目的：比较全飞秒小切口角膜基质透镜取出术(SMILE)与Q值引导的飞秒激光制瓣准分子激光原位角膜磨镶术(Q值-FS-LASIK)术后角膜波前像差的变化特征，探讨两种术式对视觉质量的影响。

方法：纳入2024年1月至2024年6月行屈光手术的近视患者60例120眼，分为SMILE组(60眼)和Q值-FS-LASIK组(60眼)。术前，术后1、3、6 mo采用Pentacam HR、iTrace测量角膜前表面6 mm区域的总高阶像差(RMS HOA)、球差(Z40)、垂直彗差(C8)、水平彗差(C9)及三叶草(C11)、斯特列尔比(SR)及调制传递函数(MTF)。结合患者报告结局(PROs)评估主观视觉质量，并比较组间差异。

结果：两组患者一般资料具有可比性。术后6 mo，两组裸眼视力(UCVA)均≥1.0，等效球镜(SE)稳定在±0.50 D以内。术后6 mo，SMILE组总RMS HOA(0.38±0.12 μm)显著低于Q值-FS-LASIK组(0.45±0.15 μm)(P=0.012)； Q值-FS-LASIK组球差(0.52±0.18 μm)较SMILE组(0.35±0.14 μm)更高(P<0.001)，而SMILE组垂直彗差(0.21±0.09 μm)显著高于Q值-FS-LASIK组(0.12±0.07 μm)(P=0.003)； 两组不同时间水平彗差及三叶草无差异(均P>0.05)。术后6 mo，SMILE组SR(0.26±0.05)优于Q值-FS-LASIK组(0.22±0.04)(P=0.008)。SMILE组夜间驾驶困难发生率(12%)低于Q值-FS-LASIK组(21%)(P=0.023)。

结论：Q值-FS-LASIK通过优化角膜非球面性有效控制球差，但总高阶像差较高； SMILE因无需制瓣减少了总像差，但垂直彗差增加更显著。临床需根据患者屈光状态及视觉需求个性化选择术式。

METHODS:A total of 60 myopic patients(120 eyes)who underwent refractive surgery between January 2024 and June 2024 were enrolled and divided into two groups: the SMILE group(60 eyes)and the Q-value-FS-LASIK group(60 eyes). Preoperatively and at 1, 3, and 6 mo postoperatively, the following parameters were measured using the Pentacam HR and iTrace systems within a 6 mm corneal zone: root mean square of higher-order aberrations(RMS HOA), spherical aberration, vertical coma, horizontal coma, trefoil, Strehl ratio(SR), and modulation transfer function(MTF). Patient-reported outcomes(PROs)were used to assess subjective visual quality, and group differences were compared.

RESULTS:The general data of the two groups were comparable. At 6 mo postoperatively, uncorrected visual acuity(UCVA)was ≥1.0 in both groups, and the spherical equivalent(SE)remained within ±0.50 D. The total RMS HOA was significantly lower in the SMILE group(0.38±0.12 μm)than in the Q-value-FS-LASIK group(0.45±0.15 μm; P=0.012). Spherical aberration was higher in the Q-value-FS-LASIK group(0.52±0.18 μm)compared to the SMILE group(0.35±0.14 μm; P<0.001), while vertical coma was significantly greater in the SMILE group(0.21±0.09 vs 0.12±0.07 μm; P=0.003). No significant intergroup differences were observed in horizontal coma or trefoil(all P>0.05). The SR was superior in the SMILE group(0.26±0.05)compared to the Q-value-FS-LASIK group(0.22±0.04; P=0.008). PROs indicated a lower incidence of nighttime driving difficulties in the SMILE group(12% vs 21%; P=0.023).

CONCLUSION:Q-value-FS-LASIK effectively controls spherical aberration by optimizing corneal asphericity but results in higher total higher-order aberrations. SMILE reduces total aberrations due to its flap-free design but induces greater vertical coma. The choice of procedure should be tailored to the patient's refractive status and visual demands.