目的：探讨飞秒激光小切口角膜基质透镜取出术(SMILE)联合角膜胶原交联术(CXL)治疗屈光不正患者术后早期角膜形态学变化及可能影响因素。

方法：回顾性病例研究。选取2018-09/2019-03在我院接受SMILE手术的年龄偏小、度数较高、角膜偏薄或地形图显示形态欠规则的屈光不正患者39例76眼，按照治疗方式不同分为SMILE联合CXL术组患者17例32眼和仅行SMILE术组患者22例44眼。分别于术前、术后1mo测定两组术眼的角膜形态学参数。

结果：两组患者术眼K1、K2、Km、中央角膜厚度、角膜顶点后表面高度、最薄点前表面高度、最薄点后表面高度、D值和曲率对称性指数(IVA)的变化量间的比较均有差异(P<0.05)，高度偏中心指数(IHD)的变化量间的比较无差异(P>0.05)。两组的前表面形态的部分参数变化量与激光切削深度、术前等效球镜度和光学区间有相关性(P<0.05)，后表面形态的部分参数变化量与激光切削深度、术前等效球镜度和光学区间无明显相关性(P>0.05)。SMILE联合CXL术组的前后表面形态参数变化量与交联深度无明显相关性(P>0.05)。

结论：SMILE联合CXL术应用于年龄偏小、度数较高、角膜偏薄或地形图显示形态欠规则的患者安全有效，且对角膜的后表面形态没有显著影响，对前表面形态有影响，其影响因素可能与激光切削深度、术前等效球镜度和光学区有关。

METHODS: This was a retrospective case study. The patients(76 eyes)with ametropia who had undergone SMILE surgery in our hospital from September 2018 to March 2019 were small age, high degree of severity, thin cornea or irregular shape. The patients were divided into the SMILE combined with CXL group with 17 patients(32 eyes)and the SMILE group with 22 patients(44 eyes). The corneal morphological parameters of the two groups were measured preoperatively and 1mo postoperatively.

RESULTS: There were significant statistically differences in the changes of K1, K2, Km, central corneal thickness, posterior corneal elevation, anterior corneal elevation parameters, posterior corneal elevation parameters, the D value and index of vertical asymmetry(IVA)between these two groups(P<0.05), while there were no significant statistically difference in the changes of index of highest decentration(IHD)(P>0.05). The changes of some parameters of the corneal anterior surface morphology of the two groups were correlated with the corneal cutting depth, spherical equivalent and optical zone diameter(P<0.05). While the changes of some parameters of the corneal posterior surface morphology were not correlated with the corneal cutting depth, spherical equivalent,and optical zone diameter(P>0.05). There was no apparent correlation between the changes of corneal surface morphology and the cross-linking depthin SMILE combined with CXL group(P>0.05).

CONCLUSION: SMILE combined with CXL was applied to the high-risk patients with small age, high degree of severity, thin cornea or irregular shape, which increased its safety and effectiveness. SMILE combined with CXL didn't make significant effects on the posterior surface morphology of the cornea, but it influenced the anterior surface morphology. The influenced factors may be related to the corneal cutting depth, the spherical equivalent and the optical zone diameter.