手工与飞秒激光弧形角膜切开术矫正白内障散光效果比较

doi:10.6040/j.issn.1673-3770.0.2025.293

摘要/Abstract

摘要： 目的比较前穿透型飞秒激光弧形角膜切开术(femtosecond laser-assisted arcuate keratotomy, FSAK)与手工弧形角膜切开术(manual arcuate keratotomy, mAK)对矫正白内障患者的轻中度规则性角膜散光效果。方法非随机队列研究共纳入54眼,其中22眼行角膜定深刀mAK,32眼接受FSAK。两组均联合超声乳化白内障吸除及非散光型人工晶状体植入。比较两组术后3个月的视力及角膜散光的变化,采用Alpins矢量分析法比较两组的目标诱导散光量(target-induced astigmatism, TIA)、手术诱导散光量(surgery-induced astigmatism, SIA)、差异矢量(difference vector, DV)及矫正指数(correction index, CI)等指标,采用独立样本t检验比较两组散光矫正效果。结果 mAK组散光由(1.26±0.27)D降至(0.90±0.59)D,FSAK组由(1.24±0.27)D降至(0.70±0.37)D,两组差异无统计学意义(P=0.133)。Alpins分析示mAK组的SIA、DV、CI均高于FSAK组(P=0.238、P=0.133、P=0.191),两组均呈欠矫趋势,差异无统计学意义,但mAK组较大的标准差提示其可控性及可预测性较差。mAK组观察到1例角膜穿透。结论 FSAK与mAK均能有效矫正白内障患者低中度数规则性角膜散光,FSAK 在安全性与手术可预测性方面更具优势,但费用更高。

关键词: 飞秒激光, 角膜定深刀, 弧形角膜切开术, 角膜散光, 白内障手术

Abstract: Objective To compare the effectiveness of penetrating femtosecond laser-assisted arcuate keratotomy(FSAK)and manual arcuate keratotomy(mAK)in correcting mild-to-moderate regular corneal astigmatism in cataract patients. Methods This non-randomised cohort study involving 54 eyes, including 22 eyes that underwent mAK using a corneal depth marker knife and 32 eyes that received penetrating FSAK. Both groups underwent combined phacoemulsification and implantation of non-toric intraocular lenses. The primary outcomes included postoperative visual acuity and changes in corneal astigmatism at three months. Alpins vector analysis was used to compare target-induced astigmatism(TIA), surgically induced astigmatism(SIA), difference vector(DV), and correction index(CI)between the two groups. An independent-samples t-test was employed to compare the effects of astigmatism correction. Results Astigmatism in the mAK group decreased from(1.26±0.27)D to(0.90±0.59)D, while the FSAK group decreased from(1.24±0.27)D to(0.70±0.37)D, with no statistically significant difference between the two groups(P=0.133). Alpins analysis revealed that the SIA, DV, and CI of the mAK group were all higher than the FSAK group(P=0.238、P=0.133、P=0.191). Both groups showed a tendency toward undercorrection. Although intergroup differences were not statistically significant, the larger standard deviations oberved in the mAK group indicate diminished controllability and predictability. One case of corneal perforationwas observed in the mAK group. Conclusion Both FSAK and mAK can successfully correct mild-to-moderate regular astigmatism in cataract patients. However, FSAK exhibits superior safety and surgical predictability, albeit at a higher cost.

Key words: Femtosecond laser, Corneal depth knife, Arcuate keratotomy, Corneal astigmatism, Cataract surgery

中图分类号:

R779.66

和雨平,胡尊霞,官凡钰,郭琼天,吕航,段阗阗,司马晶,曹加国. 手工与飞秒激光弧形角膜切开术矫正白内障散光效果比较[J]. 山东大学耳鼻喉眼学报, 2026, 40(5): 123-132.

HE Yuping, HU Zunxia, GUAN Fanyu, GUO Qiongtian, LYU Hang, DUAN Tiantian, SIMA Jing, CAO Jiaguo. Comparison of manual and femtosecond laser arcuate keratotomy for correction of corneal astigmatism in patients undergoing cataract surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2026, 40(5): 123-132.

