目的：分析不同程度近视患者飞秒激光小切口角膜基质透镜取出术(SMILE)前后双眼视功能变化情况。方法：前瞻性非随机对照研究。连续纳入2022年6月至2023年6月就诊于解放军总医院第三医学中心眼科医学部屈光门诊并自愿选择SMILE治疗近视患者94例188眼，按照近视程度分三组：低度近视组[-3.00 D<等效球镜(SE)≤-0.50 D]24例48眼、中度近视组(-6.00 D< SE≤-3.00 D)40例80眼、高度近视组(SE≤ -6.00 D)30例60眼。比较三组患者术前，术后1 wk， 1、3 mo SE和双眼视功能[远近水平隐斜、远近水平融像范围、集合近点(NPC)、正负相对调节(PRA/NRA)、调节反应(BCC)、单双眼调节灵敏度(MAF/BAF)、调节幅度(AMP)]。结果：术后1 wk，1、3 mo三组患者双眼SE均优于术前(均P<0.05)。低度近视组患者远距正融像性聚散(BO)恢复点在术后先提高后下降至趋于术前(P=0.043)。中度近视组患者远距BO破裂点术后逐渐下降(P=0.014)，术后3 mo最低(均P<0.05)； 远距BO恢复点在术后先提高后下降至趋于术前(P=0.042)。高度近视组患者术后远距水平隐斜较术前改善(P=0.01)； 远距BO破裂点在术后逐渐降低(P=0.017)，术后3 mo最低； 集合近点术后较术前先下降后上升(P=0.038)，且在术后3 mo较术后1 wk集合近点远移(P<0.008)； 术后双眼调节灵敏度较术前逐渐提高(P=0.032)。结论：SMILE手术可以有效改善患者的近视性屈光不正，且具有良好的可预测性和稳定性； 对低、中、高度近视的双眼视功能均有一定的改善作用，尤其是对于高度近视患者的调节和集合功能均有不同程度的改善。

AIM: To analyze the changes in binocular visual function before and after small incision lenticule extraction(SMILE)in patients with different degrees of myopia.METHODS:A prospective non-randomized controlled study was conducted. A total of 94 patients(188 eyes)who visited the refractive outpatient department of the ophthalmology department of the General Hospital of the PLA from June 2022 to June 2023 and voluntarily chose SMILE were consecutively included. They were grouped according to the degree of myopia, including 24 cases(48 eyes)in the low myopia group(-3.00 D<SE≤-0.50 D), 40 cases(80 eyes)in the moderate myopia group(-6.00 D<SE≤-3.00 D), and 30 cases(60 eyes)in the high myopia group(SE≤-6.00 D). The preoperative spherical equivalent(SE)and binocular visual function, including near and far horizontal phoria, near and far horizontal fusional range, near point of convergence(NPC), positive/negative relative accommodation(PRA/NRA), binocular cross-cylinder(BCC), monocular and binocular accommodative facility(M/BAF), and amplitude of accommodation(AMP), among the three groups of patients were compared.RESULTS:At 1 wk, 1 and 3 mo preoperatively, the SE of both eyes of the patients in the three groups was better than that before operation(all P<0.05). In the low myopia group, the recovery point of the positive fusional convergence at a far distance first increased after the operation and then decreased to approach the level before the operation(P=0.043). In the moderate myopia group, the break point of the positive fusional convergence at a far distance gradually decreased after the operation(P=0.014), and it was the lowest at 3 mo after the operation(all P<0.05); the recovery point first increased after the operation and then decreased to approach the level before the operation(P=0.042). In the high myopia group, the horizontal phoria at a far distance after the operation was improved compared with that before the operation(P=0.01); the break point of the positive fusional convergence at a far distance gradually decreased after the operation(P=0.017), and it was the lowest at 3 mo after the operation; the NPC first decreased and then increased after the operation compared with that before the operation(P=0.038), and the NPC shifted farther at 3 mo after the operation compared with that at 1 wk after the operation(P<0.008); the BAF after the operation gradually increased compared with that before the operation(P=0.032).CONCLUSION:SMILE can effectively improve myopic refractive errors in patients and has good predictability and stability; it has a certain improvement effect on the binocular visual function of low, moderate, and high myopia, especially for the accommodative and convergence functions of patients with high myopia to varying degrees.