目的：评估飞秒激光小切口角膜微透镜取出术(SMILE)治疗非弱视成人近视性屈光参差的视觉结果与视觉功能。

方法：前瞻性对比队列研究。纳入2015年10月至2016年1月在中山眼科中心连续接受SMILE手术治疗近视或近视散光的患者。根据双眼等效球镜度差值≥1.50 D将其分为两组：屈光参差性近视组(双眼等效球镜度差值≥1.50 D)和非屈光参差性近视组(双眼等效球镜度差值<1.50 D)。于术前及术后1 wk、1、3、6 mo分别测量屈光状态、裸眼与矫正远视力(UDVA与CDVA)，以及视觉功能参数，包括融合性聚散幅度、立体视锐度和水平隐斜视。

结果：研究共纳入49例98眼，其中屈光参差组19例38眼，男11例，女8例，平均年龄25.4±6.2岁，非屈光参差性近视组30例60眼，男19例，女11例，平均年龄26.8±4.6岁。术后6 mo，非屈光参差组的矫正视力(CDVA)显著优于屈光参差组(P=0.036)。然而，两组的安全性和有效性指数未见显著差异。术后6 mo，屈光参差组的融合性聚散幅度(破裂点与恢复点)下降(P=0.005和P=0.03)，且显著低于非屈光参差组(P=0.029和P=0.046)。与术前及术后1 wk相比，两组在术后1、3、6 mo的远近立体视均有显著改善(均P<0.05)。两组术后在远近距离的眼位偏斜量均未出现有临床意义的改变。

结论：SMILE是矫正非弱视成人近视性屈光参差的一种可预测、有效且安全的方法。尽管融合性聚散幅度发生变化，但术后立体视功能可以得到改善。

METHODS:Prospective comparative cohort study. The consecutive patients who underwent SMILE for the treatment of myopia or myopic astigmatism at Zhongshan Ophthalmic Center(Guangzhou, China)between October 2015 and January 2016 were included. They were divided into two groups based on the bilateral difference of a spherical equivalent(SE)refraction ≥1.50 D: the anisometropic myopia group(interocular SE difference ≥1.50 D)and non-anisometropic myopia group(interocular SE difference<1.50 D). Refractive status, uncorrected and corrected distance visual acuity(UDVA and CDVA), and visual function parameters including fusional vergence amplitude, stereoacuity and horizontal phoria were measured preoperatively and at 1 wk,1,3 and 6 mo after surgery.

RESULTS:A total of 49 cases(98 eyes)were included in the study, and 19 cases(38 eyes)in the anisometropic group, including 11 males and 8 females, with a mean age of 25.4±6.2 y, and 30 cases(60 eyes)in the non-anisometropic myopia group, including 19 males and 11 females, with a mean age of 26.8±4.6 y. The CDVA of the non-anisometropia group was significantly better than that of the anisometropia group 6 mo postoperatively(P=0.036). However, the safety and efficacy indexes of the two groups did not show significant differences. The fusional vergence(break point and recovery point)of the anisometropia group decreased(P=0.005 and P=0.03)and was significantly lower than that in the non-anisometropia group at 6 mo post operatively(P=0.029 and P=0.046). Both groups showed a significant improvement in distance and near stereopsis at 1, 3 and 6 mo in comparison with the preoperative baseline and 1 wk postoperatively(all P<0.05). No clinically significant change in the amount of ocular alignment in terms of distance and near deviation postoperatively in either groups.

CONCLUSION: SMILE is a predictable, effective, and safe method for correcting myopic anisometropia in adults without amblyopia. Although the fusional vergence amplitudes changed, stereopsis can be improved after surgery.