目的：应用双通道视觉质量分析系统(OQASⅡ)及Pentacam角膜地形图对比研究高度近视患者分别行小切口飞秒激光角膜基质透镜取出术(SMILE)和飞秒激光辅助制瓣的准分子激光原位角膜磨镶术(FS-LASIK)后早期视觉质量的变化。方法：前瞻性非随机对照研究。选取2020-03/09于我院行手术矫治的高度近视患者74例148眼，其中SMILE组43例86眼，FS-LASIK组31例62眼。分析患者术前、术后1、7d裸眼视力(UCVA)、调制传递函数截止频率(MTF cut off)、斯特列尔比值(SR)、客观散射指数(OSI)、模拟对比度视力(VA 100%、VA 20%、VA 9%)、高阶像差(HOA)、水平彗差(Z13)、垂直彗差(Z-13)和球差(Z04)情况。结果：两组患者术前年龄、等效球镜、UCVA、MTF cut off、SR、OSI、VA 100%、VA 20%、VA 9%、HOA、Z13、Z-13和Z04均无差异(P>0.05)。SMILE组术后1d OSI值高于FS-LASIK组(2.3±2.1 vs 1.8±1.1)，术后7d无差异(1.2±0.7 vs 1.3±0.7)。FS-LASIK组术后1、7d HOA和Z04均高于SMILE组(P<0.001)，但术后1、7d两组患者UCVA、Z13、Z-13、MTF cut off、SR、VA 100%、VA 20%、VA 9%均无差异(P>0.05)。结论：FS-LASIK术后早期更易引入角膜高阶像差和球差，而2mm切口的SMILE术仅在术后1d引入更高的散射，因此，高度近视患者行角膜屈光手术矫正采用SMILE术较FS-LASIK术后早期能够获得更佳的视觉质量。

AIM: To evaluate the changes of early visual quality of patients with high myopia after small incision lenticule extraction(SMILE)and femtosecond assisted laser in situ keratomileusis(FS-LASIK)by the double-pass optical quality analysis system Ⅱ(OQAS Ⅱ)and Pentacam corneal topography.METHODS: A prospective non-randomized controlled study was conducted among 148 eyes of 74 patients with high myopia. These patients were treated by the same surgeon in our hospital from March 2020 to September 2020. According to their wishes, 86 eyes with 43 patients were treated with SMILE and 62 eyes with 31 patients were treated with FS-LASIK. The uncorrected visual acuity(UCVA), modulation transfer function cut off frequency(MTF cut off), Strehl ratio(SR), objective scattering index(OSI), predicted visual acuity values(VA 100%, VA 20%, VA 9%), high-order aberration(HOA), horizontal aberration(Z 13), vertical coma(Z -13)and spherical aberration(Z 04)preoperatively, 1 and 7d postoperatively were collected and analyzed.RESULTS:There was no statistical significance in preoperative age, spherical equivalent(SE), UCVA, MTF cut off, SR, OSI, VA 100%, VA 20%, VA 9%, HOA, Z 13, Z -13 and Z 04(P>0.05). The OSI of the SMILE group was higher than the FS-LASIK group at postoperative 1d(2.3±2.1 vs 1.8±1.1). The difference in OSI between the two groups was not statistically significant at postoperative 7d(1.2±0.7 vs 1.3±0.7). The HOA and Z04 in the FS-LASIK group were higher than the SMILE group at postoperative 1d and 7d(P<0.001). The UCVA, Z 13, Z -13, MTF cut off, SR, VA 100%, VA 20%, and VA 9% between the two groups were no statistical significance at postoperative 1d and 7d(P>0.05).CONCLUSION:FS-LASIK is easier to introduce corneal high-order aberration and spherical aberration in the early postoperative period, while SMILE with 2mm incision only introduces higher scatter at postoperative 1d. Therefore, SMILE can obtain better visual quality than FS-LASIK in the early postoperative period among patients with high myopia after corneal refractive surgery.

四川省科技厅资助项目(No.2020JDKP0072); 四川省卫健委资助项目(No.20PJ135); 泸州市校联合科研项目(No.2017LZXNYD-J01); 西南医科大学科研项目(No.2019ZQN040)