PURPOSE To explore the impact of different surgical sequences on the visual and refractive outcomes of bilateral small incision lenticule extraction (SMILE) surgery using propensity score matching (PSM) analysis. METHODS Participants who underwent uneventful SMILE between March 2018 and September 2019 were retrospectively analyzed and were divided into two groups: Sequence A (laser scanning [LS] of the right eye, manual separation lenticule [MSL] of the right eye, and LS and MSL of the left eye) and Sequence B (LS of the right eye, LS of the left eye, MSL of the left eye, and MSL of the right eye). PSM was conducted to minimize the effect of confounding factors on postoperative visual outcomes at days 1 and 7 and months 1, 3, and 6. Safety, efficacy, predictability, and stability were compared between groups. RESULTS Overall, 1,854 eyes of 927 participants were included (Sequence A, n = 280; Sequence B, n = 647). After PSM, there were no significant differences in baseline characteristics, and 534 eyes (267 patients) in the Sequence A group were matched (1:1) to the Sequence B group. The postoperative corrected distance visual acuity significantly differed between groups at 3 months (adjusted P = .007). The uncorrected distance visual acuity significantly differed between groups at all follow-up visits (adjusted P < .01). The safety index (1.341 ± 0.265 and 1.413 ± 0.294) and efficacy index (1.173 ± 0.191 and 1.251 ± 0.269) were different in the Sequence A and Sequence B groups, respectively, at 3 months (adjusted P < .01). No difference in visual outcomes was found between right and left eyes. CONCLUSIONS Patients who had bilateral lenticule creation followed by bilateral lenticule separation had better postoperative visual outcomes than those who underwent complete SMILE surgery in each eye separately. Regardless of the surgical sequence chosen for the SMILE procedure, there was no impact on outcomes between the right and left eyes. Adjusting the sequence of the surgical procedure may be a way to improve the visual results. [J Refract Surg. 2021;37(11):726-733.].

中文翻译：

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双侧微透镜创建，然后是双侧微透镜分离，可改善 SMILE 后的视觉效果。

目的 使用倾向评分匹配 (PSM) 分析探讨不同手术顺序对双侧小切口微透镜提取 (SMILE) 手术的视觉和屈光结果的影响。方法 回顾性分析 2018 年 3 月至 2019 年 9 月期间接受 SMILE 的参与者，并分为两组：序列 A（右眼激光扫描 [LS]、右眼手动分离透镜 [MSL]、LS 和 MSL左眼）和序列 B（右眼 LS，左眼 LS，左眼 MSL，右眼 MSL）。进行 PSM 以尽量减少混杂因素对术后第 1 天和第 7 天以及第 1、3 和 6 个月的视力结果的影响。比较组间的安全性、有效性、可预测性和稳定性。结果 总体而言，1，包括 927 名参与者的 854 只眼睛（序列 A，n = 280；序列 B，n = 647）。PSM后基线特征无显着差异，序列A组534眼（267例）与序列B组匹配（1:1）。术后矫正远视力在 3 个月时在各组之间存在显着差异（调整后的 P = .007）。在所有随访中，未矫正远距离视力在各组之间存在显着差异（调整后的 P < .01）。序列A和序列B组在3个月时的安全性指数（1.341±0.265和1.413±0.294）和疗效指数（1.173±0.191和1.251±0.269）分别不同（调整后的P < .01）。在右眼和左眼之间没有发现视觉结果的差异。结论双侧微透镜创建后双侧微透镜分离的患者术后视力结果优于单眼分别接受完整 SMILE 手术的患者。无论为 SMILE 手术选择的手术顺序如何，对左右眼之间的结果都没有影响。调整手术顺序可能是改善视觉效果的一种方式。[J 屈光手术。2021;37(11):726-733.]。[J 屈光手术。2021;37(11):726-733.]。[J 屈光手术。2021;37(11):726-733.]。