参考文献

[1] Lim R, Borasio E, Ilari L. Long-term stability of keratometric astigmatism after limbal relaxing incisions[J]. J Cataract Refract Surg, 2014, 40(10): 1676-1681. DOI:10.1016/j.jcrs.2014.01.045
[2] Loriaut P, Borderie VM, Laroche L. Femtosecond-assisted arcuate keratotomy for the correction of postkeratoplasty astigmatism: vector analysis and accuracy of laser incisions[J]. Cornea, 2015, 34(9): 1063-1066. DOI:10.1097/ICO.0000000000000487
[3] Wang J, Zhao JY, Xu J, et al. Evaluation of the effectiveness of combined femtosecond laser-assisted cataract surgery and femtosecond laser astigmatic keratotomy in improving post-operative visual outcomes[J]. BMC Ophthalmol, 2018, 18(1): 161. DOI:10.1186/s12886-018-0823-1
[4] Titiyal JS, Khatik M, Sharma N, et al. Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification[J]. J Cataract Refract Surg, 2014, 40(5): 741-747. DOI:10.1016/j.jcrs.2013.10.036
[5] 曹迎雪, 王军. 超声乳化白内障吸除联合导航下弧形角膜切开术后角膜散光变化的初期观察[J]. 中华眼科杂志, 2019, 55(7): 502-508. DOI:10.3760/cma.j.issn.0412-4081.2019.07.005
[6] Yoo A, Yun S, Kim JY, et al. Femtosecond laser-assisted arcuate keratotomy versus toric IOL implantation for correcting astigmatism[J]. J Refract Surg, 2015, 31(9): 574-578. DOI:10.3928/1081597X-20150820-01
[7] Nejima R, Terada Y, Mori Y, et al. Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery[J]. Jpn J Ophthalmol, 2015, 59(4): 209-215. DOI:10.1007/s10384-015-0383-3
[8] Roberts HW, Wagh VK, Sullivan DL, et al. Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery[J]. J Cataract Refract Surg, 2018, 44(8): 955-963. DOI:10.1016/j.jcrs.2018.05.027
[9] Zhou L, Zhou QZ, Llovet-Rausell A. Manual versus femtosecond laser-assisted relaxing incisions for correction of low astigmatism in implantable collamer lens surgery[J]. Indian J Ophthalmol, 2025, 73(7): 980-987. DOI:10.4103/IJO.IJO_2012_24
[10] González-Cruces T, Cano-Ortiz A, Sánchez-González MC, et al. Cataract surgery astigmatism incisional management. Manual relaxing incision versus femtosecond laser-assisted arcuate keratotomy. A systematic review[J]. Graefes Arch Clin Exp Ophthalmol, 2022, 260(11): 3437-3452. DOI:10.1007/s00417-022-05728-0
[11] Kane JX, Chang DF. Intraocular lens power formulas, biometry, and intraoperative aberrometry: a review[J]. Ophthalmology, 2021, 128(11): e94-e114. DOI: 10.1016/j.ophtha.2020.08.010
[12] Mirshahi A, Latz C. Femtosecond laser-assisted astigmatic keratotomy[J]. Ophthalmologe, 2020, 117(5): 415-423. DOI: 10.1007/s00347-020-01058-w
[13] Alpins NA, Goggin M. Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery[J]. Surv Ophthalmol, 2004, 49(1): 109-122. DOI:10.1016/j.survophthal.2003.10.010
[14] Reinstein DZ, Archer TJ, Srinivasan S, et al. Standard for reporting refractive outcomes of intraocular lens-based refractive surgery[J]. J Cataract Refract Surg, 2017, 43(4): 435-439. DOI: 10.1016/j.jcrs.2017.04.005
[15] Mingo-Botín D, Mu oz-Negrete FJ, Won Kim HR, et al. Comparison of toric intraocular lenses and peripheral corneal relaxing incisions to treat astigmatism during cataract surgery[J]. J Cataract Refract Surg, 2010, 36(10): 1700-1708. DOI:10.1016/j.jcrs.2010.04.043
[16] Kessel L, Andresen J, Tendal B, et al. Toric intraocular lenses in the correction of astigmatism during cataract surgery: a systematic review and meta-analysis[J]. Ophthalmology, 2016, 123(2): 275-286. DOI:10.1016/j.ophtha.2015.10.002
[17] Vickers LA, Gupta PK. Femtosecond laser-assisted keratotomy[J]. Curr Opin Ophthalmol, 2016, 27(4): 277-284. DOI:10.1097/ICU.0000000000000267
[18] Rückl T, Dexl AK, Bachernegg A, et al. Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism[J]. J Cataract Refract Surg, 2013, 39(4): 528-538. DOI:10.1016/j.jcrs.2012.10.043
[19] Nubile M, Carpineto P, Lanzini M, et al. Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty[J]. Ophthalmology, 2009, 116(6): 1083-1092. DOI:10.1016/j.ophtha.2009.01.013
