Analysis of the efficacy of femtosecond laser-assisted sub-Bowman keratomileusis on the correction of myopia and astigmatism with six dimensional eye tracking system_West China Medical Journal

Authors：

ZHENG Qiongqin ^1,2 ,  DENG Yingping ¹

1. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Ophthalmology, Hospital of Chengdu Office of the People’s Government of Tibet Autonomous Region, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

DENG Yingping, Email: dyp558@163.com

Keywords：

Myopia; Astigmatism; Static cyclotosrion component; Dynamic cyclotorsion control; Femtosecond laser-assisted sub-Bowman keratomileusis; Total higher-order aberrations; Strehl ratio

DOI：

10.7507/1002-0179.201806175

Video：

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ObjectiveTo evaluate the effectiveness of using a six-dimensional eye-tracking system during femtosecond laser-assisted sub-Bowman keratomileusis (FS-SBK) surgery to correct myopia and astigmatism. MethodsA total of 23 patients (36 eyes) with ametropia undergoing FS-SBK were retrospectively analyzed and divided into the static cyclotorsion control (SCC) group (11 patients, 20 eyes) and the non-SCC group (12 patients, 16 eyes). According to the static eyeball rotation degrees, the SCC group was further divided into three subgroups: within ±2° group (5 patients, 9 eyes), ±2°-±5° group (4 patients, 7 eyes), and above ±5° group (2 patients, 4 eyes). The preoprative and postoperative one-month uncorrected visual acuity, best corrected visual acuity, diopter of spherical power, diopter of cylindrical power, corneal curvature, and the rotating degree in SCC were observed; the root-mean-square values of the total higher-order aberrations, spherical aberration, coma, Strehl ratio, etc. when the pupil diameter was 6.5 mm were extracted; and the therapeutic efficacy was observed. ResultsNo severe intraoperative or postoperative complications occurred in any subject. The effectiveness index of the SCC group was 0.947±0.145, and that of the non-SCC group was 1.005±0.141, with no statistically significant difference (P>0.05). Compared with the preoperative levels, in the two groups, the postoperative uncorrected visual acuity was significantly elevated; the postoperative diopter of spherical power, diopter of cylindrical power, and corneal curvature difference were reduced; the postoperative total higher-order aberrations, spherical aberration, and coma increased; all the differences mentioned above were statistically significant (P<0.05). In the SCC group, the difference between the preoperative and the postoperative Strehl ratio was statistically significant (P<0.05). There was no significant difference in postoperative indicators between the SCC group and the non-SCC group (P>0.05). The difference in postoperative increment of coma between the SCC group and the non-SCC group was statistically significant (P<0.05). In the SCC group, no statistically significant difference was found in postoperative increment of any indicator among the three subgroups (P<0.05). ConclusionsFS-SBK of six-dimensional eye-tracking system is effective in correcting myopia and astigmatism. FS-SBK can reduce lower-order aberrations while introducing higher-order aberrations, and whether SCC is performed intraoperatively is meaningless.

Citation： ZHENG Qiongqin, DENG Yingping. Analysis of the efficacy of femtosecond laser-assisted sub-Bowman keratomileusis on the correction of myopia and astigmatism with six dimensional eye tracking system. West China Medical Journal, 2018, 33(11): 1376-1381. doi: 10.7507/1002-0179.201806175 Copy

