目的：比较全飞秒激光小切口角膜基质内透镜取出术(SMILE)与飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)治疗中度近视的疗效。方法：回顾性研究。选择2022年8月至2024年10月本院收治的中度近视患者100例100眼(均取右眼数据进行研究)。根据选择的手术方式不同分为FS-LASIK组52例给予FS-LASIK治疗，SMILE组48例给予SMILE治疗。术后随访6 mo，比较两组患者视力恢复情况、手术前后等效球镜度、角膜曲率、角膜Q值、中央角膜厚度、角膜体积、高阶像差、角膜生物力学参数以及并发症发生情况。结果：术后3、6 mo，两组患者裸眼视力(UCVA)和等效球镜度数较术前均改善(均P<0.05)。术后6 mo，两组患者角膜曲率、中央角膜厚度、角膜体积均降低，且FS-LASIK组角膜体积更低； 两组Q值均较术前升高，且FS-LASIK组更高(均P<0.001)； 两组患者术后总高阶像差、球差、三叶草相差均升高，且FS-LASIK组更高(均P<0.001)； 两组患者综合半径(IR)、反向凹面半径(ICR)、形变幅度比值(DAR2)均升高，硬度参数(SP-A1)、最大压陷曲率半径(HC-Radius)、相关厚度-水平方向(ARTh)均降低(均P<0.001)。两组患者并发症发生率比较无差异(P>0.05)。结论：FS-LASIK与SMILE均有助于改善中度近视患者的视力，术后早期角膜形态变化各具特点，术后接受FS-LASIK的患者角膜Q值、高阶像差较大。

AIM: To compare and analyze the efficacy of femtosecond laser-assisted in situ keratomileusis(FS-LASIK)with small incision lenticule extraction(SMILE)in the treatment of moderate myopia.METHODS:Retrospective study. A total of 100 patients(100 eyes)with moderate myopia admitted to our hospital from August 2022 to October 2024 were selected(all the data of the right eye were taken for study). The 52 cases in FS-LASIK group received FS-LASIK, while the 48 cases in SMILE group received SMILE. The patients were followed up for 6 mo, the visual recovery, spherical equivalent, corneal curvature, corneal Q value, central corneal thickness, corneal volume, high-order aberrations, corneal biomechanical parameters and incidence of complications were compared between the two groups.RESULTS: At 3 and 6 mo after surgery, the uncorrected visual acuity(UCVA)and spherical equivalent of both groups increased compared to before surgery(all P<0.05). At 6 mo after surgery, both groups showed a decrease in corneal curvature, central corneal thickness, and corneal volume, with the FS-LASIK group having a lower corneal volume; both groups showed a great increase in Q values, with the FS-LASIK group having a higher Q value(all P<0.001); the total high-order aberration, spherical aberration, and trefoil aberration all increased in both groups, with higher values observed in the FS-LASIK group(all P<0.001); the integrated radius(IR), inverse concave radius(ICR)and deformation amplitude ratio 2(DAR2)were all increased, while the stiffness parameter at first applanation(SP-A1), the highest concavity radius(HC-Radius)and the ambrosio's relational thickness to the horizontal profile(ARTh)were all decreased in both groups(all P<0.001). There was no statistical difference in the incidence of complications between two groups(P>0.05).CONCLUSION: Both FS-LASIK and SMILE can help improve the visual quality of patients with moderate myopia, and their early postoperative corneal morphological changes have their own characteristics. In addition, patients who receive FS-LASIK have larger corneal Q value and high-order aberrations after surgery.

上海市眼病防治中心“沪眼星光”儿童青少年近视防控人员培养计划(No.HYXG-YY05); 浦东新区卫生健康委员会领先人才培养项目(No.PWR12020-01)