[20] Nagy ZZ, Filkorn T, Takács AI, et al. Anterior segment OCT imaging after femtosecond laser cataract surgery[J]. J Refract Surg, 2013, 29(2): 110-112. DOI:10.3928/1081597X-20130117-05
[21] Hummel CD, Diakonis VF, Desai NR, et al. Cyclorotation during femtosecond laser-assisted cataract surgery measured using iris registration[J]. J Cataract Refract Surg, 2017, 43(7): 952-955. DOI:10.1016/j.jcrs.2017.04.034
[22] Chang JSM. Femtosecond laser-assisted astigmatic keratotomy: a review[J]. Eye Vis, 2018, 5: 6. DOI:10.1186/s40662-018-0099-9
[23] Callou TP, Garcia R, Mukai A, et al. Advances in femtosecond laser technology[J]. Clin Ophthalmol, 2016, 10: 697-703. DOI:10.2147/OPTH.S99741
[24] 吴双, 余婷, 冯晓玲, 等. 飞秒激光辅助的白内障摘除手术中开放性与非开放性角膜松解术矫正散光效果的对比研究[J]. 中华眼科杂志, 2023, 59(2): 96-101. DOI:10.3760/cma.j.cn112142-20220815-00402
[25] Day AC, Lau NM, Stevens JD. Nonpenetrating femtosecond laser intrastromal astigmatic keratotomy in eyes having cataract surgery[J]. J Cataract Refract Surg, 2016, 42(1): 102-109. DOI:10.1016/j.jcrs.2015.07.045
[26] Nordan LT. Quantifiable astigmatism correction: concepts and suggestions, 1986[J]. J Cataract Refract Surg, 1986, 12(5): 507-518. DOI: 10.1016/s0886-3350(86)80125-0
[27] Thornton SP, Sanders DR. Graded nonintersecting transverse incisions for correction of idiopathic astigmatism[J]. J Cataract Refract Surg, 1987, 13(1): 27-31. DOI: 10.1016/s0886-3350(87)80005-6
[28] Duffey RJ, Jain VN, Tchah H, et al. Paired arcuate keratotomy. A surgical approach to mixed and myopic astigmatism[J]. Arch Ophthalmol, 1988, 106(8): 1130-1135. DOI: 10.1001/archopht.1988.01060140286043
[29] Sorkin N, Mimouni M, Santaella G, et al. Comparison of manual and femtosecond astigmatic keratotomy in the treatment of postkeratoplasty astigmatism[J]. Acta Ophthalmol, 2021, 99(5): e747-e752. DOI: 10.1111/aos.14653
[30] Schweitzer C, Brezin A, Cochener B, et al. Femtosecond laser-assisted versus phacoemulsification cataract surgery(FEMCAT): a multicentre participant-masked randomised superiority and cost-effectiveness trial[J]. Lancet, 2020, 395(10219): 212-224. DOI:10.1016/S0140-6736(19)32481-X
[31] Al Sabaani N, Al Malki S, Al Jindan M, et al. Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism[J]. Saudi J Ophthalmol, 2016, 30(3): 163-168. DOI:10.1016/j.sjopt.2016.04.003
[32] Fadlallah A, Mehanna C, Saragoussi JJ, et al. Safety and efficacy of femtosecond laser-assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty[J]. J Cataract Refract Surg, 2015, 41(6): 1168-1175. DOI:10.1016/j.jcrs.2014.08.046
[33] Alkharashi MS, Abusayf MM, Alburayk KB, et al. Outcomes of femtosecond laser-assisted arcuate keratotomy in the management of keratoplasty-related astigmatism[J]. J Clin Med, 2025, 14(13): 4526. DOI:10.3390/jcm14134526
[34] Blehm C, Potvin R. Clinical outcomes after femtosecond laser-assisted arcuate corneal incisions versus manual incisions[J]. Clin Ophthalmol, 2021, 15: 2635-2641. DOI:10.2147/OPTH.S321358
[35] Loriaut P, Borderie VM, Laroche L. Femtosecond-assisted arcuate keratotomy for the correction of postkeratoplasty astigmatism: vector analysis and accuracy of laser incisions[J]. Cornea, 2015, 34(9): 1063-1066. DOI:10.1097/ICO.0000000000000487
[36] 李华, 王雁, 窦瑞, 等. 不同侧切角对飞秒激光辅助的LASIK术后角膜生物力学影响的对比研究[J]. 中华眼科杂志, 2017, 53(1): 23-32. DOI:10.3760/cma.j.issn.0412-4081.2017.01.006
[37] 王雁, 刘晶. 重视生物力学对于角膜屈光手术的作用[J]. 中华眼科杂志, 2021, 57(2): 81-85. DOI:10.3760/cma.j.cn112142-20201216-00822
[38] Dzhaber D, Mustafa OM, Alsaleh F, et al. Visual and refractive outcomes and complications in femtosecond laser-assisted versus conventional phacoemulsification cataract surgery: findings from a randomised, controlled clinical trial[J]. Br J Ophthalmol, 2020, 104(11): 1596-1600. DOI:10.1136/bjophthalmol-2019-314548
[39] Roberts HW, Wagh VK, Sullivan DL, et al. A randomized controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery[J]. J Cataract Refract Surg, 2019, 45(1): 11-20. DOI:10.1016/j.jcrs.2018.08.033

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