方法：老视患者44例77眼行角膜地形图引导下LASIK(TOSCA)手术并加入Shotfile老视切削模式，随访时间6mo且资料完整。观察患者术后远、近视力，屈光度，高阶像差，对比敏感度，立体视觉及患者术后满意度。

结果：术后6mo平均裸眼远视力：主视眼为 1.00±0.16，非主视眼为1.00±0.23； 平均裸眼近视力：主视眼为 1.07±0.29，非主视眼为1.09±0.33。屈光度：术后6mo时的平均等效球镜-0.41±0.56D。高阶像差：瞳孔直径6mm时，术后6mo较术前，水平及垂直彗差向负值方向漂移，球差向正值方向漂移，差异有统计学意义(P<0.05)。对比敏感度(CS)：低、中、高频对比敏感度于术后10d及1mo较术前降低，但差异无统计学意义(P>0.05)，3mo时恢复术前水平。立体视：术后1，3，6mo立体视觉与术前比较差异无统计学意义(P>0.05)。满意度：患者对手术效果满意38例(86.4%)，比较满意4例(9.1%)，对近视力不满意2例(4.5%)。术中、术后并发症：全部手术顺利，无术中、术后相关并发症发生。

结论：Shotfile切削模式治疗老视近期安全有效，患者满意度高，能显著改善近视力，远视力无明显丢失； 术后球差向正值漂移，可以补偿老视患者调节力的降低； 本术式对患者立体视觉无明显影响。

METHODS: Seventy-seven eyes of 44 patients with complete information received the operation by the TOSCA surgery and the Shotfile software for the correction of presbyopia. The distance and near vision(dominant eye, non-dominant eye, binocular), refraction, higher order aberration, contrast sensitivity and stereo vision were compared between the preoperative and postoperative. The degree of the postoperative satisfaction was investigated.

RESULTS: The average distance vision of dominant eyes 6 months after operation were 1.00±0.16; and non-dominant eyes were 1.00±0.23. The average near vision of dominant 6 months after operation were 1.07±0.29; and non-dominant eyes were 1.09±0.33. The average spherical equivalent 6 months after operation were -0.41±0.56D. The postoperative mean spherical equivalent was lower than the preoperative, which was statically different(P<0.05). With the 6mm pupil diameter, the preoperative total higher order aberrations, horizontal coma, vertical coma and spherical aberration were: 0.573±0.308, -0.025±0.173, -0.025±0.110, 0.174±0.133; the total higher order aberrations, horizontal coma, vertical coma, spherical aberration 6 months after operation were 0.594±0.247, -0.090±0.212, -0.272±0.195 and 0.297±0.146. There was statistically difference in the vertical coma and spherical aberration between the preoperative and the postoperative 6 months(P<0.05). The low, medium and high frequency contrast sensitivity were decreased after 10 days and 1 month and it returned to the preoperative level 3 months after operation. There was no significant difference between the preoperative and postoperative stereo vision(P>0.05). 38 patients(86.4%)were satisfied with the effect of surgery; 4 patients(9.1%)relatively were satisfied with the effect of surgery; 2 patients(4.5%)were not satisfied with the near vision after operation. There were no operative or postoperative serious complications.

CONCLUSION: We found that the Shotfile software was a well-tolerated and effective procedure for treating patients with prisbyopia, and it can effectively improve the near vision without loss of distance vision in early period. The increasing spherical aberration can compensate for the depression of lens regulation ability in patients with presbyopia. While the increase of horizontal coma and vertical coma, it may lead to a decline of visual quality. There was no difference between the preoperative and postoperative stereo vision.