目的：探讨角膜Q值调整的优化单眼视飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)矫正近视散光合并老视手术后的安全性、有效性、视觉质量及患者满意度。

方法：前瞻性研究，纳入行FS-LASIK矫正近视散光合并老视患者为研究对象。手术后1 a内观察裸眼远、中、近视力(UDVA、UIVA、UNVA)，屈光度，角膜高阶像差，Q值，客观视觉质量，近距离立体视锐度，术后1 a采用美国国家眼科研究所-屈光不正质量问卷(NEI-RQL)评估手术对患者生活质量的影响及满意度。

结果：本研究纳入患者36例72眼，男12例(33%)，女24例(67%)，年龄40-53(46.03±3.60)岁。术后1 a，双眼UDVA≥1.0者占97%，UIVA≥0.63者占89%，UNVA≥1.0者占97%； 主视眼等效球镜度(SE)100%在±1.00 D范围内； 非主视眼SE与术前预期矫正相比存在欠矫，手术前后差值-0.27±0.34 D(P<0.001)； 非主视眼角膜前表面5 mm Q值较术前负向增加(-0.33±0.24 vs -0.21±0.09，P<0.001)； 非主视眼球差、纵向球差均低于术前(均P<0.001)； 主视眼与非主视眼手术前后OSI、MTF和SR无变化(均P>0.05)； 术后1 a近立体视锐度优于手术前(P=0.007)； 患者对手术满意率为94%，远、近视力满意率均为98%，11%患者夜间开车需辅助低度数眼镜。

结论：Q值调整的优化单眼视FS-LASIK矫正近视散光合并老视安全、有效，主观、客观视觉质量良好，患者满意度较高。非主视眼存在欠矫，后期需对诺莫图进行调整。

METHODS: This prospective study enrolled patients suffering myopia, astigmatism, and presbyopia. At 1 y post operation, uncorrected distance, intermediate and near visual acuity(UDVA, UIVA, UNVA), refraction, corneal higher order aberrations(HOAs), Q value, objective visual quality, and near stereoacuity were evaluated. The impact of surgery on patients' living quality and their satisfaction were evaluated based on National Eye Institute Refractive Error Quality of Life Instrument(NEI RQL)scores at 1-year follow-up.

RESULTS:The study enrolled 36 patients(72 eyes)including 12 males(33%)and 24 females(67%)with an average age of 46.03±3.60(range 40-53)y. One year postoperatively, 97% of patients achieved binocular UDVA of 1.0 or better, 89% achieved UIVA of 0.63 or better, and 97% achieved UNVA of 1.0 or better. The spherical equivalent refraction(SE)in dominant eye within ±1.00 D was 100%. SE in non-dominant eyes was uncorrected compared with the preoperative target correction, with a mean difference of -0.27±0.34 D before and after surgery(P<0.001). while in the non-dominant eyes, the anterior corneal Q-value within the 5 mm zone increased negatively compared with the preoperative value(-0.33±0.24 vs -0.21±0.09, P<0.001). In the non-dominant eye, spherical aberration and longitudinal spherical aberration were lower than preoperative values(both P<0.001). Besides, there were no significant changes in objective scatter index(OSI), modulation transfer function cutoff frequency(MTF cut off)and Strehl ratio(SR)in both dominant and non-dominant eyes(all P>0.05), and the near stereoacuity was better after surgery(P=0.007). Additionally, the patient satisfaction rate with the surgery was 94%, the satisfaction rates for UDVA and UNVA were both 98%. The 11% of patients required to wear low-diopter glasses when driving at night.

CONCLUSION:Optimized monovision Q-value-customised FS-LASIK is a safe and effective procedure for correcting myopia, astigmatism, and presbyopia. It provides favorable subjective and objective visual quality and high patient satisfaction. The under correction in non-dominant eyes is observed, indicating the further optimization of nomogram is needed.