Purpose <p>To investigate the long-term clinical outcomes of femtosecond laser-assisted laser in situ keratomileusis combined with accelerated corneal cross-linking (FS-LASIK Xtra) in patients with refractive error, evaluating its safety, efficacy, and stability.</p> Methods <p>This retrospective comparative study included 80 eyes of 40 patients, divided into an FS-LASIK Xtra group (40 eyes) and a standard FS-LASIK group (40 eyes). Clinical outcomes, including visual acuity, refractive status, posterior corneal elevation, higher-order aberrations (HOAs), and corneal biomechanics, were evaluated preoperatively and up to 12&#xa0;months postoperatively.</p> Results <p>At 1&#xa0;year, both groups achieved excellent uncorrected distance visual acuity (UDVA), although the median UDVA was statistically slightly better in the standard FS-LASIK group (<i>P</i> = 0.036). The spherical equivalent (SE) was comparable between the groups (<i>P</i> = 0.172). Regarding the posterior corneal surface, the standard FS-LASIK group demonstrated a significant progressive forward shift (<i>P</i> &lt; 0.001), while the FS-LASIK Xtra group remained stable (<i>P</i> = 0.209). The change in the biomechanical integrated radius (ΔIR) was significantly smaller in the FS-LASIK Xtra group, indicating better biomechanical preservation (<i>P</i> = 0.032). While total higher-order aberrations increased in both groups, horizontal trefoil was significantly higher in the FS-LASIK Xtra group (<i>P</i> = 0.004).</p> Conclusion <p>FS-LASIK Xtra demonstrated advantages in maintaining posterior corneal surface stability and better preserving corneal biomechanical properties over a 1-year follow-up period. Combining FS-LASIK with accelerated corneal cross-linking may serve as an enhancement strategy, providing additional structural support following the procedure.</p>