探讨角膜地形图引导个性化切削(T－CAT)屈光术矫正近视眼和散光的早期临床疗效。

选择2020年1月至2022年1月于石家庄市人民医院眼科收治的90例(154只眼)近视眼和散光患者的临床资料进行研究。其中，男性49例(83只眼)，女性41例(71只眼)；年龄18~40岁，平均年龄为(25.4±2.5)岁。采用随机数字表法将患者分为对照组45例(78只眼)和试验组45例(76只眼)。对照组采用T－CAT引导准分子激光角膜屈光手术(CV－LASEK)，试验组采用T－CAT引导全飞秒激光微透镜取出术(SMILE)。两组患者的裸眼视力、角膜前表面彗差、球差、球镜屈光度、柱镜屈光度、等效球镜屈光度、散光矫正指数(CI)、成功指数(IOS)、变平指数(FI)、角膜滞后量(CH)及角膜阻力因子(CRF)等符合正态分布，以±s表示，组间比较采用t检验，治疗前后组内比较采用配对t检验；术后并发症以眼数和百分比表示，组间比较采用χ²检验。

术后7 d试验组的裸眼视力、彗差、球差、球镜屈光度、柱镜屈光度、等效球镜屈光度、CI、IOS、FI、CH及CRF分别为(0.85±0.12)logMAR、(0.30±0.07)μm、(0.45±0.05)μm、(0.19±0.07)D、(－0.39±0.10)D、(－0.39±011)D、(0.95±0.15)D、(0.44±0.17)D、(2.58±0.25)D、(6.06±0.58)mmHg(1 mmHg＝0.133 kPa)及(5.22±0.51)mmHg；对照组患者分别为(0.72±0.14)logMAR、(0.38±0.09)μm、(0.59±0.06)μm、(0.21±0.09)D、(－0.40±0.12)D、(－0.40±0.10)D、(0.96±0.17)D、(0.42±0.18)D、(2.56±0.24)D、(6.18±0.63)mmHg及(5.36±0.56)mmHg。两组患者裸眼视力、彗差及球差比较的差异均有统计学意义(t＝6.180，6.147，15.709；P<0.05)；其余比较的差异均无统计学意义(t＝1.537，0.561，0.591，0.387，0.709，0.507，1.229，1.621；P>0.05)。试验组和对照组患者术后并发症发生率分别为13.16%和26.92%，比较的差异有统计学意义(χ²＝4.507，P<0.05)。

T－CAT引导SMILE术矫正近视眼和散光的早期有效性、稳定性均较好，术后并发症少，安全性高，值得推广。

The aim of this study is to analyze the early clinical efficacy of topography-guided customized ablation treatment (T-CAT) refractive surgery for correcting myopia and astigmatism.

Retrospective analysis of clinical data of 90 cases (154 eyes) with myopia and astigmatism registered at the Ophthalmology Department of Shijiazhuang People′s Hospital from January 2020 to January 2022. Among them, there were 49 males (83 eyes) and 41 females (71 eyes) ranged from 18 to 40 years with an average age of (25.4±2.5) years. According to the random number table method, patients were divided into control group with 45 cases (78 eyes) and testing group with 45 cases (76 eyes). The control group underwent T-CAT contoura vision-laser epithelial keratomileusis (CV-LASEK), while the testing group underwent T-CAT small incision lenticule extraction (SMILE). Naked eye visual acuity, anterior corneal surface aberration, spherical aberration, spherical degree, cylindrical degree, equivalent spherical degree, correction index (CI), index of success (IOS), flattening index (FI), corneal hysteresis (CH), and corneal resistance factor (CRF) according with normal distribution were expressed as ±s, and compared by t test between the two groups, by paired sample t test before and after surgery. The postoperative complications were expressed as eyes number and percentage and compared by χ² test.

After surgery for 7 days, the naked eye visual acuity, coma and spherical aberration, spherical, cylindrical and equivalent spherical degree, CI, IOS, FI, CH and CRF of patients in the testing group were (0.85±0.12) logMAR, (0.30±0.07)μm, (0.45±0.05)μm, (0.19±0.07)D, (-0.39±0.10)D, (-0.39±011)D, (0.95±0.15)D, (0.44±0.17)D, (2.58±0.25)D, (6.06±0.58)mmHg(1 mmHg=0.133 kPa) and (5.22±0.51)mmHg, respectively; those of patients in the control group were (0.72±0.14)logMAR, (0.38±0.09)μm, (0.59±0.06)μm, (0.21±0.09)D, (-0.40±0.12)D, (-0.40±0.10)D, (0.96±0.17)D, (0.42±0.18)D, (2.56±0.24)D, (6.18±0.63)mmHg and (5.36±0.56)mmHg, respectively. There were significantly differences in the naked eye visual acuity, coma and spherical aberration between the two groups (t=6.180, 6.147, 15.709; P<0.05). There were no significant differences in the others (t=1.537, 0.561, 0.591, 0.387, 0.709, 0.507, 1.229, 1.621; P>0.05). The incidence of postoperative complications in the testing group and the control group were 13.16% and 26.92%, respectively. There were significantly difference in them between the two groups (χ²=4.507, P<0.05).

T-CAT SMILE has good early effectiveness and stability in correcting myopia and astigmatism, with fewer postoperative complications and high safety, and is worth promoting.