1.	劉建國, 葉璐, 萬雅群, 等. 虹膜定位聯合波前像差引導 LASIK 與常規 LASIK 矯正重度散光的療效對比分析. 中國激光醫學雜志, 2010, 19(6): 388.
2.	Porter J, Yoon G, MacRae S, et al. Surgeon offsets and dynamic eye movements in laser refractive surgery. J Cataract Refract Surg, 2005, 31(11): 2058-2066.
3.	Tomita M, Watabe M, Yukawa S, et al. Supplementary effect of static cyclotorsion compensation with dynamic cyclotorsion compensation on the refractive and visual outcomes of laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg, 2013, 39(5): 752-758.
4.	Chernyak DA. Iris-based cyclotorsional image alignment method for wavefront registration. IEEE Trans Biomed Eng, 2005, 52(12): 2032-2040.
5.	Wu HK. Astigmatism and LASIK. Curr Opin Ophthalmol, 2002, 13(4): 250-255.
6.	Bará S, Mancebo T, Moreno-Barriuso E. Positioning tolerances for phase plates compensating aberrations of the human eye. Appl Opt, 2000, 39(19): 3413-3420.
7.	Guirao A, Williams DR, Cox IG. Effect of rotation and translation on the expected benefit of an ideal method to correct the eye’s higher-order aberrations. J Opt Soc Am A Opt Image Sci Vis, 2001, 18(5): 1003-1015.
8.	Tevens JD. Astigumfic axcimer laser treatment: theoretical effects of axis misaligument. Eur J Implant Ref Surg, 1994, 6: 310-318.
9.	Swami AU, Steinert RF, Osborne WE, et al. Rotational malposition during laser in situ keratomileusis. Am J Ophthalmol, 2002, 133(4): 561-562.
10.	Smith EM Jr, Talamo JH. Cyclotorsion in the seated and supine patient. J Cataract Refract Surg, 1995, 21(4): 402-403.
11.	Hori-Komai Y, Sakai C, Toda I, et al. Detection of cyclotorsional rotation during excimer laser ablation in LASIK. J Refract Surg, 2007, 23(9): 911-915.
12.	Chang J. Cyclotorsion during laser in situ kertomileusis. J Cataract Refract Surg, 2008, 34(11): 1720-1726.
13.	Porter J, Yoon G, Macrae S, et al. Surgeon offsets and dynamic eye movements in laser refractive surgery. J Cataract Refract Surg, 2005, 31(11): 2058-2066.
14.	Ciccio AE, Durrie DS, Stahl JE, et al. Ocular cyclotorsion during customized laser ablation. J Refract Surg, 2005, 21(6): S772-S774.
15.	顧國貞, 呂雪漫, 曲新, 等. 1038 眼 LASIK 術中應用虹膜定位技術校正眼球旋轉及瞳孔中心移位的研究. 中國實用眼科雜志, 2007, 25(9): 964-967.
16.	Seider MI, Ide T, Kymionis GD, et al. Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis. J Cataract Refract Surg, 2008, 34(5): 859-863.
17.	Chernyak DA. Cyclotorsional eye motion occurring between wavefront measurement and refractive surgery. J Cataract Refract Surg, 2004, 30(3): 633-638.
18.	Swami AU, Steinert RE. Osbone WE, et al Rotational malpostion during laser in situ keratomileusis. Ophthalmol, 2002, 133(4): 561-562.
19.	Chernyak DA. From wavefront device to laser: an alignment method for complete registration of the ablation to the cornea. J Refract Surg, 2005, 21(5): 463-468.
20.	Harris WF. Astigmatism. Opthalmic Physiol Opt, 2000, 20(1): 11-30.
21.	Srinivasan S, Rootman DS. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK. J Refract Surg, 2007, 23(8): 828-830.
22.	Ustundag C, Bahcecioglu H, Ozdamar A, et al. Optical coherence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis. J Cataract Refract Surg, 2000, 26(10): 1458-1462.
23.	Pallikaris IG, Kymionis GD, Panagopoulou SI, et al. Induced optical aberrations following formation of a laser in situ keratomileusis flap. J Cataract Refract Surg, 2002, 28(10): 1737-1741.
24.	Applegate RA, Sarver EJ, Khemsara V. Are all aberrations equal. J Refract Surg, 2002, 18(5): S556-S562.
25.	Mrochen M, Kaemmerer M, Mierdel P, et al. Increased higher-order optical aberrations after laser refractive surgery: a problem of subclinical decentration. J Cataract Refract Surg, 2001, 27(3): 362-369.

