PURPOSE To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism. METHODS Retrospective analysis of 1,274 consecutive LASIK eyes treated on the topography-measured anterior corneal astigmatism axis compared to eyes treated on the conventional clinical manifest refractive astigmatism axis. RESULTS In eyes with a small axis discrepancy between anterior corneal astigmatism and refractive astigmatism of 5° to 20°, there was no significant difference in efficacy index, refractive astigmatism accuracy, and most Alpins vector analysis parameters. Both treatment modalities achieved 20/20 uncorrected distance visual acuity (UDVA) in 90% of eyes, with 95% having postoperative cylinder of 0.50 diopters (D) or less. In eyes with a large axis discrepancy between 21° and 45° treated on the anterior corneal astigmatism axis, outcomes were both statistically and clinically inferior. Fewer eyes achieved UDVA of 20/20 (88.9% vs 73.6%; P = .01) and fewer had a defocus equivalent of 0.25 (65.6% vs 52.7%), 0.50 (86.9% vs 80.0%), and 0.75 (97.5% vs 90.9%) D or less (P < .05 for all). Significantly more eyes achieved an angle of error greater than 15° (25.4% vs 8.1%; P = .004), had postoperative residual astigmatism of 0.75 D or less (18.2% vs 7.4%; P = .03), and needed an excimer laser re-treatment (11% vs 1.6%; P = .007). CONCLUSIONS Topography-guided myopic astigmatism LASIK treated on the topography-measured anterior corneal astigmatism axis resulted in inferior refractive and visual outcomes compared to treating on the clinical manifest refractive astigmatism axis. [J Refract Surg. 2019;35(1):15-23.].

中文翻译：

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主要地形引导 LASIK：治疗明显屈光性散光与地形测量的前角膜散光。

目的 探讨与临床测量的明显屈光散光治疗相比，使用 WaveLight Contoura（爱尔康实验室公司，沃斯堡，德克萨斯州）测量前角膜散光的地形引导激光原位角膜磨镶术 (LASIK) 是否会带来更好的屈光结果原发性近视散光眼的轴。方法 对 1,274 例连续的 LASIK 眼进行回顾性分析，将在地形测量的前角膜散光轴上治疗的眼睛与在传统临床表现的屈光散光轴上治疗的眼睛进行比较。结果对于前角膜散光与屈光散光的小轴差为5°～20°的眼，疗效指数、屈光散光准确度和大部分Alpins矢量分析参数均无显着差异。两种治疗方式的 90% 眼睛的未矫正远视力 (UDVA) 均达到 20/20，其中 95% 的术后柱镜为 0.50 屈光度 (D) 或更低。对于前角膜散光轴治疗的轴偏差在 21° 至 45° 之间的眼睛，结果在统计学和临床​​上均较差。UDVA 达到 20/20 的眼睛较少（88.9% vs 73.6%；P = .01），散焦当量达到 0.25（65.6% vs 52.7%）、0.50（86.9% vs 80.0%）和 0.75（97.5%）的眼睛较少vs 90.9%) D 或更少（所有 P < .05）。明显更多的眼睛达到了大于 15° 的误差角（25.4% vs 8.1%；P = .004），术后残余散光为 0.75 D 或更小（18.2% vs 7.4%；P = .03），并且需要矫正准分子激光再治疗（11% vs 1.6%；P = .007）。结论 与临床明显屈光散光轴上的治疗相比，在地形图测量的前角膜散光轴上进行地形图引导的近视散光 LASIK 治疗导致屈光和视力结果较差。[J 屈光外科杂志。2019;35(1):15-23.]。