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目的:探讨高度近视眼行飞秒激光小切口角膜基质透镜取出术（SMILE）、飞秒激光制瓣的准分子激光原位角膜磨镶术（FS-LASIK）及准分子激光上皮瓣下角膜磨镶术（LASEK）术后12个月角膜不同区域上皮下神经的修复情况和角膜透明度的差异。方法:队列研究。收集于2018年6月至2019年10月在山东省青岛大学附属医院眼科就诊并进行角膜屈光手术的高度近视眼（近视等效球镜度数6.00~10.00 D）患者30例（60只眼），其中女性16例（32只眼），男性14例（28只眼）；年龄（22.46±3.15）岁，按手术方式分为SMILE组（10例）、FS-LASIK组（11例）、LASEK组（9例），于术后12个月在激光共聚焦显微镜下观察角膜不同区域上皮下神经的修复情况，并通过ACCMetrics软件分析其形态学参数，包括神经纤维密度（CNFD）、主要神经分叉节点密度（CNBD）、神经纤维长度（CNFL）、总神经分叉节点密度（CTBD）和神经纤维宽度（CNFW）；采用Pentacam眼前节分析仪对角膜不同直径范围内的光密度进行检测。各组间神经形态学参数、角膜光密度的比较采用随机区组方差分析，组间多重比较采用Turkey真实显著差（n HSD）检验。n 结果:术后12个月，3种术式角膜各区域内的CNFD差异均无统计学意义（n P>0.05）。SMILE组、FS-LASIK组及LASEK组上方角膜切口周围的CNBD分别为（7.81±7.93）、（9.61±7.18）、（21.25±15.55）个/mmn 2；CTBD分别为（22.00±16.02）、（24.44±11.42）、（54.37±22.13）个/mmn 2，LASEK组与其他两组相比，差异均有统计学意义（n HSD=2.823，-3.010，3.053，-3.048；n P<0.01）；3个组CNFL分别为（9.19±3.25）、（12.88±3.52）、（15.75±2.36）mm/mmn 2，SMILE组与其他两组相比，差异有统计学意义（n HSD=-3.151，-4.418；n P<0.01）。SMILE术后直径12 mm内角膜的光密度为14.06±1.36，低于其他2种术式（n HSD=-6.031，-5.519；n P0.05). The CNBD around the upper corneal incision in the SMILE group, FS-LASIK group and LASEK group was (7.81±7.93), (9.61±7.18) and (21.25±15.55) branches/mmn 2, respectively. The CTBD was (22.00±16.02), (24.44±11.42) and (54.37±22.13) branches/mmn 2, respectively. The values in the LASEK group significantly differed from the other two groups (n HSD=2.823, -3.010, 3.053, -3.048, n P<0.01). The CNFL was (9.19±3.25), (12.88±3.52) and (15.75±2.36) mm/mmn 2, respectively. The value in the SMILE group was significantly different (n HSD=-3.151, -4.418; n P<0.0l). The corneal optical density after SMILE was 13.16±0.72 in the 0-6 mm diameter area(n HSD=-4.164, -4.489; n P<0.01), 16.12±3.18 in the 6-12 mm diameter area(n HSD=-3.918, -3.493;n P<0.01) and 14.06±1.36 in the total diameter (n HSD=-6.031, -5.519;n P<0.01), which differed significantly from the other two groups.n Conclusions:Twelve months after SMILE for high myopia, the nerve repair around the superior corneal incision is slightly worse than that after FS-LASIK and LASEK, but the nerve repair in other areas has some advantages, and the corneal transparency is better. (n Chin J Ophthalmol, 2021, 57:268-276)