AIM: To analyze the influence of total femtosecond laser small incision lenticule extraction(SMILE)on corneal surface regularity index(SRI).METHODS:Totally 210(401 eyes)myopic patients treated in Qinhuangdao Optometry Ophthalmology Hospital between January 2017 and December 2019 were enrolled in the study. Among them, patients treated with total femtosecond laser SMILE were included in the observation group(n=110, 205 eyes), while those treated with femtosecond laser-assisted in situ keratomileusis(FS-LASIK)were includded in the control group(n=100, 196 eyes). The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), anterior corneal surface asphericity index(Q-value)at a diameter of 6mm and SRI were compared between the two groups before and after operation.RESULTS: The UCVA and BCVA of both groups were improved at 3mo and 6mo after operation(P<0.05), without significant differences between the groups(P>0.05). The observation group had higher SRI than the control group at 3mo, 6mo and 1a(P<0.05). The asphericity parameter Q-values increased at each time point after operation. Besides, the observation group had lower Q-values than the control group at 6mo and 1a(P<0.05).CONCLUSION: Compared with FS-LASIK, SMILE can achieve similar visual recovery effect. However, the SRI is larger after SMILE, and the influence on asphericity index Q-value is less.