目的：探讨不同屈光状态下SMILE手术前后患者的调节灵敏度情况及变化规律。

方法：前瞻性临床队列研究。随机选取2023-06/12就诊于我院行SMILE手术且建立视功能档案的患者59例118眼，其中男37例，女22例，年龄18-35(平均25.19±5.65)岁。按照术前等效球镜(SE)分为两组：中低度近视组(SE≥-6.00 DS)40例80眼，高度近视组(SE<-6.00 DS)19例38眼。比较术前，术后1 wk，1 mo单眼(右眼、左眼)和双眼调节灵敏度，分析两组患者SMILE手术前后的调节灵敏度变化情况。

结果： 所有患者手术均顺利完成，中低度近视组33例66眼完成术后1 mo随访，失访率为17.5%(7/40)； 高度近视组15例30眼完成术后1 mo随访，失访率为21.1%(4/19)。两组患者SMILE术后裸眼视力和等效球镜均较术前明显改善(均P<0.05)。所有患者右眼调节灵敏度术后1 mo较术前和术后1 wk均提高(P=0.002、0.006)。左眼调节灵敏度术后1 mo较术后1 wk显著提高(P=0.005)。双眼调节灵敏度术后1 mo较术前显著提高(P<0.017)。中低度近视组患者术后 1 mo右眼调节灵敏度较术前和术后1 wk比较均有差异(P=0.011、0.004)，左眼术后 1 mo较术后1 wk显著提高(P=0.001)，双眼术后 1 mo较术前显著提高(P<0.001)。高度近视组患者手术前后右眼、左眼和双眼调节灵敏度均无差异(均P>0.017)。

结论：SMILE术后单眼调节灵敏度出现一过性下降后在术后1 mo提升至超过术前，双眼调节灵敏度在术后逐渐提高。SMILE手术对中低度近视的单眼和双眼调节灵敏度均产生积极影响，对高度近视的调节灵敏度无明显影响。加强SMILE术前和术后单眼及双眼的调节灵敏度检测具有临床意义。

METHODS:A prospective clinical cohort study was conducted. A total of 59 patients(118 eyes)who underwent SMILE surgery and had visual function files established in our hospital from June to December 2023 were randomly selected, including 37 males and 22 females, aged 18-35 years(with an average age of 25.19±5.65 years). According to the preoperative spherical equivalent(SE), they were divided into two groups: the low-to-moderate myopia group(SE≥-6.00 DS)with 40 patients(80 eyes), and the high myopia group(SE<-6.00 DS)with 19 patients(38 eyes). The monocular and binocular accommodative facility before surgery and at 1 wk and 1 mo after surgery were compared, and the changes in accommodative facility before and after SMILE surgery in the two groups of patients were analyzed.

RESULTS:All surgeries were completed successfully. In the low-to-moderate myopia group, 33 cases(66 eyes)completed the 1-month follow-up after surgery, with a loss to follow-up rate of 17.5%(7/40). In the high myopia group, 15 patients(30 eyes)completed the 1-month follow-up after surgery, with a loss to follow-up rate of 21.1%(4/19). After SMILE surgery, the uncorrected visual acuity and SE of both low-to-moderate myopia and high myopia were significantly improved(all P<0.05). The accommodative facility of the right eyes in all the patients at 1 mo after surgery was better than that before surgery and at 1 wk after surgery(P=0.002, 0.006), the accommodative facility of the left eyes was significantly increased at 1 mo after surgery than that at 1 wk after surgery(P=0.005), and the binocular accommodative facility at 1 mo after surgery was significantly increased compared with that before surgery(P<0.017). Furthermore, there were statistical significance in accommodative facility of the right eyes in the low-to-moderate group at 1 mo compared with that before surgery and at 1 wk after surgery(P=0.011, 0.004); it was significantly increased in the left eyes at 1 mo after surgery compared with that at 1 wk after surgery(P=0.001), and binocular accommodative facility at 1 mo after surgery was significantly better than that before surgery(P<0.001). Furthermore, there was no statistical significance in the right, left and binocular accommodative facility of patients in the high myopia group(all P>0.017).

CONCLUSION: After SMILE surgery, the monocular accommodative facility shows a transient decrease and then exceeds the preoperative level at 1 mo after surgery, and the binocular accommodative facility gradually improves after surgery. SMILE surgery has a positive impact on the monocular and binocular accommodative facility in patients with low-to-moderate myopia, but has no significant impact on the accommodative facility in patients with high myopia. It is of clinical significance to strengthen the detection of monocular and binocular accommodative facility before and after SMILE surgery.