目的：观察用monovision原理设计治疗近视合并老视在飞秒激光小切口基质透镜取出术(SMILE)和飞秒激光辅助原位角膜磨镶术(FS-LASIK)应用后的远视力、近视力。

方法：在我院行monovision设计进行近视激光治疗的近视合并老视患者，SMILE组10例20眼，年龄45±2.83岁，屈光度-5.42±1.74D； FS-LASIK组9例18眼，年龄45±1.97岁，屈光度-5.60±1.84D。组间及组内对比手术前后单眼及双眼远、近视力。

结果：术前SMILE组：主视眼：远视力0.05±0.04，近视力0.36±0.15； 客观眼：远视力0.35±0.11，近视力0.16±0.11； 双眼：远视力0.05±0.05，近视力0.18±0.09。术前FS-LASIK组：主视眼：远视力0.09±0.09，近视力0.42±0.17； 客观眼：远视力0.44±0.11，近视力0.19±0.10； 双眼：远视力0.03±0.04，近视力0.19±0.11。两组间术前各参数均无差异(P>0.05)。术后SMILE组：主视眼：远视力为-0.01±0.06，近视力为0.32±0.14； 客观眼：远视力0.16±0.18，近视力0.12±0.12； 双眼：远视力-0.04±0.07，近视力0.10±0.11。术后FS-LASIK组：主视眼：远视力0.03±0.03，近视力0.45±0.13； 客观眼：远视力0.20±0.15，近视力0.24±0.12； 双眼：远视力0.01±0.03，近视力0.22±0.09。术后两组双眼远视力、近视力均有差异(t=-2.383，P=0.034； t=-2.424，P=0.027)。SMILE组术后主视眼远视力(t=3.914，P=0.004)，客观眼远视力(t=4.894，P=0.001)，双眼远视力(t=4.870，P=0.001)，双眼近视力(t=2.388，P=0.041)均优于术前预计视力。FS-LASIK组术后客观眼远视力优于术前(t=4.068，P=0.004)。

结论：对近视角膜屈光手术的患者，用monovision设计治疗老视，SMILE和FS-LASIK均能达到预计效果，但SMILE术后的双眼远、近视力更优。

METHODS: According to the methods of operation, the presbyope with myopia were divided into two groups, who received the treatment with monovision design. SMILE group had 10 patients(20 eyes),the average age were 45±2.83 years old and myopia degree was -5.42±1.74D. FS-LASIK group had 9 patients(18 eyes), the average age were 45±1.97 years old and myopia degree was -5.60±1.84D. The far vision and the near vision of monocular and binocular of preoperative and postoperative between two groups were observed.

RESULTS: SMILE group in preoperative: the preoperative subjective eye's far visual acuity was 0.05±0.04, the subjective eye's near vision was 0.36±0.15; the objective eye's far visual acuity was 0.35±0.11, the objective eye's near visual acuity was 0.16±0.11; the binocular far visual acuity was 0.05±0.05 and the binocular near visual acuity was 0.18±0.09. Preoperative FS-LASIK group: preoperative subjective eye's far visual acuity was 0.09±0.09, subjective eye's near vision was 0.42±0.17; the objective eye's far visual acuity was 0.44±0.11, the objective eye's near visual acuity was 0.19±0.10; the binocular far visual acuity was 0.03±0.04 and the binocular near visual acuity was 0.19±0.11. The result of before surgery between the two groups had no statistical difference(P﹥0.05). Postoperative SMILE group: the far visual acuity of subjective eye was -0.01±0.06, the near vision of subjective eye was 0.32±0.14; the far visual acuity of objective eye was 0.16±0.18, the near visual acuity of objective eye was 0.12±0.12; the binocular far visual acuity was -0.04±0.07, the binocular near visual acuity was 0.10±0.11. Postoperative FS-LASIK group: the far visual acuity of subjective eye was 0.03±0.03, the near vision of subjective eye was 0.45±0.13; the far visual acuity of objective eye was 0.20±0.15, the near visual acuity of objective eye was 0.24±0.12; the binocular far visual acuity was 0.01±0.03 and the binocular near visual acuity was 0.22±0.09. The comparisons of after surgery between the two groups were statistical differences in the binocular far vision(t= -2.383, P=0.034), and the binocular near vision(t= -2.424, P=0.027). The vision comparisons between preoperative and postoperative in SMILE group, there were all statistically significant in the far visual acuity of subjective eye(t=3.914, P=0.004), the far visual acuity of objective eye(t=4.894, P=0.001), the binocular far visual acuity(t=4.870, P=0.001)and the binocular near visual acuity(t=2.388, P=0.041). That means the vision of postoperative was better than the expected vision before operation. The far visual acuity of objective eye were compared between preoperative and postoperative in FS-LASIK group, the differences was statistically significant(t=4.068, P=0.004).

CONCLUSION: To presbyope with myopia, the treatment of SMILE and FS-LASIK all can get expected results with monovision design. But the patients after SMILE would have better binocular far vision and binocular near vision than after FS-LASIK.