Background: To comparatively evaluate of the visual and refractive outcomes after small-incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (T-PRK) surgery.Methods: This was a retrospective, case-series, non-blinded clinical study. Consecutive eligible patients underwent SMILE, FS-LASIK, and T-PRK at the Department of Ophthalmology of Peking Union Medical Hospital, a tertiary referral center. All

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... pic patients were treated with corneal refractive surgery (SMILE, FS-LASIK, and T-PRK) using the VisuMax (Carl Zeiss Meditec AG, Jena, Germany) 500-kHz femtosecond laser system and the Amaris 750S excimer laser platform (SCHWIND eye-tech solutions, Kleinostheim, Germany). Visual and topographic astigmatism changes at 6 months were the main outcome measure. Secondary outcomes were the efficacy index at 1, 3, and 6 months postoperatively.Results: We recruited 75 consecutive patients (mean age, 27.88 ± 5.76 years; 68% women; all Asian) with no significant differences between groups in terms of preoperative demographic data, except in preoperative spherical equivalent (SE) (-5.54 ± 1.86 D, -5.64 ± 1.66 D, and -3.78 ± 1.30 D, respectively; P<0.001), astigmatism (1.24 ± 1.62 D, 1.16 ± 0.75 D, and 0.72 ± 0.42 D, respectively; P=0.008), and residual bed thickness (313.08 ± 32.18 μm, 427.59 ± 30.69 μm, and 427.09 ± 41.07 μm, respectively; P<0.001). A superior efficacy index was shown in SMILE and FS-LASIK compared to T-PRK 1 month after surgery.Conclusions: The results from this retrospective, non-blind, case-series clinical study suggest that all of the corneal refractive surgery options are safe and effective. However, while SMILE and FS-LASIK procedures have equal visual outcomes, they have superior efficacy index values in the early postsurgical period.