PURPOSE To evaluate the outcomes of primary topography-guided laser in situ keratomileusis (LASIK) in eyes with subjective refractive astigmatism of 2.00 diopters (D) or greater. METHODS This was a prospective study in consecutive eyes with cylinder of 2.00 D or greater that had LASIK using the Alcon WaveLight EX500 excimer laser and T-CAT/Contoura software (Alcon Laboratories, Inc., Fort Worth, TX). The accuracy, efficacy, safety, cylinder vector analysis, higher order aberrations, and patients' subjective quality of vision were assessed. Eyes with naturally occurring topographic irregular astigmatism were not excluded. RESULTS The mean cylinder was -2.55 D preoperatively and -0.34 D postoperatively; 81% and 95% of eyes were within ±0.50 and ±0.75 D of intended cylinder after LASIK, respectively. The correction index and index of success were 1.00 and 0.13, respectively. The efficacy and safety indexes were 0.98 and 1.04, respectively. The preoperative corneal topography irregularity index, anterior corneal higher order aberrations, and refractive astigmatism magnitude were mildly correlated to postoperative residual astigmatism. Mean ocular and corneal coma were not increased postoperatively. Patients had significant improvements after LASIK in both subjective uncorrected quality of vision and night vision disturbances compared to spectacle- and contact lens-corrected vision before LASIK. CONCLUSIONS Topography-guided ablation using the Alcon WaveLight EX500 excimer laser and T-CAT/Contoura software results in excellent accuracy, efficacy, and safety, with improved postoperative subjective quality of vision and reduced night vision disturbances in virgin eyes with refractive astigmatism of 2.00 D or greater, including eyes with topographic naturally occurring irregular astigmatism. [J Refract Surg. 2019;35(2):78-86.].

中文翻译：

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主要地形学指导的LASIK：散光⩾2.00屈光度的屈光，视觉和主观视觉质量。

目的评估主观屈光散光为2.00屈光度（D）或更高的主地形引导激光原位角膜磨镶术（LASIK）的结果。方法这是一项前瞻性研究，使用Alcon WaveLight EX500准分子激光和T-CAT / Contoura软件（Alcon Laboratories，Inc.，Fort Worth，TX）在2.00 D或更大的连续眼中进行了LASIK。评估准确性，有效性，安全性，柱面矢量分析，高阶像差和患者的主观视觉质量。不排除自然发生地形不规则散光的眼睛。结果术前平均气柱为-2.55 D，术后为-0.34 D；LASIK后，分别有81％和95％的眼睛位于目标圆柱的±0.50和±0.75 D之内。校正指数和成功指数分别为1.00和0.13。疗效和安全性指标分别为0.98和1.04。术前角膜地形图不规则指数，角膜前高阶像差和屈光散光程度与术后残余散光有轻微相关性。术后平均眼和角膜昏迷没有增加。与LASIK手术前的眼镜和隐形眼镜校正后的视力相比，LASIK术后患者的主观未经校正的视力质量和夜视障碍均有显着改善。结论使用Alcon WaveLight EX500准分子激光和T-CAT / Contoura软件进行地形引导的消融可产生出色的准确性，功效和安全性，在屈光散光为2.00 D或更高的原始眼睛中，包括在地形上自然发生不规则散光的眼睛，具有改善的术后主观视觉质量和减少的夜间视力障碍。[J Refract Surg。2019; 35（2）：78-86。]。