目的：分析SMILE术后主导眼的转变情况及对视觉质量的影响。

方法：前瞻性临床研究。选取2022-06/12在新疆医科大学第一附属医院行SMILE术矫正近视的患者140例280眼，根据术后3 mo内随访时卡洞法检查主导眼别转变情况分为转变组(46例92眼)和非转变组(94例188眼)。术前、术后1、3 mo，评估两组患者的裸眼视力(UCVA)，采用屈光矫正者生活质量(QIRC)量表评估主观视觉质量，并检测全眼高阶像差评价客观视觉质量。

结果：纳入患者SMILE术前主导眼为右眼105例，左眼35例，术后1 mo 46例患者主导眼发生转变，术后3 mo较术后1 mo无新发主导眼转变。术前、术后1、3 mo，转变组和非转变组患者UCVA、QIRC量表评分均无差异(P>0.05)。两组患者主导眼比较，术后3 mo转变组患者总高阶像差、球差显著高于非转变组(P=0.030、0.046)； 两组患者非主导眼比较，术后1 mo转变组患者三叶草像差显著高于非转变组(P=0.008)。术后1 mo，转变组患者双眼三叶草像差差值明显高于非转变组(P=0.022)，余均无差异。

结论：SMILE术后部分患者会发生主导眼的转变，但对主观视觉质量无显著影响，术后早期客观视觉质量下降可能是主导眼转变的相关因素。

METHODS: Prospective clinical study. A total of 140 patients(280 eyes)who underwent SMILE operation to correct myopia in the First Affiliated Hospital of Xinjiang Medical University from June to December 2022 were selected. They were divided into dominant eye transformation group(46 cases, 92 eyes)and non-transformation group(94 cases, 188 eyes)according to whether the dominant eye transformation occurred during the follow-up in postoperative 3 mo. The uncorrected visual acuity(UCVA)of the two groups was evaluated, the subjective visual quality was evaluated by the quality of life impact of refractive correction(QIRC)scale, and the objective visual quality was evaluated by measuring the high-order aberrations of the whole eye before and at 1 and 3 mo after surgery.

RESULTS: Before SMILE, the right type of dominant eye was 105 cases, left-type was 35 cases. There were 46 cases had change at 1 mo postoperatively, and there was no new change at 3 mo after operation than 1 mo after operation. There was no significant difference in UCVA and QIRC scale score between the two groups preoperatively and at 1 and 3 mo postoperatively(P>0.05). Comparison of the dominant eye between the two groups: the total higher-order aberrations and spherical aberrations at 3 mo postoperatively were significantly higher than those in the non-transformed group(P=0.030, 0.046); Comparison of the non-dominant eye between the two groups: trefoil in the transformed group at 1 mo postoperatively was significantly higher than that in the non-transformed group(P=0.008). The binocular difference of trefoil in the transition group was significantly higher than that in the non-transition group at 1 mo after surgery(P=0.022), with no differences in the rest parameters.

CONCLUSION: Some patients may experience a change in the dominant eye after SMILE surgery, with no significant impact on subjective visual quality. The decrease of objective visual quality in the early postoperative period may be an associated factor in the dominant eye transformation.