目的：分析飞秒激光小切口角膜基质透镜取出术(SMILE)治疗不同曲率近视患者的疗效及其影响因素。

方法：前瞻性纳入行SMILE的近视患者72例144眼，按照术前角膜曲率分为低曲率组(<41D，21例42眼)、中曲率组(41～46D，26例52眼)、高曲率组(>46D，25例50眼)。比较各组术前和术后1wk，3mo屈光状态、裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜光学质量的改变情况，筛选近视眼患者SMILE视力恢复的影响因素。

结果：三组患者组内手术前后不同时间UCVA、BCVA比较有差异(P<0.05)，组间不同时间比较无差异(P>0.05)。三组术后不同时间球镜度数、柱镜度数、等效球镜度数比较无差异(P>0.05)。三组主观验光屈光力矢量变化值比较有差异(P<0.05)，低曲率组主观验光屈光力矢量变化值低于中曲率组、高曲率组(P<0.05)。多元Logistic回归分析显示：年龄、眼轴长度、术前等效球镜度均为影响SMILE手术疗效的相关因素(P<0.05)。

结论：SMILE对不同曲率近视患者视力均有较好的改善作用，安全有效。年龄、眼轴长度、术前等效球镜度均为影响SMILE术后视力的相关因素。

METHODS: Totally 72 patients(144 eyes)with myopia who underwent SMILE were prospectively included. According to the preoperative corneal curvature, they were divided into low curvature group(<41D, n=21 cases, 42 eyes), middle curvature group(41-46D, n=26 cases, 52 eyes)and high curvature group(>46D, n=25 cases, 50 eyes). The refraction state, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and corneal optical quality were compared among the groups before operation and at 1wk after operation and at 3mo after operation, and the influencing factors of SMILE visual acuity recovery in patients with myopia were screened out.

RESULTS: There were significant differences in UCVA and BCVA at different time points before and after operation within the three groups(P<0.05), and there were no significant differences at different time points among groups(P>0.05). There were no significant differences in the spherical degree, cylindrical degree and spherical equivalent degree among the three groups at different time points(P>0.05). There was a statistically significant difference in the vector change value of subjective optometry refractive power(P<0.05), and the value in low curvature group was lower than that in middle curvature group and high curvature group(P<0.05). Multivariate Logistic regression analysis showed age, ocular axial length and preoperative spherical equivalent were related factors affecting the efficacy of SMILE surgery(P<0.05).

CONCLUSION: SMILE can better improve the visual acuity of patients with different curvature myopia, and it is safe and effective, but age, ocular axial length and preoperative spherical equivalent are related factors affecting the visual acuity after SMILE.