗效等进行统计分析。结果　行LASIK治疗的大龄近视患者术前屈光度 (球镜等量 ) :轻度近视 (≤ -3D) 5眼 ,占 3% ,中度近视 (>- 3D ,≤ - 6D) 2 8眼 ,占 17% ,高度近视 (>- 6D ,≤ - 10D) 4 2眼 ,占 2 6 % ,超高度近视 (>- 10D) 89眼 ,占 5 4 %。为保证角膜的安全性 ,2 0例 (2 2 73% ) 39眼(2 3 78% )术前设计的预矫屈光度需低于术前屈光度。术后裸眼视力 0 0 6～ 1 5 ,平均 0 78± 0 39,其中裸眼视力≥ 0 5者为 6 1眼 ,占 78 2 1% ,裸眼视力≥ 1 0者 2 5眼 ,占 32 0 5 %。结论　大龄近视患者行LASIK治疗以高度、超高度近视患者为主 ,术前角膜厚度的仔细测量、预矫屈光度数的确定、激光切削直径的选择对减少眩光以及术后屈光度数回退 ,提高术后视力、改善视觉质量至关重要。     

Fibrinous anterior uveitis following laser in situ keratomileusis

A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.     

Factors influencing corneal flap thickness in laser in situ keratomileusis with a femtosecond laser

Purpose

To evaluate factors responsible for the variability between intended and achieved corneal-flap thickness during femtosecond laser-assisted laser in situ keratomileusis (LASIK).

Methods

A prospective, nonrandomized, case study was performed on 35 eyes of 18 consecutive patients who underwent LASIK surgery using the 60 kHz femtosecond laser microkeratome. Eyes were assigned to three different thickness groups, with 110-, 120-, or 130-µm cut depths. Anterior segment optical coherence tomography was used to assess the morphology of 35 LASIK flaps at postoperative one week postoperatively. The flap thickness was assessed at seven measuring points across each flap. Patient age, preoperative spherical equivalent, manual keratometry, preoperative central pachymetry, and regional variability of the cornea were evaluated to determine where they influenced the achieved corneal flap thickness.

Results

Cuttings of all flaps were easily performed without any intraoperative complications. Flap-thickness measurements had a mean of 115.21 ± 4.98 µm (intended thickness, 110 µm), 121.90 ± 5.79 µm (intended, 120 µm), and 134.38 ± 5.04 µm (intended, 130 µm), respectively. There was no significant difference between the 110-µm and 120-µm groups when compared with the 130-µm group (one-way analysis of variance test, p > 0.05). Patients'' age, preoperative spherical equivalent, manual keratometry, and preoperative central pachymetry did not affect the achieved flap thickness (Pearson correlations test, p > 0.05). The reproducibility of flap thickness in the central 1.5-mm radius area was more accurate than that in the peripheral 3.0 to 4.0-mm radius area (paired samples t-test, p < 0.05).

Conclusions

Femtosecond laser-assisted LASIK is likely to reproduce a reliable thickness of the corneal flap, which is independent of corneal shape factors or refractive status. Future studies should focus on variations in corneal biomechanical factors, which may also play an important role in determining flap thickness.     

飞秒准分子激光原位角膜磨镶术光学区对复性近视散光矫正的影响

目的 研究飞秒准分子激光原位角膜磨镶术（LASIK）的光学区大小对于复性近视散光矫正的影响.方法 随机选取2009年4月～ 2012年3月来我院准备接受飞秒LASIK的复性近视散光患者13例（18眼）,等效球镜为（-9.90 ±0.44）D,根据光学区大小分为2组：A组9眼,光学区为6.0 mm;B组9眼,光学区为6.5 mm.分析2组散光矫正的有效性和预测性.结果 所有手术都顺利完成且没有发生并发症.术前A组的等效球镜、球镜和柱镜分别为（-10.08±0.50）D、（-9.31 ±0.68）D和（-1.56±0.74）D,术前B组的等效球镜、球镜和柱镜分别为（-9.72±0.29）D、（-9.22±0.36）D和（-1.00±0.25）D,差异没有统计学意义（P =0.086,0.751,0.058）.A组和B组术后散光分别为（-0.31±0.27）D和（-0.33±0.28）D,差异没有统计学意义（P=0.834）.A组和B组分别有7眼和8眼术后等效球镜在±0.50 D区间和术后散光≤0.50 D.2组散光矫正的成功系数（IOS）分别为0.27和0.34,差异没有统计学意义（P =0.526）.结论 飞秒LASIK矫正复性近视散光具有较好的有效性、预测性和安全性,其中光学区大小对散光矫正的影响有待扩大样本进一步研究.     

Review of current indications for combined very high fluence collagen cross-linking and laser in situ keratomileusis surgery

In this brief review we will discuss the reasoning and evolution of our current use of combined very high-fluence collagen crosslinking and laser in situ keratomileusis. Several presentations and pertinent publications are reviewed, along with the key steps of the enhanced LASIK procedure. Long term outcome data support the safety and efficacy of LASIK Xtra in stabilizing myopic but also hyperopic LASIK results. In conclusion, we have compelling evidence that LASIK Xtra is a safe and effective adjunct.     

