Objective: To observe the change of refractive status and possible influencing factors for patients with different corneal power who underwent small incision lenticule extraction (SMILE) surgery. Methods: Prospective cohort study was performed for patients who underwent small incision lenticule extraction (SMILE) surgery at Daping Hospital and Research Institute of Surgery of Third Military Medical University between January and August 2016. The patients were divided into 3 groups according to their corneal power: low curvature group (K(1)≤41.00 D), common curvature group (41.00 D<K(1) and K(2)< 46.00 D), and high curvature group (K(2) ≥ 46.00 D). Preoperative and postoperative (1 day, 1 week, 1, 3 and 6 month) ophthalmic examination results of the patients including uncorrected distance visual acuity (UCDVA), refractive status, intraocular pressure (IOP) and slip lamp microscope examination were recorded. Subjective refraction and Pentacam HR were detected at 6 month after operation so as to monitor the incidence of intraoperative and postoperative complications. The total corneal refractive power (TCRP) based on Ray Tracing technique was applied to evaluate the changes of corneal curvature before and after the surgery. Power vector analysis was applied to evaluate the refraction status based on preoperative and postoperative corneal topography. At 6 months postoperatively, Hotelling t(2) test was applied to compare the refractive status among the groups, and multiple linear regression was applied to analyze the potential influencing factors of under-correction/over-correction. Results: Fifty-four patients (108 eyes) were enrolled, among which 34 were male (68 eyes) and 20 were female (40 eyes). The 3 groups had the same sample size (18 patients and 36 eyes). The low curvature group was featured with youngest average age [(22±4) years, χ(2)=8.94, P<0.05], largest male patients proportion (15/18, χ(2)=11.20, P<0.01) and largest average pupil diameter [(3.26±0.36) mm, F=4.83, P<0.05], as compared to the other 2 groups. The incidence of severe OBL (25/36) was significantly higher in the high curvature group (χ(2)=65.06, P<0.01). All patients showed no diminution of vision and their UCDVA averaged 5.1 at 6 months postoperatively, however patients with low curvature were slightly "under-corrected" in 1-mm and 2-mm zones (Error values<0). The preoperative spherical equivalent (SE) and postoperative spherical aberration in 6-mm zone were the significant factors affecting the relationship between preoperative corneal curvature and postoperative refractive status (r=0.392, 2.745, P<0.05). Conclusions: SMILE is safe and effective for patients with both low and high curvature, but the incidence of intraoperative OBL is significantly higher in high curvature group. Patients with low curvature were slightly "under-corrected" in 1-mm and 2-mm zones, which may imply that the design of the lenticule may be aspheric and that the cornea reshaping process of younger patients may be of particular characteristics. (Chin J Ophthalmol, 2018, 54: 48-54).