目的：比较全飞秒小切口角膜基质透镜取出术（SMILE）与Q值引导的飞秒激光制瓣准分子激光原位角膜磨镶术（Q值-FS-LASIK）术后角膜波前像差的变化特征，探讨两种术式对视觉质量的影响。 方法：纳入2024年1月至2024年6月行屈光手术的近视患者60例（120眼），分为SMILE组（60眼）和Q值-FS-LASIK组（60眼）。术前及术后1、3、6个月采用Pentacam HR、iTrace测量角膜前表面6 mm区域的总高阶像差（RMS HOA）、球差（Z40）、垂直彗差（C8）、水平彗差（C9）及三叶草（C11）、斯特列尔比（SR）及调制传递函数（MTF）。结合患者报告结局（PROs）评估主观视觉质量。通过重复测量方差分析及独立样本t检验比较组间差异。 结果：术后6个月，两组裸眼视力（UCVA）均≥1.0，等效球镜（SE）稳定在±0.50 D以内。SMILE组总RMS HOA（0.38±0.12 μm）显著低于Q值-FS-LASIK组（0.45±0.15 μm）（P=0.012）。Q值-FS-LASIK组球差（0.52±0.18 μm）较SMILE组（0.35±0.14 μm）更高（P<0.001），而SMILE组垂直彗差（0.21±0.09 μm）显著高于Q值-FS-LASIK组（0.12±0.07 μm）（P=0.003）。两组水平彗差及三叶草差异无统计学意义（P>0.05）。SMILE组SR（0.26±0.05）优于Q值-FS-LASIK组（0.22±0.04）（P=0.008）。患者报告显示，SMILE组夜间驾驶困难发生率（12%）低于Q值-FS-LASIK组（21%）（P=0.023）。 结论：Q值-FS-LASIK通过优化角膜非球面性有效控制球差6，但总高阶像差较高；SMILE因无需制瓣减少了总像差，但垂直彗差增加更显著。临床需根据患者屈光状态及视觉需求个性化选择术式。

Objective: To compare the characteristics of corneal wavefront aberrations following small incision lenticule extraction (SMILE) and Q-value-guided femtosecond laser-assisted in situ keratomileusis (Q-value-FS-LASIK), and to evaluate the impact of these two procedures on visual quality. Methods: A total of 60 myopic patients (120 eyes) who underwent refractive surgery between January 2024 and June 2024 were enrolled and divided into two groups: the SMILE group (60 eyes) and the Q-value-FS-LASIK group (60 eyes). Preoperatively and at 1, 3, and 6 months postoperatively, the following parameters were measured using the Pentacam HR and iTrace systems within a 6 mm corneal zone: total higher-order aberrations (RMS HOA), spherical aberration (Z40), vertical coma (C8), horizontal coma (C9), trefoil (C11), Strehl ratio (SR), and modulation transfer function (MTF). Patient-reported outcomes (PROs) were used to assess subjective visual quality. Group differences were analyzed using repeated-measures ANOVA and independent samples t-tests. Results: At 6 months postoperatively, uncorrected visual acuity (UCVA) was ≥1.0 in both groups, and the spherical equivalent (SE) remained within ±0.50 D. The total RMS HOA was significantly lower in the SMILE group (0.38 ± 0.12 μm) than in the Q-value-FS-LASIK group (0.45 ± 0.15 μm) (P = 0.012). Spherical aberration was higher in the Q-value-FS-LASIK group (0.52 ± 0.18 μm) compared to the SMILE group (0.35 ± 0.14 μm) (P < 0.001), while vertical coma was significantly greater in the SMILE group (0.21 ± 0.09 μm vs. 0.12 ± 0.07 μm, P = 0.003). No significant intergroup differences were observed in horizontal coma or trefoil (P > 0.05). The Strehl ratio was superior in the SMILE group (0.26 ± 0.05) compared to the Q-value-FS-LASIK group (0.22 ± 0.04) (P = 0.008). Patient-reported outcomes indicated a lower incidence of nighttime driving difficulties in the SMILE group (12% vs. 21%, P = 0.023). Conclusion: Q-value-FS-LASIK effectively controls spherical aberration by optimizing corneal asphericity but results in higher total higher-order aberrations. SMILE reduces total aberrations due to its flap-free design but induces greater vertical coma. The choice of procedure should be tailored to the patient’s refractive status and visual demands.