Objective: To compare the effects of femtosecond laser-assisted astigmatic keratotomy (FSAK) with and without a manual opening for correction of low to moderate corneal astigmatism at the time of cataract surgery. Methods: It was a prospective cohort study. Patients undergoing cataract surgery from June 2021 to June 2022 at the Army Specialty Medical Center were consecutively enrolled. To correct low to moderate astigmatism, they had combined FSAK with the corneal epithelium manually opened or not according to their own decisions. Pentacam HR corneal topography was performed at 3 months after surgery. The main indicators were target induced astigmatism, surgically induced astigmatism, difference vector, correction index and angle of error. The independent samples t-test was used for continuous variables conforming to a normal distribution, the Mann-Whitney U-test for those not conforming to a normal distribution, and the Chi-square test for categorical variables. Results: There were 51 patients (61 eyes), including 27 patients (31 eyes) receiving combined open FSAK and 24 patients (30 eyes) with non-open keratotomy. No statistical difference was found between the two groups of patients in terms of age, gender and mean follow-up time (P>0.05). The target induced astigmatism was 1.10(0.80, 1.50) D in patients with open keratotomy and 1.30(0.98, 1.73) D in patients with non-open keratotomy (Z=1.729, P=0.084). The surgically induced astigmatism was 0.70 (0.59, 1.25) D and 0.42 (0.20, 0.66) D (Z=-3.571, P<0.001), the difference vector was (0.51±0.31) D and (1.21±0.44) D (t=-7.238, P<0.001), the correction index was 0.78±0.32 and 0.38±0.25 (t=5.386, P<0.001), and the angle of error was -1.08°±10.76° and 5.93°±46.98° (t=0.809, P=0.422) in the two groups, respectively. Conclusion: Open FSAK can achieve better astigmatism correction and less postoperative residual astigmatism than non-open FSAK in cataract surgery.
目的： 对比飞秒激光辅助的白内障摘除手术联合角膜散光松解术（FSAK）中对FSAK切口表面进行手动开放与不开放对于中低度角膜散光的矫正效果。 方法： 前瞻性队列研究。纳入2021年6月至2022年6月到解放军陆军特色医学中心眼科行白内障摘除手术的连续病例，根据患者意愿选择决定手术方式，观察组为开放性FSAK，对照组为非开放性FSAK。两组患者均在LensAR飞秒激光手术平台下行飞秒激光辅助白内障超声乳化联合人工晶状体植入术，术中观察组对FSAK切口的角膜上皮进行手动开放，对照组不作手动开放。术后3个月行Pentacam HR角膜地形图检查。检查所有术眼的目标散光矫正量、术源性散光、残余散光、矫正指数、角度误差。符合正态分布的连续变量进行独立样本t检验；不符合正态分布的连续变量进行Mann-Whitney U检验；分类变量使用卡方检验。 结果： 纳入患者51例（61只眼），其中观察组27例（31只眼），对照组24例（30只眼）。两组患者年龄、性别及平均随访时间差异均无统计学意义（P>0.05）。观察组与对照组的目标散光矫正量分别为1.10（0.80，1.50）和1.30（0.98，1.73）D，差异无统计学意义（Z=1.729，P=0.084）；观察组与对照组的术源性散光分别为0.70（0.59，1.25）和0.42（0.20，0.66）D（Z=-3.571，P<0.001），残余散光分别为（0.51±0.31）和（1.21±0.44）D（t=-7.238，P<0.001），矫正指数分别为0.78±0.32和0.38±0.25（t=5.386，P<0.001），差异均有统计学意义；观察组与对照组的角度误差分别为-1.08°±10.76°和5.93°±46.98°，差异无统计学意义（t=0.809，P=0.422）。 结论： 开放性FSAK对比非开放性FSAK可以取得更好的散光矫正效果和更小的术后残余散光。.