目的：观察Phorcides分析软件用于显然验光的散光度数与轴向和角膜地形图测量所得偏差较大的初始近视合并散光眼行角膜地形图引导个性化准分子激光原位角膜磨镶术(LASIK)治疗效果。方法：回顾性临床研究。选取2019年12月至2021年3月在西安交通大学第一附属医院眼科屈光手术中心接受初始眼角膜地形图引导个性化LASIK的近视合并散光患者32例42眼。记录术前和术后6 mo的裸眼远视力(UDVA)、最佳矫正远视力(CDVA)、屈光状态和像差。结果：纳入研究男15例，女17例，年龄23.00(18.00，29.25)岁； 术前显然验光球镜-5.75(-6.25，-4.00)D，显然验光柱镜-0.75(-1.38，-0.25)D。术后6 mo 19眼(45%)UDVA超越术前CDVA。术后6 mo所有眼(100%)等效球镜(SEQ)为-0.50-+0.50 D，其中23眼(55%)SEQ为-0.13-+0.13 D。33眼(79%)术后散光≤0.25 D，目标矫正散光量(TIA)为0.94±0.96 D，手术矫正散光量(SIA)为0.94±0.86 D，二者无差异(P>0.05)； 术后6 mo 33眼(79%)散光轴位偏差为-5°-+5°。与术前相比，术后6 mo角膜前表面中央6 mm直径范围内的总高阶像差及球差增加(Z=-3.778，P<0.001； Z=-4.929，P<0.001)； 术后彗差无显著性改变(Z=-1.763，P=0.078)； 术后三叶草减少(Z=-2.490，P=0.013)。与术前相比，术后6 mo角膜前表面点扩散函数斯特列尔比显著增加(t=-5.401，P<0.001)。结论：显然验光的散光度数与轴向和角膜地形图测量所得偏差较大的初始近视合并散光眼接受角膜地形图引导个性化LASIK手术前使用Phorcides分析软件辅助手术方案设计获得良好的治疗效果，近半数眼术后UDVA超越术前CDVA，且术后角膜成像质量提升。

AIM: To observe the clinical outcomes of Phorcides analytic engine-assisted topography-guided personalized laser assisted in situ keratomileusis(LASIK)for the treatment of myopia and astigmatism in virgin eyes with the refractive astigmatism significantly deviating from corneal topography.METHODS: Retrospective clinical study. A total of 32 cases(42 eyes)with myopia and astigmatism that received corneal topography-guided personalized LASIK in the Ophthalmology Refractive Surgery Center of the First Affiliated Hospital of Xi'an Jiaotong University from December 2019 to March 2021 were selected. The uncorrected distance visual acuity(UDVA), best corrected distance visual acuity(CDVA), refractive state and aberrations before and at 6 mo after surgery were recorded.RESULTS: There were 15 males and 17 females, with an age of 23.00(18.00, 29.25)years old; preoperative sphere was -5.75(-6.25, -4.00)D, and cylinder was -0.75(-1.38, -0.25)D. At 6 mo postoperatively, the UDVA exceeded the preoperative CDVA in 19 eyes(45%). The spherical equivalent(SEQ)of all eyes(100%)was -0.50 to +0.50 D at 6 mo postoperatively, and the postoperative SEQ of 23 eyes(55%)was -0.13 to +0.13 D. There were 33 eyes(79%)had a postoperative astigmatism ≤ 0.25 D, the target-induced astigmatism(TIA)was 0.94±0.96 D, and the surgically induced astigmatism(SIA)was 0.94±0.86 D, with no statistical significance between TIA and SIA(P>0.05). The astigmatism axial deviation ranged from -5° to +5° in 33 eyes(79%)at 6 mo postoperatively. Compared to pre-operation, the total higher-order aberrations and spherical aberrations within the central 6 mm diameter of the anterior corneal surface increased at 6 mo postoperatively(Z=-3.778, P<0.001; Z=-4.929, P<0.001); the postoperative coma aberrations had no change(Z=-1.763, P=0.078); the postoperative trefoil aberrations decreased(Z=-2.490, P=0.013). Compared to pre-operation, the Strehl ratio of the anterior corneal surface increased significantly at 6 mo after surgeries(t=-5.401, P=0.013).CONCLUSION: Using the Phorcides analytic engine to assist topography-guided personalized LASIK for the treatment of myopia and astigmatism in virgin eyes with the refractive astigmatism significantly deviating from topography-measured astigmatism can achieve good therapeutic effects. Postoperative UDVA exceeded preoperative CDVA in nearly half of the eyes, and the quality of postoperative corneal imaging was improved.

陕西省重点研发计划(No.2023-YBSF-568); 陕西省自然科学基础研究计划(No.2024JC-YBQN-0962); 西安交通大学第一附属医院新医疗新技术(No.XJYFY-2023YL10)