目的：观察小切口基质内透镜取出术(small incision lenticule extraction，SMILE)治疗大散光患者的2a临床疗效。

方法：回顾性分析在我院手术的大散光患者17例33眼，年龄18～36岁，其中散光-3.50～-4.00D者12例24眼，散光-4.25～-5.00D 5例9眼； 合并球镜+1.00～0D者4例7眼，合并-1.00～0D者13例26眼。采用小切口基质内透镜取出术，手术切口长度为2mm，位于120°，角膜帽的厚度均为120μm，透镜直径6.6～6.8mm，帽直径为7.3～7.5mm。观察时间点为术后1d，1wk，1、3、6mo，1、2a。分别观察术后裸眼视力、术后等效球镜、残余残光度数、角膜地形图SimK平均值及SimK值的差值。

结果：与术前裸眼视力相比，术后1d裸眼视力差异有统计学意义(P<0.05)，与术后1wk裸眼视力相比，术后1、3、6mo，1、2a差异均无统计学意义(P>0.05)。裸眼视力均无增加或减少两行及以上，目标屈光度为+0.25D。与术后1d相比，术后各时间点等效球镜及残余散光差异均无统计学意义(P>0.05)。术后各时间点SimK等效值、SimK差值差异无统计学意义(P>0.05)。

结论：远期观察SMILE治疗大散光均安全有效，稳定性及可预期高，术后2a角膜形态良好，值得临床应用。

METHODS: Totally 33 eyes of 17 consecutive patients were enrolled in this retrospective study, aged from 18 to 36 years old, which included 24 eyes of 12 patients with astigmatism within -3.50D to -4.00D and 9 eyes of 5 patients within -4.25D to -5.00D, 7 eyes of 4 patients with sphere within 0 to +1.00D and 26 eyes of 13 patients within -1.00D to 0. Intended cap diameters was 7.3-7.5mm, lenticule diameter was 6.6-6.8mm, the thickness of cap was 120μm, the surgical incision was 2mm. We observed the results after 1d, 1wk, 1, 3, 6mo, 1 and 2a. Preoperative best corrected visual acuity, spherical equivalent refraction, postoperative uncorrected visual acuity, SimK equivalent value and SimK value was observed.

RESULTS: Compared with preoperation, uncorrected visual acuity showed significant difference statistically at 1d postoperatively(P<0.05). Compared with 1wk postoperatively, uncorrected visual acuity showed no significant difference statistically at postoperative 1, 3, 6mo, 1 and 2a(P>0.05). Uncorrected visual acuity did not increase or decrease more than two lines. The target diopter was +0.25D. Compared with 1d postoperatively, the spherical equivalent refraction and residual astigmatism showed no significant difference statistically at each postoperative period(P>0.05). postoperative SimK equivalent value and SimK value difference showed no significant difference statistically compared with each postoperative period(P>0.05).

CONCLUSION: It is both safe, effective, predictable and stable to correct large astigmatism with SMILE by long-term observation, postoperative 2a. The corneal morphology is good and worthy of clinical application.