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Panigrahi T, Khamar P, Shetty R, Kannan R, Ashok N, Nishtala K, Ghosh A, Deshpande V. Longitudinal analysis of wound healing response post SMILE and LASIK surgery using proteomic profiling of tears. Exp Eye Res 2024; 246:109987. [PMID: 38964497 DOI: 10.1016/j.exer.2024.109987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
Different types of refractive surgeries often exhibit differences in wound healing responses. The current study investigated post-operative tear protein profiles in subjects who underwent LASIK and SMILE to elucidate global changes to the proteomic profile during the period the patient cornea undergoes healing. In this study, 10 patients underwent LASIK and SMILE surgery with a contralateral paired eye design. Tear samples were collected using Schirmer's strips preoperatively, at 1 month, 3 months and 6 months postoperatively. Quantitative ITRAQ labeled proteomics was performed and the tear protein ratios were normalized to pre-operative protein levels for each subject. Whole proteomics identified 1345 proteins in tears from LASIK and 1584 proteins in SMILE across time points. About 67 proteins were common in LASIK and SMILE tears across all the time points. Wound healing responses were differentially regulated between two refractive surgeries (SMILE and LASIK). The proteins Ceruloplasmin, Clusterin, Serotransferrin were upregulated at 1 month and 3 months and downregulated at 6 months post operatively in LASIK surgery where as in SMILE these were downregulated. Galectin 3 binding protein showed upregulation at 1 month and the levels decreased at 3 months and 6 months postop in LASIK tears whereas the levels increased at 3 months and 6 months post-op in SMILE tears. The levels of proteins that protect from oxidative stress were higher in SMILE as compared to LASIK postoperatively. The extracellular matrix proteins showed an increase in expression at 6 months in SMILE tears and was stabilized at 6 months in LASIK tears post operatively. Different refractive surgeries induce distinct wound healing responses as identified in tears. This study has implications in targeting key proteins for improving the clinical outcome postrefractive surgery.
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Affiliation(s)
| | - Pooja Khamar
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Ramaraj Kannan
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Nikhil Ashok
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | | | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.
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Moin KA, Manion GN, Pandiri S, Hoopes PC, Moshirfar M. Three-Month Comprehensive Outcomes of Topography-Guided LASIK Versus Keratorefractive Lenticule Extraction (KLEx): A Prospective Contralateral Study. Ophthalmol Ther 2024; 13:2265-2284. [PMID: 38951314 PMCID: PMC11246376 DOI: 10.1007/s40123-024-00987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION The aim of this study was to compare outcomes of topography-guided laser-assisted in situ keratomileusis (TG-LASIK) and small incision lenticule extraction (SMILE®) for correcting myopia and myopic astigmatism. METHODS In this prospective, randomized contralateral study, 34 patients (68 eyes) received TG-LASIK in one eye, and SMILE in their fellow eye. Efficacy, safety, predictability, higher-order aberrations, corneal tomography, biomechanics, and patient-reported outcomes (PROs) were assessed preoperatively and up to 3 months postoperatively. RESULTS Both platforms showed comparable efficacy at 3 months (TG-LASIK 1.08 ± 0.19; SMILE 0.98 ± 0.17, p = 0.055). However, TG-LASIK demonstrated quicker visual recovery, with 63% and 89% achieving uncorrected distance visual acuity (UDVA) of 20/16 or better at 1 day and 1 week, respectively, compared to SMILE (34% and 63%; p < 0.05). Safety index at 3 months did not significantly differ between TG-LASIK and SMILE (p = 0.223). TG-LASIK and SMILE had 44% and 56% of eyes within 0.13 D of spherical equivalent (SEQ) target, respectively. SMILE induced more total higher-order aberrations (HOAs), vertical coma, and oblique trefoil than TG-LASIK at 3 months (p < 0.05). Both platforms showed similar increases in epithelial remodeling, but SMILE induced thicker epithelium than TG-LASIK at the 7.0-mm nasal zonal area. No significant differences were found in corneal hysteresis (CH) or corneal resistance factor (CRF) at 3 months (p > 0.05). Reported symptoms of glare, halos, rings, starbursts, or dry eye did not significantly differ between groups at 3 months (p > 0.05). Overall, 59% of patients preferred their TG-LASIK treated eye at 1 month, but 65% of patients had no specific eye preference at 3 months. CONCLUSION TG-LASIK and SMILE demonstrate excellent and comparable efficacy, safety, and predictability at 3 months, but TG-LASIK offers faster postoperative visual recovery at 1 day and 1 week. TG-LASIK induces fewer HOAs than SMILE, but both procedures affect corneal biomechanics similarly. TRIAL REGISTRATION ClincialTrials.gov identifier, NCT05611294.
