Objective: To evaluate the 10-year long-term outcomes of patients undergoing small incision lenticule extraction (SMILE). Methods: In this continuous case series, we enrolled a total of 113 patients (208 eyes) who underwent SMILE 10 years prior. Measured parameters included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), cycloplegia spherical equivalent error (SER). Results:113 patients were enrolled in this study. Patients’ age ranged from 18 to 44 years (mean: 30.2 years). 193 eyes (92.8%) and 176 eyes (84.6%) had an UCVA≥20/20 at 3 months and 10 years postoperatively. The mean efficacy index, measured at 3 months and 10 years postoperatively, were 1.041 and 1.023, respectively; the difference was not statistically significant.Three months after operation, best-corrected visual acuity (BCVA) decreased by 1 line in 19 eyes (9.1%), remained unchanged in 158 eyes (76.0%), increased by ≥1 line in 31 eyes (14.9%). Ten years after operation, BCVA decreased by 2 lines in 15 eyes (7.2%) and by 1 line in 35 eyes (16.8%); remained unchanged in 142 eyes (68.3%); increased ≥1 line in 16 eyes (7.7%). The mean safety index, measured at 3 months and 10 years postoperatively, were 1.147 and 1.331, respectively; the difference was not statistically significant. The mean SER at 3 months and 10 years postoperatively was - 0.112 and -0.276, respectively; the difference was statistically significant. Conclusion: There was a decrease in SER 10 years after SMILE surgery compared with 3 months postoperatively, there was no significant decrease in the efficacy index or safety index. term follow-up A