PURPOSE: To investigate the refractive predictability and corneal thickness change after femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) or small-incision lenticule intrastromal keratoplasty (SMI-LIKE). METHODS: Pentacam topography and optical coherence tomography measurements were taken of all eyes at 1 day and 1, 3, and 6 months after surgery. Anterior lamellar thickness, lenticule thickness, and posterior lamellar thickness were measured. RESULTS: The study included 23 eyes (18 patients) that underwent FS-LIKE (n = 12) or SMI-LIKE (n = 11). At 6 months after surgery, the linear regression model suggested superior predictability for the FS-LIKE group (102% correction efficiency) and slight under-correction for the SMI-LIKE group (95% correction efficiency). Compared with preoperative values, the central corneal thickness and the corneal volume were highest on the first postoperative day and subsequently remained stable in both groups. After surgery, the mean lenticule thickness for the FS-LIKE and SMI-LIKE groups were 102.3 ± 29.8 and 114.1 ± 22.5 μm, respectively, which was consistent with planned values. The mean anterior lamellar thickness for the FS-LIKE group was thicker than the planned flap thickness, whereas the value for the SMI-LIKE group was thinner. No significant changes were observed in the posterior lamellar thickness for the 2 groups over the follow-up period. CONCLUSIONS: FS-LIKE could achieve better refractive predictability compared with SMI-LIKE, and the corneal remodeling might explain the difference between the 2 procedures.