目的：分析有意愿接受准分子激光角膜屈光手术治疗近视的患者在术前检查后未行手术的原因。方法：选取2015年1月至2017年6月在安徽医科大学附属第一医院眼科激光中心检查的近视患者，分析其中未行激光手术的原因。结果：共2 875例患者准备接受准分子激光角膜屈光手术，其中821例(28.6%)检查后未进行手术，男462例(56.3%)，女359例(43.7%)，年龄18~51(23.69±5.85)岁。821例中社会心理因素影响484例(59.0%)，角膜薄或角膜厚度不足182例(22.2%)，超高度近视(>10.00 D)100例(12.2%)，高眼压19例(2.3%)，弱视13例(1.6%)，角膜曲率异常11例(1.3%)，眼底病变7例(0.9%)，角膜变性3例(0.4%)，其他2例(0.2%)。结论：近视治疗术前检查后未进行准分子激光角膜屈光手术的原因多种多样，其中社会心理因素及角膜厚度不足是最主要的原因。术前详细检查，严格掌握手术适应证和禁忌证以及充分医患沟通是手术安全的保障。

Objective: To analyze the reasons for not performing laser refractive keratomileusis surgery among refractive surgery candidates under regular preoperative examination. Methods: The patients with myopia examined in the Center of Ophthalmology in the First Affiliated Hospital of Anhui Medical University Laser between January 2015 and June 2017 were selected, the reasons for not performing laser refractive keraomileusis after regular preoperative examination were analyzed. Results: A total of 2 875 patients requested refractive surgery and 2 054 (71.4%) of them received refractive surgery. Among 821 (28.6%) patients who did not get laser refractive keratomileusis, 462 (56.3%) were male and 359 (43.7%) were female, aged 18–51 years (range, 23.69±5.85 years). The most common reason for not offering refractive surgery were social psychological factors (59.0%), low central corneal thickness (22.2%), high myopia (12.2%), high intraocular pressure (2.3%), poor corrected visual acuity (1.6%), corneal topography anomaly (1.3%), retinal disease (0.9%), corneal (0.4%) and other diseases (0.2%). Conclusion: Reasons for not performing refractive surgery are quite diverse. Social psychological factors and inadequate corneal thickness were the most common reasons in the present study. Careful preoperative examination, strictly mastering indications and contraindications and full doctor-patient communication should be done for the safety of surgery.

角膜屈光手术是目前屈光手术的主流术式，随着全飞秒、全激光手术方式的发展，手术变得更加安全精准，不仅角膜创伤小，术后恢复时间也进一步缩短。角膜具有屈光特性和典型的生物软组织力学特性，角膜力学特性不仅参与维持角膜形态，影响角膜手术尤其屈光手术的效果及预后，而且还与部分角膜疾病的发生和发展密切相关。近年来生物力学研究发展迅速，其在眼部疾病的诊疗中发挥着越来越重要的作用。角膜生物力学的变化与术前角膜的形态、不同手术方式的选择、术后角膜厚度的改变等多种因素相关，但手术导致的角膜自身形态改变是不可逆的，若术后角膜生物力学的变化较大，可能会引起医源性角膜扩张、继发性圆锥角膜等并发症的发生。为了规避术后角膜扩张风险和指导个性化的术式选择，了解角膜生物力学特性的影响至关重要。文章对角膜的基础结构、角膜生物力学特性、生物力学测量方法和不同术式及不同角膜瓣厚度术后生物力学变化的研究进展进行综述，为近视患者的个性化精准治疗提供理论指导。

Corneal refractive surgery is currently main stream of refractive surgery. With the development of femtosecond and laser surgery, the surgery has become safer and more accurate, resulting in less corneal trauma and a shorter postoperative recovery time. In recent years, biomechanics research has rapidly progressed, and its clinical application has gradually increased. The cornea not only possesses refractive properties but also exhibits typical biological soft tissue mechanical properties. Corneal mechanical properties not only play a role in maintaining corneal morphology but also influence the outcome and prognosis of corneal surgery, especially refractive surgery, and are closely related to the occurrence and development of some corneal diseases. Corneal refractive surgery involves cutting the cornea according to the patient's diopter, which disrupts the integrity of the cornea and inevitably affects its biomechanical stability. Changes in corneal biomechanics are associated with various factors, such as preoperative corneal morphology, the selection of different surgical methods, and postoperative changes in corneal thickness. However, the self-morphology changes caused by surgery are irreversible. If the postoperative changes in corneal biomechanics are significant, it may lead to complications such as postoperative corneal dilation and secondary keratoconus. To avoid postoperative iatrogenic corneal dilation and guide personalized surgical choice, it is crucial to understand the limits of influence of corneal biomechanical properties. This article reviews the research progress regarding corneal biomechanical properties and changes associated with corneal refractive surgery.

随着科学技术的提高、手术方式的改进，角膜屈光手术成为治疗近视的主要方式。角膜屈光手术后角膜形态及生物力学的变化对于尽早发现术后相关并发症及术后长期稳定性具有重要意义，不同的术式及术后不同的恢复阶段角膜表面非球面参数及生物力学指标的变化存在一定差异，明确其变化的原因及机制可对临床研究提供一定的参考。

With the improvement of science and technology and the improvement of surgical methods, corneal refractive surgery has become the main way to treat myopia. The changes of corneal morphology and biomechanics after corneal refractive surgery are of great significance for early detection of postoperative complications and also affect the long-term stability after corneal refractive surgery. There are some differences in the changes of aspheric parameters and biomechanical properties in different surgical procedures and different postoperative recovery stages. Clarifying the reasons and mechanisms of these changes can provide some reference for clinical research.