目的：比较飞秒激光小切口角膜基质透镜取出术(SMILE)与飞秒激光辅助制瓣的准分子激光角膜原位磨镶术(FS-LASIK)术后角膜光密度的变化，探讨SMILE术后角膜界面混浊对视觉的影响。

方法：前瞻性队列研究。选取2020-05/2021-10在南通大学附属医院眼科屈光手术中心拟行角膜屈光手术的患者93例186眼，其中SMILE组48例96眼，FS-LASIK组45例90眼，观察两组患者术前和术后1d，1wk，1、3、6mo时角膜光密度、等效球镜、裸眼视力(UCVA)的变化。

结果：纳入93例患者均顺利完成手术，术中及术后均未出现相关并发症，无失访病例。FS-LASIK组在术后1d，1wk UCVA分别为0.044±0.064和-0.001±0.065优于SMILE组(0.102±0.077和0.023±0.064)(均P<0.05)。两组间术后各随访时间的等效球镜均无差异(P>0.05)。FS-LASIK组术后1d在距角膜顶点0～2、2～6mm的角膜光密度及总角膜光密度分别为18.0(17.5，18.6)、16.2(15.6，16.7)、16.7(16.1，17.3)，均低于SMILE组\〖18.6(18.1，19.3)、16.8(16.4，17.4)、17.2(16.6，17.8)\〗(均P<0.05)； FS-LASIK组术后1wk在距角膜顶点0～2、2～6mm处的角膜光密度及总角膜光密度分别为17.2(16.7，17.6)、15.5(15.0，15.9)、 15.9(15.3，16.7)，均低于SMILE组\〖17.6(17.1，18.3)、 16.0(15.6，16.5)、16.6(15.9，17.1)\〗(均P<0.05)。

结论：SMILE术后出现的一过性界面混浊是导致其早期角膜光密度高于FS-LASIK的原因，界面混浊的出现或是视觉质量的影响因素。

METHODS: Prospective cohort study. A total of 93 patients(186 eyes)who were scheduled to undergo refractive surgery at the Ophthalmic Refractive Surgery Center of the Affiliated Hospital of Nantong University from May 2020 to October 2021 were included in the study, and there were 48 patients(96 eyes)in the SMILE group and 45 patients(90 eyes)in the FS-LASIK group. The changes in corneal densitometry, spherical equivalent(SE), and uncorrected visual acuity(UCVA)were observed and compared between the two groups before and at 1d, 1wk, 1, 3 and 6mo after surgery.

RESULTS: The 93 patients all successfully completed the surgery, and there were no related complications during and after the surgery, and there were no lost cases. The UCVA of FS-LASIK group was 0.044±0.064 and -0.001±0.065 respectively at 1d and 1wk after surgery, which was better than that of SMILE group(0.102±0.077 and 0.023±0.064; all P<0.05). There was no statistical difference in the SE between the two groups at the postoperative follow-ups(P>0.05). The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1d postoperatively in the FS-LASIK group were 18.0(17.5, 18.6), 16.2(15.6, 16.7)and 16.7(16.1, 17.3), which were lower than those of SMILE group \〖18.6(18.1, 19.3), 16.8(16.4, 17.4), 17.2(16.6, 17.8)\〗(all P<0.05); The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1wk postoperatively in the FS-LASIK group were 17.2(16.7, 17.6), 15.5(15.0, 15.9)and 15.9(15.3, 16.7), which were lower than those of SMILE group \〖17.6(17.1, 18.3), 16.0(15.6, 16.5), 16.6(15.9, 17.1)\〗(all P<0.05).

CONCLUSIONS: The transient interface haze after SMILE is responsible for the early higher corneal densitometry than FS-LASIK. The presence of interface haze is probably a factor for the quality of vision.