PURPOSE To investigate whether the degree of astigmatism axis discrepancy between preoperative manifest refractive astigmatism and anterior corneal astigmatism impacts refractive and visual outcomes of primary topography-guided laser in situ keratomileusis (LASIK) targeting the refractive astigmatism, and to provide guidance on treating eyes with very large axis discrepancy. METHODS Comparative retrospective analysis of 25,396 consecutive eyes treated with topography-guided LASIK on the manifest refractive astigmatism. Standard outcomes of the 14,534 eyes with small axis discrepancy (SAD) (Δ in axis ⩽ 10°) were compared to the 2,222 eyes with very large axis discrepancy (VLAD) (Δ in axis ⩾ 45°). Pearson correlation coefficient was used to assess relationships between selected variables. RESULTS The mean axis discrepancy was 4.47 ± 2.92° in SAD eyes, and 65.0 ± 13.4° in VLAD eyes. An equivalent number of eyes achieved a cumulative postoperative unilateral uncorrected distance visual acuity of 20/20 in both the SAD and VLAD groups (93.02% vs 93.42%; P = .4892). The efficacy index (0.98 ± 0.13 vs 0.98 ± 0.07; P = .3931) and the safety index (1.00 ± 0.11 vs 1.00 ± 0.03; P = .4757) were identical between groups. There was no clinically meaningful correlation between the preoperative axis discrepancy and preoperative total root mean square anterior corneal coma, postoperative refractive astigmatism, defocus equivalent, spherical equivalent, and angle of error, all with weak correlation coefficients (R = -0.02, -0.03, -0.02, 0.01, and 0.05). CONCLUSIONS Large preoperative axis discrepancy (45° to 90°) between refractive astigmatism and topography-measured anterior corneal astigmatism does not negatively impact topography-guided LASIK, having identical refractive and visual outcomes compared to eyes with small (0° to 10°) discrepancy. There is no basis to exclude eyes with large axis discrepancy from topography-guided LASIK, and these eyes should be treated on the manifest refractive astigmatism. [J Refract Surg. 2021;37(10):662-673.].

中文翻译：

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地形前角膜散光和明显屈光散光之间的大轴差异：地形引导的 LASIK 可以瞄准明显轴吗？

目的 研究术前明显屈光散光和前角膜散光之间散光轴差异的程度是否会影响以屈光散光为目标的初级地形引导激光原位角膜磨镶术 (LASIK) 的屈光和视力结果，并为治疗非常严重的眼睛提供指导。轴差大。方法 对 25,396 只连续眼用地形引导 LASIK 治疗明显的屈光散光进行比较回顾性分析。将 14,534 只眼轴差异小 (SAD)（轴 ⩽ 10° 中的Δ）的标准结果与 2,222 只眼轴差异非常大（VLAD）（轴 ⩾ 45° 中的 Δ）的标准结果进行比较。Pearson 相关系数用于评估所选变量之间的关系。结果 平均轴差异为 4.47 ± 2。SAD 眼为 92°，VLAD 眼为 65.0 ± 13.4°。在 SAD 和 VLAD 组中，相同数量的眼睛实现了 20/20 的累积术后单侧未矫正远视力（93.02% 对 93.42%；P = .4892）。疗效指数（0.98 ± 0.13 vs 0.98 ± 0.07；P = .3931）和安全指数（1.00 ± 0.11 vs 1.00 ± 0.03；P = .4757）在组间相同。术前轴差与术前前角膜总均方根昏迷、术后屈光散光、等效离焦、等效球面镜和角度误差之间没有临床意义的相关性，相关系数均较弱（R = -0.02，-0.03， -0.02、0.01 和 0.05）。结论 屈光散光与地形测量的前角膜散光之间的术前轴差异较大（45° 至 90°）不会对地形引导的 LASIK 产生负面影响，与具有较小（0° 至 10°）差异的眼睛相比，具有相同的屈光和视力结果. 没有根据地形引导的LASIK排除轴差异大的眼睛，这些眼睛应该在明显的屈光散光上进行治疗。[J 屈光手术。2021;37(10):662-673.]。