目的：比较0.05 D间隔球镜片与常规0.25 D间隔球镜片验光引导下飞秒激光小切口角膜基质透镜取出术(SMILE)矫正中低度近视患者术后视觉质量的差异。

方法：回顾性对照研究。选取2021年8月至2023年8月于联勤保障部队第九八九医院眼科接受SMILE手术矫正低中度近视患者共400例400眼。所有患者均收集右眼数据纳入统计分析。按照术前插片验光以及红绿平衡试验采用间隔球镜片的不同，分为两组：0.05 D组200眼采用0.05 D间隔球镜片验光和0.25 D组200眼采用常规0.25 D间隔球镜片验光。比较两组患者术中的角膜切削厚度，术前与术后1、3、6 mo 裸眼远视力(UDVA)以及角膜总高阶像差(HOA)、球差、垂直彗差、水平彗差及三叶草像差，术后6 mo时残余等效球镜度数(SE)≤±0.25 D眼数百分比，术后6 mo时不良视觉症状以及视觉质量(Qov)调查问卷评分。

结果： 术中角膜切削厚度0.05 D组为92.78±16.56 μm，略高于0.25 D组(83.24±17.33 μm)(P<0.001)。0.05 D组术后各时间点的UDVA优于0.25 D组(均P<0.001)。两组术后1、3、6 mo HOA、球差、水平彗差、垂直彗差均较术前增大(均P<0.05)； 0.05 D组术后各时间点的球差高于0.25 D组，而垂直彗差低于0.25 D组(均P<0.05)。术后6 mo，0.05 D组残余SE≤±0.25 D为195眼(97.5%)高于0.25 D组175眼(87.5%)(P<0.05)。两组最常见的不良视觉症状为视觉朦胧和眩光，Qov总评分0.05 D组为0.35(0.24，0.55)分，小于0.25 D组\〖0.62(0.32，0.89)分\〗(P<0.05)。

结论：与常规0.25 D间隔球镜片验光相比，0.05 D间隔球镜片验光引导下SMILE具有更好的可预测性，能够获得更好的视力和视觉质量。

METHODS: Retrospective study. A total of 400 cases(400 eyes)with low-to-moderate myopia that underwent SMILE in the ophthalmology department of 989th Hospital of Joint Logistic Support Force from August 2021 to August 2023 were enrolled and the data from the right eyes were collected for analysis. According to the method of optometry test modality, they were divided into 0.05 D group and 0.25 D group, with 200 eyes in each group. The differences were compared between the two groups of patients in intraoperative corneal ablation thickness, uncorrected distance visual acuity(UDVA), high-order corneal aberrations(HOA), spherical aberrations, vertical coma, horizontal coma and trefoil aberrations before and at 1, 3 and 6 mo after surgery. Additionally, the percentage of eyes with residual spherical equivalent(SE)≤±0.25 D, postoperative visual symptoms and scores on the quality of visual(Qov)were compared between the two groups at 6 mo after surgery.

RESULTS: The corneal ablation thickness in the 0.05 D group was 92.78±16.56 μm, which was slightly higher than that in the 0.25 D group(83.24±17.33 μm; P<0.001). The UDVA at each postoperative time point in the 0.05 D group was superior to that in the 0.25 D group(all P<0.001). The HOA, spherical aberration, horizontal coma and vertical coma in the two groups at 1, 3 and 6 mo after operation were higher than those before operation(all P<0.05). The spherical aberration in the 0.05 D group at each time point after surgery were higher than those in the 0.25 D group, and vertical coma were lower than those in the 0.25 D group(all P<0.05). At 6 mo postoperatively, the percentage of eyes with residual SE ≤±0.25 D in the 0.05 D group was 97.5%(195 eyes), which was higher than 87.5%(175 eyes)in the 0.25 D group(P<0.05). The most common adverse visual symptoms after SMILE in both groups were hazy vision and glare. The total Qov score in the 0.05 D group was 0.35(0.24, 0.55), which was lower than \〖0.62(0.32, 0.89)\〗 in the 0.25 D group(P<0.05).

CONCLUSION: Compared with conventional 0.25 D interval spherical lens optometry-guided SMILE, the 0.05 D interval spherical lens optometry-guided SMILE for the correction of low-to-moderate myopia has better predictability and can achieve better vision and visual quality.