目的：应用眼反应分析仪(ORA)观察不同近视程度患者行飞秒激光辅助的准分子激光原位角膜磨镶术(FS-LASIK)或飞秒激光小切口微透镜取出术(SMILE)术前术后不同时间角膜生物力学的变化情况，探讨两种手术方式及近视程度对角膜生物力学的影响是否存在差异。

方法：病例系列研究。选取2023年12月至2024年6月在兰州华厦眼科医院接受FS-LASIK或SMILE手术的近视患者共132眼。根据术式不同分为FS-LASIK组和SMILE组，再根据等效球镜度数(SE)分为高度近视组(-10.00 D结果：FS-LASIK组和SMILE组角膜生物力学状态具有良好的可比性。术后3 mo，FS-LASIK组与SMILE组患者SE较术前显著升高，UCVA值、CCT、IOPcc较术前显著降低(均P<0.05)，但两组间上述指标比较无差异(均P>0.05)。术后1 d，FS-LASIK组与SMILE组患者CH和CRF均显著下降(均P<0.05)，与SMILE组相比，FS-LASIK下降更显著(P<0.05)； 术后1、3 mo，两组患者CH和CRF均较术后早期有所回升并趋于稳定，但仍低于术前(均P<0.05)，且FS-LASIK组低于SMILE组(均P<0.05)。SMILE组内，高度近视组与中低度近视组相比，术后1 d，1 wk时的CH和CRF下降更显著(均P<0.05)。

结论：FS-LASIK与SMILE手术术后具有较好的安全性、可预测性和有效性，但均会导致角膜生物力学降低，且FS-LASIK降低更显著。术后早期高度近视组患者角膜生物力学降低更显著，而术后3 mo，近视程度对角膜生物力学的影响无差异。

METHODS: Case series study. A total of 132 eyes that underwent FS-LASIK or SMILE surgery at Lanzhou Huaxia Eye Hospital between December 2023 and June 2024 were enrolled. Based on the surgical procedure, they were categorized into FS-LASIK and SMILE groups and further stratified into a high myopia group(-10.00 DRESULTS: The corneal biomechanical status in the FS-LASIK group and the SMILE group was well comparable. At 3 mo postoperatively, both the FS-LASIK and SMILE groups showed a significant increase in SE compared with preoperative values, whereas UCVA, CCT, and IOPcc were significantly decreased(all P<0.05). No statistically significant differences were observed in these parameters between the two groups(all P>0.05). At 1 d after surgery, both CH and CRF decreased significantly in the FS-LASIK and SMILE groups(all P<0.05). The reduction was more pronounced in the FS-LASIK group than in the SMILE group(P<0.05). By 1 and 3 mo postoperatively, CH and CRF in both groups exhibited recovery relative to early postoperative levels and tended to stabilize, though they remained lower than preoperative values(all P<0.05). Furthermore, the FS-LASIK group had lower CH and CRF than the SMILE group at these time points(all P<0.05). Within the SMILE group, the high myopia subgroup demonstrated more pronounced decreases in CH and CRF at 1 d and 1 wk after surgery compared with the moderate-to-low myopia subgroup(all P<0.05).

CONCLUSION: Both FS-LASIK and SMILE procedures demonstrated good safety, predictability, and effectiveness postoperatively. However, both techniques resulted in reduced corneal biomechanical parameters, with FS-LASIK causing a more significant decrease. In the early postoperative period, patients in the high myopia group showed a more pronounced reduction in corneal biomechanics. By 3 mo after surgery, no statistically significant difference was observed in the effect of myopia degree on corneal biomechanical properties.