目的：比较全飞秒小切口透镜取出术(small-incision lenticule extraction，SMILE)与Q值引导飞秒辅助原位角膜磨镶术(femtosecond laser-assisted laser in situ keratomileusis，FS-LASIK)治疗近视眼术后患者角膜生物力学特性的变化，以探讨两种术式的生物力学稳定性，为临床术式的选择提供客观依据。

方法：采用前瞻性临床研究方法，选择我院进行SMILE或Q值引导FS-LASIK的近视及近视散光患者102例200眼，其中SMILE组51例100眼，Q值引导FS-LASIK组51例100眼，分别于术前及术后1d，2wk，1、3mo使用眼反应分析仪(ocular response analyzer，ORA)测量角膜黏滞力(corneal hysteresis，CH)和角膜阻力因子(corneal resistance factor，CRF)。

结果：SMILE组与Q值引导FS-LASIK组手术前后CH和CRF均较术前降低(P<0.01)，然而术后各时间点间差异无统计学意义(P>0.05)。SMILE组与Q值引导FS-LASIK组手术前与术后各时间点CH和CRF变化量的差异无统计学意义(P>0.05)。

结论：SMILE与Q值引导FS-LASIK都会引起角膜生物力学特性的降低，且术后1d生物力学特性即趋于稳定。此外，Q值引导FS-LASIK与无瓣SMILE对角膜生物力学特性的改变无显著差异。

AIM:By comparing the changes of biomechanical properties of the cornea after small-incision lenticule extraction(SMILE)and those after Q value guided femtosecond laser-assisted laser in situ keratomileusis(FSLASIK), to study the stability of biomechanical properties of the cornea after these two kinds of surgery and provide objective data for clinical operation.

METHODS: Prospective comparative cases. One hundred and two cases(200 eyes)with myopia and myopic astigmatism were divided into 2 groups, 51 cases(100 eyes)for SMILE, and 51 cases(100 eyes)for Q value guided FS-LASIK. Corneal hysteresis(CH)and the corneal resistance factor(CRF)were quantitatively assessed with the Ocular Response Analyzer(ORA)preoperatively and 1d, 2wk, 1 and 3mo postoperatively.

RESULTS: The decrease in CH and the CRF were statistically significant in both groups(P<0.01). However, the changes subsequently stabilized with no further deterioration(P>0.05). There were no statistically significant differences between the biomechanical changes in the two groups at any time(P>0.05).

CONCLUSION: Both SMILE and Q value guided FS-LASIK can cause biomechanical decreases in the cornea. After 1d postoperatively, the decreases are nearly stable. There are no significant differences between the effect of SMILE and Q value guided FS-LASIK on the biomechanical properties of the cornea.

杭州市科技发展计划项目(No.20140633B44)