目的：观察飞秒激光小切口角膜基质透镜取出术(SMILE)和经上皮准分子激光屈光性角膜切削术(Trans-PRK)矫正近视对角膜前表面三阶水平彗差、三阶垂直彗差、四阶球差和总高阶像差的影响。

方法：前瞻性非随机对照研究。收集2016-12/2017-02在乐山市眼科中心行SMILE手术及Trans-PRK手术矫正近视患者各20例40眼，分别于术前及术后1、3mo用Pentacam角膜地形图仪进行角膜像差检查。采用重复测量方差分析对角膜前表面三阶水平彗差、三阶垂直彗差、四阶球差和总高阶像差均方根进行统计分析。

结果：术后1、 3mo SMILE组和Trans-PRK组患者裸眼视力均达到或超过术前最佳矫正视力。术前两组患者各项角膜像差比较差异无统计学意义(P>0.05)，术后两组患者角膜像差较术前均增高，差异有统计学意义(P<0.05)，两组患者角膜像差在术后1、 3mo之间比较差异无统计学意义(P>0.05)，术后各时间点两组患者水平彗差、垂直彗差之间比较差异无统计学意义(P>0.05)，SMILE组患者术后四阶球差及总高阶像差均方根低于Trans-PRK组，差异有统计学意义(P<0.05)。

结论：SMILE与Trans-PRK手术矫正近视术后角膜像差均增高，两种手术方式对角膜三阶水平彗差和垂直彗差影响相似，SMILE手术对四阶球差及总高阶像差的影响较Trans-PRK手术更小。

METHODS: This was a prospective non-randomized cohort study. The cohort included 40 patients(80 eyes)with myopia, who received refraction correction surgery from December 2016 to February 2017 in Leshan Ophthalmic Center. Twenty patients(40 eyes)received SMILE surgery and the other 20 patients(40 eyes)received Trans-PRK surgery. Corneal aberrations were determined by a high-resolution Pentacam Scheimpflug camera before the surgery and at 1 and 3mo after the operation. Statistical analyses were performed using analysis of variance of repeated measures.

RESULTS: At 1 and 3mo post-operation, the uncorrected visual acuity in both groups was better than or equal to the preoperative best corrected visual acuity. The preoperative corneal aberrations showed no significant difference between the two groups(P>0.05). Significantly higher aberration was found after the surgery in both groups(P<0.05), however, no significant difference in higher aberration was found between 1 and 3mo post-operation(P>0.05). Post-operation, horizontal and vertical coma had no significant difference between the two groups(P>0.05), while SMILE group showed lower spherical aberration and lower total higher order aberration than Trans-PRK group(P<0.05).

CONCLUSION: Both SMILE and Trans-PRK increase corneal aberration and their effects on horizontal and vertical coma are similar. However, SMILE has a minor influence on spherical aberration and total high order aberration than Trans-PRK.