Evaluating the Effectiveness and Corneal Aberrations After FS-LASIK and SMART (SPT-Guided TransPRK) Surgery for Myopia and Astigmatism: Retrospective Study.

Purpose: To evaluate the effects of SMART surgery (SCHWIND eye-tech-solutions GmbH) on corneal abnormalities and refractive errors compared to traditional femtosecond laser-assisted laser in situ keratomileusis (FSLASIK).

Methods: A retrospective case series was conducted at Xi'an Gucheng Aier-Eye Hospital, analyzing data from 83 patients who underwent FS-LASIK and SMART procedures in 2021. Pentacam (Oculus Optikgeräte GmbH) measurements were taken before surgery and at 1, 3, and 6 months postoperatively to assess corneal higher order aberrations, spherical aberrations, and coma. Statistical analyses included an independent Student test between the two groups. Visual acuities were compared by the Mann-Whitney U test, paired t-tests, and repeated measures analysis of variance.

Results: Comparison of visual acuity at 1 week and 1 month postoperatively showed significant differences between the FSLASIK and SMART groups. After 6 months, a higher percentage of patients in the SMART group achieved spherical equivalent within +1.00 diopter compared to the FS-LASIK group. Both groups showed a shift from negative to positive Q-values, indicating improved visual quality. Corneal spherical aberrations and horizontal coma were more prevalent at 6 months postoperatively in both groups compared to preoperatively.

Conclusions: In the long term, SMART surgery demonstrates comparable results to FS-LASIK for myopia and astigmatism correction. Higher order aberrations were less common after SMART surgery compared to FS-LASIK. These findings suggest that SMART surgery may be a suitable option for patients seeking refractive surgery, considering its potential benefits for visual quality and corneal health. [J Refract Surg. 2025;41(2):e164-e172.].