南方医科大学学报

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (6): 1113-1121.doi: 10.12122/j.issn.1673-4254.2025.06.01

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高度近视合并散光治疗中Toric-ICL比FS-LASIK具有更好的可预测性和近视治疗效果

李红阳(), 廖文雄, 雷鹏, 杨春园, 黎燕英, 薛丽萍, 谭朵, 刘思静, 吴艺(), 陈美兰()   

  1. 广东省第二人民医院眼科，广东 广州 510317
  • 收稿日期:2024-08-03 接受日期:2025-04-10 出版日期:2025-06-20 发布日期:2025-06-27
  • 通讯作者: 吴艺,陈美兰 E-mail:362342650@qq.com;13332877439@189.com;13332877439@189.cn;meilanchen918@163.com
  • 作者简介:李红阳，博士，副主任医师，E-mail： 362342650@qq.com
  • 基金资助:
    广东省医学科学技术研究基金(B2023041);双一流学科建设和提升专项(2023B10564003);广州市科技计划项目(2024A03J0992);广东省基础与应用基础研究自然科学基金(2024A1515012868)

Toric-ICL shows better predictability and efficacy than FS-LASIK for myopia correction in patients with moderate to high myopia and astigmatism

Hongyang LI(), Wenxiong LIAO, Peng LEI, Chunyuan YANG, Yanying LI, Liping XUE, Duo TAN, Sijing LIU, Yi WU(), Meilan CHEN()   

  1. Department of Ophthalmology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
  • Received:2024-08-03 Accepted:2025-04-10 Online:2025-06-20 Published:2025-06-27
  • Contact: Yi WU, Meilan CHEN E-mail:362342650@qq.com;13332877439@189.com;13332877439@189.cn;meilanchen918@163.com
  • Supported by:
    Guangdong Provincial Medical Research Foundation(B2023041);Special Project for the Construction and Enhancement of Double First-Class Disciplines(2023B10564003);Joint Fund of Basic and Applied Basic Research Fund of Guangdong Province(2024A03J0992);Guangdong Provincial Natural Science Foundation for Basic and Applied Basic Research Project(2024A1515012868)

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摘要：

目的 评估散光型有晶体眼人工晶状体（Toric-ICL）与飞秒激光辅助准分子激光原位角膜磨镶术（FS-LASIK）对中高度近视伴散光患者的近视治疗效果。 方法 回顾性分析2019年1月~2020年12月期间在广东省第二人民医院眼科接受屈光手术的64 例患者（年龄18~42 岁）资料，其中 28 例患者（56 眼）接受Toric-ICL手术，36例（72眼）行 FS-LASIK 手术。所有患者术后均随访6个月，对比分析两组间术后裸眼远视力（UCVA）、等效球镜度（SE）、散光矫正指数（CI）、术后散光度数、角膜内皮细胞密度（ECD），以及术后眼压的变化。 结果 FS-LASIK组72眼和Toric-ICL组55眼的术后UCVA≥1.0，两组间无显著差异（P=0.2374）。FS-LASIK组的术后SE为0.43±0.06 D（-1.0~1.50 D），与Toric-ICL组的术后SE（0.38±0.05 D；-0.75~1.00 D）无显著差异（P=0.56）。FS-LASIK 组和 Toric-ICL 组的CI平均值分别为 0.8561 和 0.7176（P<0.0001）。此外，术后散光度数≤0.50 D的眼在FS-LASIK组中占比为88.89%，在Toric-ICL组中则占比69.64%。FS-LASIK 组术后角膜ECD无显著变化，而 Toric-ICL 组术后ECD 明显降低（P=0.0057）。Toric-ICL 组术后眼压无显著变化，但 FS-LASIK 组眼压在术后有所降低（P<0.001）。 结论 尽管纳入 Toric-ICL 组的患者近视度数更高且散光度数更高，但该组表现出更好的可预测性和散光矫正效果。因此，Toric-ICL 在矫正中度近视方面与 FS-LASIK 同样有效且安全。Toric-ICL 在矫正伴有散光的高度近视方面有其优势。

关键词: 散光型有晶体眼人工晶状体, 飞秒激光辅助准分子激光原位角膜磨镶术, 近视, 散光, 治疗效果

Abstract:

Objective To compare the efficacy of toric implantable collamer lens (Toric-ICL) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia correction in patients with moderate to high myopia complicated with astigmatism. Methods We retrospectively collected data from 64 patients (aged 18-42 years) with moderate to high myopia complicated with astigmatism (128 eyes) undergoing either Toric-ICL (28 patients/56 eyes) or FS-LASIK (36 patients/72 eyes) at our department between January, 2019 and December, 2020. The changes of uncorrected distance visual acuity (UCVA), spherical equivalent (SE), mean astigmatism correction index (CI), corneal endothelial cell density (ECD) and intraocular pressure (IOP) following the procedures were compared between the two groups. Results In FS-LASIK group, all the eyes (72/72) achieved an UCVA≥1.0, similar to the rate in Toric-ICL group (55/56 eyes; P=0.2374). The postoperative SE was also comparable between FS-LASIK and Toric-ICL groups [0.43±0.06 D (range: -1.0 to 1.50 D) vs 0.38±0.05 D (range: -0.75 to 1.00 D); P=0.56]. The mean astigmatism CI was significantly higher in FS-LASIK group than in Toric-ICL group (0.8561 vs 0.7176; P<0.0001), and 88.89% of the eyes in FS-LASIK group and 69.64% in Toric-ICL group had postoperative astigmatism ≤0.50 D. No significant changes were observed in postoperative corneal ECD in FS-LASIK group, whereas ECD decreased significantly after the procedure in Toric-ICL group (P=0.0057). The patients undergoing Toric-ICL exhibited no significant changes of postoperative IOP, but the patients receiving FS-LASIK had significantly reduced IOP after the procedure (P<0.001). Conclusion Although the patients included in Toric-ICL group had higher myopia and astigmatism, Toric-ICL still showed better predictability and efficacy for astigmatic correction in Toric-ICL group. Toric-ICL is an effective and safe equivalent of FS-LASIK for correcting moderate myopia but can be more advantageous for correcting high myopia with astigmatism.

Key words: toric implantable collamer lens, femtosecond laser-assisted in situ keratomileusis, myopia, astigmatism, treatment effect