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目的:探讨个性化预留轻度近视的角膜屈光手术设计方案对40岁以上屈光不正患者的矫正效果的影响。方法:回顾性病例系列研究。收集2023年1至12月于北京协和医院眼科接受角膜屈光手术且年龄>40岁的60例（120只眼）屈光不正患者资料，其中男性25例，女性35例；年龄（44.3±3.1）岁。按患者意愿分为A组（预留部分近视度数）和B组（完全矫正），每组各30例（60只眼）。术前及术后1 d、1周、1个月、3个月、6个月、12个月进行视力、主觉验光、裂隙灯、角膜地形图及眼压等检查，根据手术前后视力计算有效性指数和安全性指数，术后采用屈光不正生活质量量表评价患者的手术满意度和术后视觉症状。结果:两组患者术前裸眼视力、矫正视力、屈光度数、角膜厚度及眼压差异均无统计学意义（均 P>0.05）。末次随访时，A组裸眼远视力≥0.8、≥1.0的眼占比分别为93.3%（56/60）、60.0%（36/60），B组则分别为100%（60/60）和83.3%（50/60）；A、B组的SE分别为（-0.35±0.52）和（-0.07±0.55）D，差异有统计学意义（ P<0.05）；A组近视力优于B组（ P<0.05）；A、B组的有效性指数分别为0.96±0.23和0.99±0.12，安全性指数分别为1.02±0.11和1.02±0.07。两组患者术后总体满意度均较高，但A组较B组在近视力、阅读及看电脑屏幕的得分更高。 结论:个性化预留轻度近视的角膜屈光手术设计方案对于40岁以上屈光不正患者具有良好的矫正效果，可以提高患者对手术的满意度和生活质量。

Objective:To explore the corrective effects of a personalized corneal refractive surgery design that retains mild myopia in patients over 40 years old with refractive errors and presbyopia.Methods:A retrospective case series study was conducted, including 60 patients (120 eyes) over 40 years old who underwent corneal refractive surgery at Peking Union Medical College Hospital l from January 2023 to December 2023. The patients were divided into two groups based on their preference: Group A (retained mild myopia) and Group B (fully corrected), with 30 patients (60 eyes) in each group. Preoperative and postoperative visual acuity, subjective refraction, slit-lamp examination, corneal topography, and intraocular pressure were assessed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. The effectiveness and safety indices were calculated based on visual acuity before and after surgery. The National Eye Institute Refractive Quality of Life questionnaire was used to evaluate patient satisfaction and postoperative visual symptoms.Results:There were no significant differences in preoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal thickness, and intraocular pressure between the two groups (all P>0.05). At the final follow-up, the proportions of eyes with UDVA≥0.8 and≥1.0 were 93.3% (56/60) and 60.0% (36/60) in Group A, and 100% (60/60) and 83.3% (50/60) in Group B, respectively. The SE was significantly different between Group A [(-0.35±0.52) D] and Group B [(-0.07±0.55) D] ( P<0.05). Near visual acuity was better in Group A than in Group B ( P<0.05). The effectiveness indices were 0.96±0.23 and 0.99±0.12, and the safety indices were 1.02±0.11 and 1.02±0.07 for Groups A and B, respectively. Both groups had high overall satisfaction, but Group A had higher scores for near vision, reading, and computer screen viewing. Conclusion:The personalized corneal refractive surgery design that retains mild myopia provides good corrective effects for patients over 40 years old with refractive errors, improving patient satisfaction and quality of life.