摘要目的:探讨角膜Q值调整的改良单眼视飞秒激光制瓣准分子激光原位角膜磨镶术（Custom-Q FS-LASIK）矫正中、低度近视眼合并老视的疗效。方法:前瞻性研究。收集2022年10月至2023年10月在北京大学第三医院眼科屈光中心行Custom-Q FS-LASIK的中、低度近视眼合并老视患者。术后随访时间为3个月，观察主视眼和非主视眼单眼和双眼的远、中、近视力及模拟全程视力（双眼离焦曲线）、屈光状态、角膜前表面Q值、高阶像差等，并进行近视力主观评价及视觉质量问卷调查。以最小分辨角的对数记录视力，采用 t检验和Wilcoxon检验进行统计学分析。 结果:纳入符合标准且完成随访患者45例（90只眼），男性21例（42只眼），女性24例（48只眼）；年龄为（42.82±2.72）岁。术后3个月，所有患者的双眼裸眼远视力达到及好于0.00，双眼裸眼近视力达到及好于0.20。离焦曲线显示在离焦度数-1.50~-1.00 D范围，术后3个月双眼视力［0.00（-0.08，0.00），-0.08（-0.08，0.00）］优于术前［0.00（-0.08，0.05），-0.08（-0.08，0.00）］，差异有统计学意义（ P<0.05）；在离焦度数-2.50~0.00 D范围，45例患者双眼视力均保持好于0.10。术后3个月主视眼角膜前表面Q值（0.01±0.26）较术前正向增加（-0.15±0.14），差异有统计学意义（ P<0.05）；非主视眼角膜前表面Q值和球差（-0.27±0.32和0.08±0.05）较术前（-0.14±0.11和0.12±0.03）负向增加，差异均有统计学意义（均 P<0.05）。42例患者（93.3%）对近视力满意，出现频率较高的3种主观视觉干扰症状为视物模糊、眩光、光晕，程度均为轻、中度，对日常生活无干扰。 结论:Custom-Q FS-LASIK矫正中、低度近视眼合并老视安全、有效，能同时获得良好的双眼远、近视力及视觉质量。

abstractsObjective:To evaluate clinical outcomes and visual quality after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) performed with the Q-value-guided optimized monocular vision protocol (Custom-Q) for correction of low-to-moderate myopia and compensation for age-related accommodation deficiency.Methods:A prospective study was performed based on patients with myopia and age-related accommodation deficiency, who underwent Custom-Q FS-LASIK in the Peking University Third Hospital from October 2022 to October 2023. Monocular and binocular distance, intermediate, and near visual acuities, simulated whole-course visual acuity (binocular defocus curve), objective and subjective refractions, anterior corneal Q factor, anterior corneal higher-order aberrations and a subjective questionnaire assessing near visual acuity and visual quality were evaluated at 3 months postoperatively. Visual acuity was recorded using the logarithm of the minimum angle of resolution. The data were analyzed using the t-test and the Wilcoxon rank-sum test. Results:A total of 45 patients (90 eyes) who met the inclusion criteria and completed the 3-month follow-up were included in the study. The mean age of the 21 men (42 eyes) and 24 women (48 eyes) was (42.82±2.72) years. During the 3-month follow-up, all the patients achieved binocular uncorrected distance visual acuity not less than 0.00 and uncorrected near visual acuity not less than 0.20. Defocus curves revealed better results at 3 months postoperatively [0.00 (-0.08, 0.00), -0.08 (-0.08, 0.00)] at intermediate and near vergence (-1.50 to -1.00 D) compared to the preoperative values [0.00 (-0.08, 0.05), -0.08 (-0.08, 0.00)] ( P<0.05). All the 45 patients maintained 0.10 or better vision at the defocus range from -2.50 to 0.00 D. The Q value in the dominant eyes was more positive postoperatively (0.01±0.26 vs.-0.15±0.14, P<0.05), while in the nondominant eyes, the Q value and corneal spherical aberration coefficient became more negative than those before surgery (-0.27±0.32 vs.-0.14±0.11, P<0.05; 0.08±0.05 vs. 0.12±0.03, P<0.05). The questionnaire demonstrated 42 (93.3%) patients were satisfied with near vision. The three most commonly reported visual discomforts after surgery were blurred vision, glare and halos. These symptoms were all mild to moderate in severity and did not interfere with daily life. Conclusion:For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be a safe and effective way to achieve acceptable near vision and visual quality without compromising distance vision.