PURPOSE: Analysis of the femtosecond laser refractive lens surgery corneal incision confi guration and corneal higher-order aberration (HOA) effect from the fi rst postoperative day. METHODS: High-resolution anterior segment optical coherence tomography was used to assess 20 eyes undergoing femtosecond laser refractive lens surgery with 2.2-mm minimal incision. The primary incision (triplanar) actual length, cord length, surface angle, surface irregularity, and regional pachymetry values and the secondary incision (uni-planar) length, angle, surface irregularity, and pachymetry values were analyzed. Hartmann-Shack aberrometer was used to assess corneal HOAs to correlate the effect. Assessment was done preoperatively and 1 month postoperatively. RESULTS: The actual length, cord length, and surface angle means for the primary incision in the fi rst postoperative day and month were 1.50 ± 0.1 and 1.47 ± 0.2 mm (P = .5), 1.41 ± 0.1 and 1.42 ± 0.2 mm (P = .8), and 27° ± 4° and 23° ± 5° (P = .07), respectively. The length and surface angle for the secondary incision in the fi rst postoperative day and month were 1.17 ± 0.01 and 1.04 ± 0.1 mm (P = .05) and 52° ± 3° and 42° ± 5° (P = .007). The regional pachymetry values for the primary and secondary incisions were signifi cantly increased in the fi rst postoperative day and then signifi cantly decreased after 1 month. All irregularities occurred in the posterior surface (endothelium): 2 cases of posterior gap (fi rst day) and 1 case of posterior retraction (fi rst month). The HOAs had not signifi cantly changed preoperatively and after 1 month. CONCLUSIONS: The femtosecond laser refractive lens surgery incision is stable and does not signifi cantly change the HOA.