目的：探究术前不同角膜曲率对飞秒激光小切口角膜基质透镜取出术(SMILE)后光学形变区大小的影响。

方法：前瞻性研究。选取2021-02/2022-01按顺序于我院接受SMILE手术患者108例，考虑双眼存在关联，仅对每例患者的左眼进行研究。根据患者术前角膜前表面平均曲率分组：角膜曲率较平组30眼：Km<42.0D，角膜曲率较陡组26眼：Km>47.0D； 常规角膜曲率组52眼：42.0D≤Km≤47.0D。所有患者均接受标准化的SMILE手术，其中激光切削直径均为6.5mm。术后6mo复查，比较三组患者的术后光学形变区直径大小。

结果：三组患者术前基线资料(除角膜曲率外)比较均无差异(均P>0.05)。术后6mo，三组患者UDVA和主觉验光比较均无差异(均P>0.05)，角膜曲率较平组、角膜曲率较陡组、常规角膜曲率组光学形变区直径分别为6.54±0.14、6.32±0.13、6.45±0.15mm(F=19.238，P<0.05)，角膜曲率较平组光学区直径大于常规角膜曲率组和角膜曲率较陡组(P<0.05)，常规角膜曲率组光学区直径大于角膜曲率较陡组(P<0.05)。

结论：当预设的激光切削直径相同时，术前角膜曲率越陡，术后光学形变区恢复越多，有效光学区直径越小。

METHODS:A prospective study was conducted on 108 consecutive patients who underwent SMILE surgery in our hospital from February 2021 to January 2022. Considering the association between both eyes, only the left eye of each patient was studied. According to the average anterior corneal surface curvature in preoperative, the patients were divided into three groups: Km<42.0D group(n=30), Km>47.0D group(n=26)and conventional corneal curvature group(n=52)with 42.0D≤Km≤47.0D. All patients underwent standardized SMILE surgery, and the laser ablation diameter was 6.5mm. The diameters of optical deformation areas in the three groups were compared at 6mo after operation.

RESULTS:There was no significant difference in preoperative data among the three groups except for the mean curvature of the anterior corneal surface(all P>0.05), and there was no significant difference in uncorrected distance visual acuity(UDVA)and subjective refraction at 6mo after operation(all P>0.05). The diameters of the optical deformation zone in the Km<42.0D group, Km>47.0D group and the conventional corneal curvature group were 6.54±0.14, 6.32±0.13, 6.45±0.15mm respectively(F=19.238, P<0.05). The optical area diameter of the group with flat corneal curvature was larger than that of the group with conventional corneal curvature and the group with steeper corneal curvature(P<0.05). The diameter of optical zone in the conventional curvature group was larger than that in the Km>47.0D group(P<0.05).

CONCLUSION: When the preset laser cutting diameter is the same, the steeper the corneal curvature before operation, the smaller the diameter of the optical deformation area after operation.