Ahluwalia Aneesha, Manche Edward E
Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
Curr Opin Ophthalmol. 2025 Jul 1;36(4):276-281. doi: 10.1097/ICU.0000000000001145. Epub 2025 Apr 21.
This review compares two refractive surgery modalities, femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE), focusing on their efficacy, safety, postoperative recovery, and patient-reported outcomes. The aim is to provide an updated review of recent findings and identify areas for additional research to further optimize surgical outcomes and patient selection.
FS-LASIK and SMILE show excellent, comparable visual outcomes for the correction of myopia and astigmatism. SMILE may have a lower risk of dry eye and has no flap-related complications, while FS-LASIK provides quicker visual recovery. SMILE may offer superior long-term visual outcomes, particularly for high myopia. However, customized FS-LASIK (wavefront- and topography-guided) outperform SMILE in some visual metrics, including uncorrected visual acuity and reduction in higher-order aberrations.
FS-LASIK remains the gold standard refractive procedure due to its rapid recovery and predictable results, but SMILE offers advantages in preserving corneal biomechanical stability and potentially minimizing dry eye symptoms. SMILE may also offer improved long-term stability for patients at risk of myopic regression. However, a growing body of evidence suggests that wavefront- and topography-guided LASIK yield superior visual outcomes compared to SMILE. Additional long-term comparative studies are needed for different refractive treatment requirements.
本综述比较了两种屈光手术方式，即飞秒激光原位角膜磨镶术（FS-LASIK）和小切口透镜切除术（SMILE），重点关注它们的疗效、安全性、术后恢复情况以及患者报告的结果。目的是对近期研究结果进行更新综述，并确定需要进一步研究的领域，以进一步优化手术效果和患者选择。
FS-LASIK和SMILE在矫正近视和散光方面显示出优异且相当的视觉效果。SMILE可能干眼风险较低且无瓣相关并发症，而FS-LASIK视觉恢复更快。SMILE可能提供更好的长期视觉效果，尤其是对于高度近视。然而，定制的FS-LASIK（波前引导和地形图引导）在一些视觉指标上优于SMILE，包括裸眼视力和高阶像差的减少。
由于其快速恢复和可预测的结果，FS-LASIK仍然是屈光手术的金标准，但SMILE在保持角膜生物力学稳定性和潜在最小化干眼症状方面具有优势。SMILE对于有近视回退风险的患者也可能提供更好的长期稳定性。然而，越来越多的证据表明，与SMILE相比，波前引导和地形图引导的LASIK产生更好的视觉效果。对于不同的屈光治疗需求，需要更多的长期比较研究。
