目的：观察暗瞳直径与光学区直径关系对飞秒激光小切口角膜基质透镜取出术(SMILE)术后短期主客观视觉质量的影响。

方法：本研究采用前瞻性队列研究，纳入2021年9月至2023年6月行SMILE手术的患者98例196眼，依据暗瞳直径与手术光学区直径比值分为：A组比值>1(70眼)、B组比值≤1(126眼)。观察并且记录患者术前及术后裸眼视力(UCVA)、等效球镜(SE)、瞳孔中心直径4、6、8 mm角膜高阶像差、客观散射指数(OSI)、术前术后主观视觉质量问卷(QoV)调查，分析不同组别患者术前与术后不同时间点屈光情况、主客观视觉质量指标差异，同时分析两组组间术后不同时间点主客观视觉质量变化量(术后-术前)差异。

结果：术后3 mo两组患者视力及屈光情况均无差异。A组和B组术后1 mo以角膜为中心8 mm角膜总高阶像差变化量有差异(P<0.05)，术后3 mo以角膜为中心8 mm角膜总高阶像差及角膜球差变化量有差异(均P<0.05)。术后3 mo A组发生率最高的前四大症状为眩光、星芒、视觉朦胧、光晕，B组发生率最高的前四大症状为视觉朦胧、光晕、星芒、眩光。两组患者术后3 mo眩光、视力波动严重程度评分与术前比较有差异(均P<0.05)，但术后3 mo光晕、星芒、视觉朦胧、视力模糊、重影、聚焦困难严重程度评分与术前比较均无明显差异(均P>0.05)。

结论：暗瞳直径大于光学区直径时，SMILE术后可能增加术后角膜像差，体现为术后以角膜为中心的8 mm范围角膜高阶像差变化量增大，术后眩光发生率增大，眩光、视力波动症状严重程度术后增高，但症状较轻，在安全范围。

METHODS:In this prospective cohort study, 98 patients(196 eyes)who underwent SMILE from September 2021 to June 2023 were included. Participants were divided into two groups based on the ratio of scotopic pupil diameter to optical zone diameter: group A(ratio >1, 70 eyes)and group B(ratio ≤1, 126 eyes). The preoperative and postoperative uncorrected visual acuity(UCVA), spherical equivalent(SE), total corneal high-order aberrations at 4, 6, and 8 mm of pupil diameters, objective scatter index(OSI), pre- and post-operative QoV subjective visual quality questionnaire were observed and recorded. The refractive status of different groups of patients at different time points before and after surgery, and differences in subjective and objective visual quality indices were analyzed. Furthermore, the changes in subjective and objective visual quality(postoperative-preoperative)at different postoperative time points were analyzed between the two groups.

RESULTS:No significant differences in visual acuity or refractive state were observed between the two groups at 3 mo postoperatively. In both the group A and the group B, there was a difference in the changes of corneal total higher-order aberration centered on 8 mm cornea at 1 mo postoperatively(P<0.05), and there was a difference in the changes of total higher-order aberration and corneal spherical aberration centered on 8 mm cornea at 3 mo postoperatively(all P<0.05). At 3 mo after surgery, the most commonly reported symptoms in the group A were glare, starburst, hazy vision, and halo. In the group B, the most common symptoms were hazy vision, halo, starburst, and glare. Statistically significant differences were observed in the severity of glare and visual fluctuation between groups before surgery and at 3 mo postoperatively(all P<0.05). However, no significant differences were found in the severity of halo, starburst, blurred vision, double vision, or focusing difficulty at 3 mo postoperatively(all P>0.05).

CONCLUSION:When the scotopic pupil diameter exceeds the optical zone, SMILE may increase postoperative corneal aberrations, as evidenced by an increase in high-order corneal aberrations within an 8-mm central corneal range, a higher incidence of postoperative glare, and more severe glare and visual fluctuation symptoms. Nevertheless, these symptoms are mild and remain within a safe range.