目的：探讨飞秒激光小切口角膜基质透镜取出术(SMILE)以视轴角膜反光点(VACRP)及角膜顶点(CV)为切削中心对术后光学区偏心及视觉质量的研究。

方法：前瞻性随机对照研究。选取2020-05/06于我院接受SMILE手术治疗的近视患者70例140眼，随机分为两组，其中34例68眼以视轴角膜反光点为切削中心(VACRP组)，36例72眼以角膜顶点为切削中心(CV组)。观察术前及术后3mo视力、屈光度数、切削中心偏移量及角膜高阶像差情况。

结果：术后3mo，两组裸眼视力、最佳矫正视力、屈光度均无差异(P>0.05)，CV组患者切削中心偏移量(0.20±0.13mm)小于VACRP组(0.27±0.14mm，P<0.01)，且CV组角膜总高阶像差(totHOA)、球差(totZ40)、垂直彗差(totZ3-1)、水平彗差(totZ31)均低于VACRP组(P<0.05)。术后3mo，VACRP组totHOA、总高阶像差变化量(ΔtotHOA)、totZ40、totZ3-1与切削中心偏移量具有相关性(r=0.470、0.486、0.254、-0.366，P<0.001、=0.001、0.037、0.002)，CV组totZ31与切削中心偏移量具有相关性(r=-0.352，P=0.002)。

结论：SMILE手术以视轴角膜反光点及角膜顶点为切削中心均可获得满意的裸眼视力及同等屈光度数，但以角膜顶点为切削中心可以减少术后偏心量和角膜高阶像差，获得更好的视觉质量。

METHODS: Prospective randomized controlled trial. Totally 70 myopic patients(140 eyes)who underwent SMILE surgery in our hospital from May to June 2020 were randomly divided into two groups, 68 eyes of 34 cases took the VACRP as the ablation center(VACRP group), and 72 eyes of 36 cases took the CV as the ablation center(CV group). The visual acuity, refractive diopter, offset from corneal ablation center, and high-order corneal aberrations were observed before and 3mo after surgery.

RESULTS: Three months after operation, there was no difference in uncorrected visual acuity, best corrected visual acuity and refractive diopter between the two groups(P>0.05). The ablation center deviation in CV group(0.20±0.13mm)was less than that in VACRP group(0.27±0.14mm, P<0.01). The total corneal high-order aberration(totHOA), spherical aberration(totZ40), vertical coma(totZ3-1)and horizontal coma(totZ31)in CV group were lower than VACRP group(P<0.05). Three months after operation, the totHOA, total high-order aberration change(ΔtotHOA), totZ40, totZ3-1 in VACRP group were correlated with ablation center deviation(r=0.470, 0.486, 0.254, -0.366, P<0.001, =0.001, 0.037, 0.002), totZ31 in CV group was correlated with the ablation center deviation(r=-0.352, P=0.002).

CONCLUSION: SMILE surgery can obtain satisfactory uncorrected visual acuity and the same level of refractive diopter with the VACRP and the CV as the ablation center, but taking the CV as the ablation center can reduce the postoperative decentration and high-order corneal aberrations and obtain better visual quality.