目的：研究不同角膜屈光手术治疗近视及散光患者术后视觉质量、干眼和生物力学稳定性。

方法：回顾性分析2015-07/2016-07在本院眼科接受治疗的近视和散光患者986例，根据研究对象所选择的手术方式不同，将986例研究对象分为SMILE组、FS-LASIK组、SBK组和LASIK组，通过对比各组患者术后25、90d的屈光度、裸眼视力(uncorrected visual acuity， UCVA)、最佳矫正视力(best corrected visual acuity， BCVA)和高阶影像差各项指标来判定术后视觉质量； 通过对比四组患者术后泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)和角膜荧光素染色(FS)评分数值来判定患者术后干眼情况； 通过对比四组患者术后的高信号强度角膜滞后量(corneal hysteresis，CH)和角膜阻力因子(corneal resistance factor，CRF)，以判定患者术后生物力学稳定性。

结果：FS-LASIK组、SBK组、LASIK组患者手术前后其屈光度、UCVA、BCVA和高阶像差对比差异均无统计学意义(P>0.05)； SMILE组患者手术前后屈光度、UCVA、BCVA对比差异均无统计学意义(P>0.05)，高阶像差对比差异有统计学意义(P<0.05)。四组患者术后BUT时间、FS数值明显下降，与术前对比差异均有统计学意义(P<0.05)，LASIK组患者术后SⅠt数值明显降低，与术前对比差异有统计学意义(P<0.05)。四组患者术后CH和CRF值均降低，与术前对比差异均有统计学意义(P<0.05)。

结论：SMILE、FS-LASIK、SBK及LASIK对治疗近视及散光有同样的安全性、有效性和稳定性。

METHODS: A total of 986 patients with myopia and astigmatism were selected as the research object in our hospital from July 2015 to July 2016, according to the operation mode of the selection of the research object, the 986 patients were randomly divided into small incision lenticule extraction(SMILE)group, femtosecond laser in situ keratomileusis(FS-LASIK)group, sub-bowman-keratomileusis(SBK)group and laser-assisted in situ keratomileusis(LASIK)group. The postoperative visual quality was determined by comparing the diopter, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA)and high-order image difference of 25d, 90d. The postoperative dry eye condition was determined by comparing the postoperative tear secretion test(Schirmer Ⅰ test), tear film rupture time(BUT)and fluorescence staining(FS). The biomechanical stability of the patients was determined by comparing the corneal hysteresis(CH)and corneal resistance factor(CRF)values of the four groups.

RESULTS: The diopter, UCVA, BCVA and high-order aberration comparison of FS-LASIK group, SBK group and LASIK group between before and after surgery, showed no significant difference(P>0.05); on diopter, BCVA, UCVA, there was no significant difference between before and after surgery in SMILE group(P>0.05), but statistical significance difference on high order aberration(P<0.05). The BUT and FS value of the four groups decreased obviously after operation, and the difference was statistically significant(P<0.05). In LASIK group SIt after operation significantly decreased, with statistically significant compared with that before operation(P<0.05). After operation, CH and CRF of the four groups decreased with significant differences(P<0.05).

CONCLUSION: SMILE, FS-LASIK, SBK and LASIK are equally safe, effective and stable in the treatment of myopia and astigmatism.