1. 劉建國, 葉璐, 萬雅群, 等. 虹膜定位聯合波前像差引導 LASIK 與常規 LASIK 矯正重度散光的療效對比分析. 中國激光醫學雜志, 2010, 19(6): 388.
2. Porter J, Yoon G, MacRae S, et al. Surgeon offsets and dynamic eye movements in laser refractive surgery. J Cataract Refract Surg, 2005, 31(11): 2058-2066.
3. Tomita M, Watabe M, Yukawa S, et al. Supplementary effect of static cyclotorsion compensation with dynamic cyclotorsion compensation on the refractive and visual outcomes of laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg, 2013, 39(5): 752-758.
4. Chernyak DA. Iris-based cyclotorsional image alignment method for wavefront registration. IEEE Trans Biomed Eng, 2005, 52(12): 2032-2040.
5. Wu HK. Astigmatism and LASIK. Curr Opin Ophthalmol, 2002, 13(4): 250-255.
6. Bará S, Mancebo T, Moreno-Barriuso E. Positioning tolerances for phase plates compensating aberrations of the human eye. Appl Opt, 2000, 39(19): 3413-3420.
7. Guirao A, Williams DR, Cox IG. Effect of rotation and translation on the expected benefit of an ideal method to correct the eye’s higher-order aberrations. J Opt Soc Am A Opt Image Sci Vis, 2001, 18(5): 1003-1015.
8. Tevens JD. Astigumfic axcimer laser treatment: theoretical effects of axis misaligument. Eur J Implant Ref Surg, 1994, 6: 310-318.
9. Swami AU, Steinert RF, Osborne WE, et al. Rotational malposition during laser in situ keratomileusis. Am J Ophthalmol, 2002, 133(4): 561-562.
10. Smith EM Jr, Talamo JH. Cyclotorsion in the seated and supine patient. J Cataract Refract Surg, 1995, 21(4): 402-403.
11. Hori-Komai Y, Sakai C, Toda I, et al. Detection of cyclotorsional rotation during excimer laser ablation in LASIK. J Refract Surg, 2007, 23(9): 911-915.
12. Chang J. Cyclotorsion during laser in situ kertomileusis. J Cataract Refract Surg, 2008, 34(11): 1720-1726.
13. Porter J, Yoon G, Macrae S, et al. Surgeon offsets and dynamic eye movements in laser refractive surgery. J Cataract Refract Surg, 2005, 31(11): 2058-2066.
14. Ciccio AE, Durrie DS, Stahl JE, et al. Ocular cyclotorsion during customized laser ablation. J Refract Surg, 2005, 21(6): S772-S774.
15. 顧國貞, 呂雪漫, 曲新, 等. 1038 眼 LASIK 術中應用虹膜定位技術校正眼球旋轉及瞳孔中心移位的研究. 中國實用眼科雜志, 2007, 25(9): 964-967.
16. Seider MI, Ide T, Kymionis GD, et al. Epithelial breakthrough during IntraLase flap creation for laser in situ keratomileusis. J Cataract Refract Surg, 2008, 34(5): 859-863.
17. Chernyak DA. Cyclotorsional eye motion occurring between wavefront measurement and refractive surgery. J Cataract Refract Surg, 2004, 30(3): 633-638.
18. Swami AU, Steinert RE. Osbone WE, et al Rotational malpostion during laser in situ keratomileusis. Ophthalmol, 2002, 133(4): 561-562.
19. Chernyak DA. From wavefront device to laser: an alignment method for complete registration of the ablation to the cornea. J Refract Surg, 2005, 21(5): 463-468.
20. Harris WF. Astigmatism. Opthalmic Physiol Opt, 2000, 20(1): 11-30.
21. Srinivasan S, Rootman DS. Anterior chamber gas bubble formation during femtosecond laser flap creation for LASIK. J Refract Surg, 2007, 23(8): 828-830.
22. Ustundag C, Bahcecioglu H, Ozdamar A, et al. Optical coherence tomography for evaluation of anatomical changes in the cornea after laser in situ keratomileusis. J Cataract Refract Surg, 2000, 26(10): 1458-1462.
23. Pallikaris IG, Kymionis GD, Panagopoulou SI, et al. Induced optical aberrations following formation of a laser in situ keratomileusis flap. J Cataract Refract Surg, 2002, 28(10): 1737-1741.
24. Applegate RA, Sarver EJ, Khemsara V. Are all aberrations equal. J Refract Surg, 2002, 18(5): S556-S562.
25. Mrochen M, Kaemmerer M, Mierdel P, et al. Increased higher-order optical aberrations after laser refractive surgery: a problem of subclinical decentration. J Cataract Refract Surg, 2001, 27(3): 362-369.

West China Medical Journal

Analysis of the efficacy of femtosecond laser-assisted sub-Bowman keratomileusis on the correction of myopia and astigmatism with six dimensional eye tracking system

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