目的：评价Shotfile老视切削模式治疗近视伴老视患者的远期临床疗效。

方法：对我院43例82眼35岁及以上近视屈光不正患者行激光角膜手术，采用Shotfile老视切削模式，随访3a。观察术后1、2、3a时的裸眼远、近视力和屈光度变化、视觉满意度情况。

结果：术后1a裸眼远视力达到术前最佳矫正视力者81眼(99%)，裸眼近视力在0.66以上者75眼(91%)，等效球镜平均为-0.64±0.63D，总体满意率为91%； 术后2a裸眼远视力达到术前最佳矫正视力者79眼(96%)，裸眼近视力在0.66以上者69眼(84%)，等效球镜平均为-0.62±0.59D，总体满意率为86%； 术后3a裸眼远视力达到术前最佳矫正视力者77眼(94%)，裸眼近视力在0.66以上者62眼(76%)，等效球镜平均为-0.55±0.56D，总体满意率为81%。所有入选病例均未出现术中或术后严重并发症，1眼等效球镜为-10.00D的患者1a后出现-1.75D的回退，尊重患者意愿为患者进行二次补矫。

结论：Shotfile老视切削模式治疗近视伴老视患者远期疗效安全稳定，患者满意度较高，随时间延长部分患者视近能力逐渐减弱，术前应与患者进行充分沟通。

METHODS: A total of 43 cases(82 eyes)over the age of 35 myopia patients were treated with laser corneal surgery in our hospital, added Shotfile software at the same time, and followed up for 3a. The uncorrected visual acuity(the distance and near vision), diopter change and visual satisfaction rate were observed at 1, 2 and 3a after operation.

RESULTS: At 1a after operation, there were 81 eyes(99%)with the uncorrected distance visual acuity reached the preoperative best corrected visual acuity, and 75 eyes(91%)with the uncorrected near visual acuity above 0.66, the average value of the spherical equivalent was(-0.64±0.63)D, the overall satisfaction rate was 91%. At 2a after operation, there were 79 eyes(96%)with the uncorrected distance visual acuity reached the preoperative best corrected visual acuity, and 69 eyes(84%)with the uncorrected near visual acuity above 0.66, the average value of the spherical equivalent was(-0.62±0.59)D, the overall satisfaction rate was 86%. At 3a after operation, There were 77 eyes(94%)with the uncorrected distance visual acuity reached the preoperative best corrected visual acuity, and 62 eyes(76%)with the uncorrected near visual acuity above 0.66, the average value of the spherical equivalent was(-0.55±0.56)D, the overall satisfaction rate was 81%. Intraoperative or postoperative serious complications were not found in all the cases, 1 eye of spherical equivalent with -10.0D was found -1.75D back after 1a, respected the willingness of patient for the second correction.

CONCLUSION: Shotfile software for the patients myopia with presbyopia is safe and stable in the long-term clinical treatment, and the patient satisfaction is higher, but the near visual ability of some patients may be weakened with the prolongation of time, preoperative communication with patients should be fully.