有晶状体眼后房型人工晶状体植入和准分子激光原位角膜磨削术矫正超高度近视的临床评价

目的:比较和评价有晶状体眼后房型人工晶状体(Phakic Posterior Chamber Intraocular Lens,PPCI-OL)植入和准分子激光原位角膜磨削术(Laser in situ Keratomileusis,Lasik)矫正高度近视的有效性、安全性和稳定性。方法:高度近视患者43例,随机分为PPCIOL组和Lasik组,分别行可植入接触镜(Implantable Con-tact Lens,ICL)植入术和Laisk,随访并比较两组有效性和安全性指数,两年屈光度回退≤2 D的生存率,低对比度视力和眩光视力的改变。结果:PPCIOL组术前平均等效球面屈光度(-16.77±3.37)D(-11.75--25.75 D);Lasik组术前平均等效球镜度(-13.8±2.71)D(-9.37--23.75 D)。术后1个月两组有效性无统计学差异,PPCIOL组安全性指数高于Lasik组(P<0.001),2 a时屈光度回退率分别为0、32.56％(P<0.001),术后3个月低对比视力和眩光视力PPCIOL组较术前提高比Lasik组明显(P<0.001)。PPCIOL组有1例2眼术后6个月时有晶状体前囊混浊,两组未见其他并发症。结论:有晶状体眼后房型人工晶状体植入矫正超高度近视有效,安全性和稳定性较Lasik更好,并能获得良好的视觉质量。     

Posterior corneal curvature assessment after Epi-LASIK for myopia: comparison of Orbscan II and Pentacam imaging

Purpose

To compare the changes in posterior corneal curvature using scanning slit topography (Orbscan II) and Scheimpflug imaging (Pentacam) before and after Epi-laser in situ keratomileusis (LASIK) for myopia.

Methods

In a prospective observational case-series study, 20 myopic patients having undergone Epi-LASIK were examined serially with two different devices, Orbscan II and Pentacam, preoperatively and one month postoperatively. Posterior central elevation (PCE) and posterior maximal elevation (PME) were compared between the two devices, and the changes in parameters after Epi-LASIK were analyzed using a difference map.

Results

All parameters (preoperative and postoperative PCE and preoperative and postoperative PME) that were measured using the Orbscan II were significantly greater compared to those of the Pentacam (for all p < 0.001). PCE and PME were significantly increased one month postoperatively in the Orbscan II measurements (p < 0.05) but were not significantly increased in the Pentacam measurements. Also, ΔPCE and ΔPME, in the difference map obtained by each serial scanning, were significantly greater in the Orbscan II measurements than with the Pentacam (p = 0.012, p = 0.016).

Conclusions

The Pentacam measurements displayed significantly reduced values in all parameters related to posterior corneal elevation compared to those of the Orbscan II. The Pentacam showed no significant change in posterior corneal curvature after Epi-LASIK, based on the difference map.     

标准矢量分析法比较FS-LASIK矫治不同来源散光的疗效

目的：采用标准矢量分析法分析飞秒激光制瓣准分子激光原位角膜磨镶术（FS-LASIK）对不同来源全眼散光的矫治效果,并对影响散光矫正效果的因素进行探讨。方法：回顾性系列病例研究。选取2012 年6 月至2013 年6 月在我院行FS-LASIK矫治近视和散光,术后6 个月内随访资料完整的患者53 例（106 眼）。根据角膜散光在全眼散光中所占的比例不同将患者分为角膜源性散光组（34 眼）,眼内源性散光组（36眼）和混合源性散光组（36眼）。记录并比较3组术后6个月时的裸眼视力（UCVA）、UCVA≥术前最佳矫正视力（BCVA）的比例、角膜前表面形态变异指数（ISV）、垂直不对称指数（IVA）等指标。采用美国国家标准委员会推荐使用的标准矢量分析法对手术前后散光的相关指标进行运算和评估。采用单因素方差分析、卡方检验对数据进行分析。结果：术后6 个月,3 组间UCVA总体差异有统计学意义（F =4.80,P =0.013）;角膜源性散光组、混合源性散光组的UCVA（P ＜0.05）,UCVA≥术前BCVA的比例（c2=7.48、5.21,P ＜0.05）均大于眼内源性散光组,角膜源性散光组和混合源性散光组差异无统计学意义。角膜源性散光组术后残留散光最小,眼内源性散光组残留散光最大,2 组差异有统计学意义（P =0.015）,其余组间两两比较差异均无统计学意义。角膜源性散光组的矫正率（CR）均大于眼内源性散光组和混合源性散光组（P ＜0.01）, 且手术引起的屈光矫正量的绝对值（|SIRC|）均大于眼内源性散光组、混合源性散光组（P ＜0.01）,眼内源性散光组和混合源性散光组差异无统计学意义。角膜源性散光组的角度误差（EA）、大小误差（EM）、误差率（ER）、矢量误差绝对值（|EV|）均小于眼内源性散光组、混合源性散光组,差异均有统计学意义（P ＜0.01）, 且混合源性散光组的|EV|小于眼内源性散光组（P =0.030）。角膜源性散光组的ISV、IVA均小于混合源性散光组（P ＜0.01）,混合源性散光组小于眼内源性散光组（P ＜0.05）。角膜源性散光组、眼内源性散光组、混合源性散光组平滑型角膜地形图比例分别为71%、39%、56%。结论：FS-LASIK矫正散光的效果取决于散光来源,对角膜源性散光的矫正效果最佳,对眼内源性散光的矫正效果最差。