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Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism
  1. Tian Han1,2,3,
  2. Ye Xu1,2,3,
  3. Xiao Han1,2,3,
  4. Li Zeng1,2,3,
  5. Jianmin Shang1,2,3,
  6. Xun Chen1,2,3,
  7. Xingtao Zhou1,2,3
  1. 1 The Key Lab of Myopia, Ministry of Health, Shanghai, China 
  2. 2 Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China
  3. 3 Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
  1. Correspondence to Dr Xingtao Zhou, Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai 200433, China; doctzhouxingtao{at}


Aims To compare long-term clinical outcomes following small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism correction.

Methods In this retrospective study, we enrolled a total of 101 patients (101 eyes) who underwent SMILE or FS-LASIK 3 years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction and corneal wavefront aberrations.

Results No significant differences in patient characteristics were found between the two groups. At the 3-year follow-up, UDVA was better than or equal to 20/20 in 90% and 85% (p=0.540) of the eyes; the efficacy indexes were 1.05±0.19 and 1.01±0.21 in the SMILE and FS-LASIK groups, respectively (p=0.352). Safety indexes were 1.19±0.17 and 1.15±0.20 in the SMILE and FS-LASIK groups, respectively (p=0.307). Eighty per cent and 65% of eyes were within ±0.50 D of the attempted spherical equivalent correction after SMILE and FS-LASIK, respectively (p=0.164). Vector analysis revealed no significant differences in astigmatic correction between the two groups (p>0.05). Surgically induced spherical aberration was higher in the FS-LASIK group than in the SMILE group (p<0.001).

Conclusion Long-term follow-up analysis suggested that both SMILE and FS-LASIK were safe and equally effective for myopic and astigmatic correction.

  • small incision lenticule extraction (SMILE)
  • femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK)
  • Myopia
  • astigmatism
  • Aberrations

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  • TH and YX are joint first authors.

  • TH and YX contributed equally.

  • Contributors Concept and design: TH, YX and XZ. Data collection and analysis: TH, YX, XH, JS, LZ and XC. Writing the article: TH and YX. Critical revision of the article: XH, JS, LZ, XC and XZ. Final approval of the article: all authors.

  • Funding Supported in part by the National Natural Science Foundation of China for Young Scholars (Grant No. 81600762 and 81500753), the National Natural Science Foundation of China (Grant Nos. 81570879 and 81770955) and the Project of Shanghai Science and Technology (Grant Nos. 17411950200 and 17411950201).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the ethics committee of the Eye and ENT Hospital of Fudan University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Available on request from the author TH.

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