方法：回顾性病例系列。研究对象为2011-02/2012-10在我院行准分子激光矫正近视手术，并随访6mo以上的患者66例112眼。采用博士伦公司217z准分子激光机进行手术，Moria公司OUP90制作110μm角膜瓣。根据患者的屈光度、角膜厚度和暗光下的瞳孔直径等因素采用不同的手术切削模式，分为S-LASIK组(n=36)、A-LASIK组(n=40)和T-LASIK组(n=36)。检测指标包括术前及术后6mo患者夜间视力满意度、裸眼视力、最佳矫正视力、等效球镜、OrbscanⅡ眼前节分析系统测量角膜K值、最薄角膜厚度(thinnest corneal thickness，TCT)及5mm瞳孔直径高阶像差分析。观察分析各组手术前后各检测指标的变化及相关性。

结果：术后6mo夜间视力满意度调查，A-LASIK组优于T-LASIK组和S-LASIK组。术后6mo三组等值球镜在 ±0.5D以内占96.43%。术后三组高阶像差RMS(RMSh)、垂直彗差(C7)、球差(C12)较术前均有增加，差异有统计学意义(P<0.05)。S-LASIK，A-LASIK和T-LASIK组角膜实际切削深度较理论切削深度分别增加14.94±29.81，11.2±10.94，5.83±17.09μm； 单位面积单位屈光度的切削厚度分别为0.85±0.27，0.72±0.08，0.59±0.09μm/(D·mm²)(P<0.05)，T-LASIK和A-LASIK切削的角膜厚度较S-LASIK分别节约30.59%和15.29%。

结论：S-LASIK，A-LASIK和T-LASIK均能有效地矫正近视散光，术后彗差、球差和高阶像差RMS值有增加，A-LASIK组术后视觉质量优于其他两组的可能与相差的改变少有关。A-LASIK和T-LASIK较S-LASIK均可有效节省角膜。T-LASIK组在保证临床矫正效果的同时减少角膜切削量，尽可能减少角膜生物力学的变化。

METHODS: Retrospective Case Series. From February 2001 to October 2012, 66 patients(112 eyes), who received laser in situ keratomileusis in our hospital and were followed up for more than 6 months, were analyzed retrospectively. The surgery was underwent with 217z excimer laser of Bausch & Lomb and with the 110μm corneal flap made by OUP90 of Moria company. According to diopter, corneal thickness and pupil diameter in dark, different surgical patterns were adopted, and thus the patients were divided into three groups: S-LASIK(n=36), A-LASIK(n=40)and T-LASIK(n=36). The preoperative nocturnal visual satisfaction, nocturnal visual satisfaction in 6 months after the operation, UCVA, BSCVA, spherical equivalent(SE), K value measured by Orbscan II anterior eye segment analysis system, thinnest corneal thickness(TCT)and high-order aberration analysis(C7, C8, C12, RMSh)at 5mm pupil diameter were noted. Changes and relevance of these testing indexes were observed and analyzed preoperatively and postoperatively.

RESULTS: According to the research on nocturnal visual satisfaction in 6 months after surgery, A-LASIK group showed better outcome than S-LASIK group and T-LASIK group. In the same period, SE less than ±0.5D in three groups accounted for 96.43%. RMSh, C7 and C12 in three groups all increased postoperatively(P<0.05). These differences were of statistical significance. In the three groups, the measured ablation depth, compared with estimated ablation depth, increased 14.94±29.81μm, 11.2±10.94μm, 5.83±17.09μm respectively and the ablated depth per unit area and per unit diopter was 0.85±0.27μm/(D·mm²), 0.72±0.08μm/(D·mm²), 0.59±0.09μm/(D·mm²)respectively(P<0.05). T-LASIK and A-LASIK saved 30.59% and 15.29% of corneal tissue compared to S-LASIK.

CONCLUSION: S-LASIK, A-LASIK and T-LASIK can correct myopia and astigmatism effectively. RMSh, C7 and C12 in three groups have all increased postoperatively. The nocturnal visual satisfaction of A-LASIK group is superior to the other two groups, which may be associated with the less change in aberration. Compared with S-LASIK, both A-LASIK and T-LASIK are effective in saving corneal tissue. Ensuring the effect of clinical correction, meanwhile, group T-LASIK reduced the corneal thickness correction to reduce the changes of corneal blomechanics as much as possible.