Abstract Background To evaluate early optical quality outcomes after small-incision lenticule extraction (SMILE) surgery for correcting high myopic astigmatism. Methods This retrospective study enrolled 55 eyes from 37 patients who had preoperative astigmatism of ≥2.00 diopters (D) been treated with SMILE surgery. Preoperatively, the mean cylinder was − 2.41 ± 0.54 D (range, 2.00 to 4.50 D). Th...