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Affiliation(s)
- Kayvon A Moin
- Hoopes Vision Research Center, Hoopes Vision, 11820 S State St #200, Draper, UT, 84020, USA
| | | | - Srujay Pandiri
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S State St #200, Draper, UT, 84020, USA
| | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S State St #200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
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Urban B, Bakunowicz-Łazarczyk A. Refractive Surgery in Myopic Children. J Clin Med 2024; 13:4311. [PMID: 39124578 PMCID: PMC11313164 DOI: 10.3390/jcm13154311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
In this paper, we summarize the current knowledge on refractive surgery performed in the myopic pediatric population. We describe the main concerns about refractive surgery in myopic children and the indications for refractive surgery in this age group. We present a range of surgical procedures that are being used for the management of unilateral/bilateral myopia in children: corneal refractive surgery (PRK, LASEK, LASIK, FS-LASIK and SMILE) and intraocular refractive surgery (phakic intraocular lens implantation, refractive lens exchange or clear lens extraction), with both their advantages and drawbacks. We also describe the various complications and measures to prevent them.
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Affiliation(s)
- Beata Urban
- Department of Pediatric Ophthalmology and Strabismus, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland;
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Poole K, Iyer KS, Schmidtke DW, Petroll WM, Varner VD. Corneal keratocytes, fibroblasts, and myofibroblasts exhibit distinct transcriptional profiles in vitro. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.28.582620. [PMID: 38464034 PMCID: PMC10925317 DOI: 10.1101/2024.02.28.582620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Purpose After stromal injury to the cornea, the release of growth factors and pro-inflammatory cytokines promotes the activation of quiescent keratocytes into a migratory fibroblast and/or fibrotic myofibroblast phenotype. Persistence of the myofibroblast phenotype can lead to corneal fibrosis and scarring, which are leading causes of blindness worldwide. This study aims to establish comprehensive transcriptional profiles for cultured corneal keratocytes, fibroblasts, and myofibroblasts to gain insights into the mechanisms through which these phenotypic changes occur. Methods Primary rabbit corneal keratocytes were cultured in either defined serum-free media (SF), fetal bovine serum (FBS) containing media, or in the presence of TGF-β1 to induce keratocyte, fibroblast, or myofibroblast phenotypes, respectively. Bulk RNA sequencing followed by bioinformatic analyses was performed to identify significant differentially expressed genes (DEGs) and enriched biological pathways for each phenotype. Results Genes commonly associated with keratocytes, fibroblasts, or myofibroblasts showed high relative expression in SF, FBS, or TGF-β1 culture conditions, respectively. Differential expression and functional analyses revealed novel DEGs for each cell type, as well as enriched pathways indicative of differences in proliferation, apoptosis, extracellular matrix (ECM) synthesis, cell-ECM interactions, cytokine signaling, and cell mechanics. Conclusions Overall, these data demonstrate distinct transcriptional differences among cultured corneal keratocytes, fibroblasts, and myofibroblasts. We have identified genes and signaling pathways that may play important roles in keratocyte differentiation, including many related to mechanotransduction and ECM biology. Our findings have revealed novel molecular markers for each cell type, as well as possible targets for modulating cell behavior and promoting physiological corneal wound healing.
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Yang F, Yang Z, Zhao S, Huang Y. To Investigate the Changes in Corneal Curvature and Its Correlation with Corneal Epithelial Remodeling After Trans-PRK and FS-LASIK. Curr Eye Res 2024:1-7. [PMID: 38867491 DOI: 10.1080/02713683.2024.2361728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/10/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate curvature changes in different regions and their correlation with corneal epithelial remodeling in myopic patients undergoing femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and transepithelial refractive keratectomy (Trans-PRK) after surgery. METHODS One hundred and sixty-three patients (163 right eyes) undergoing Trans-PRK and LASIK were evaluated for up to 6 months using anterior segment optical coherence tomography (OCT) to measure the epithelial thickness and corneal topography to measure corneal curvature in different areas (2 mm, 5 mm, and 7 mm). We calculated the curvature ΔK (ΔK = preoperative - postoperative), ΔK5-2 (ΔK5-2 = K5mm - K2mm), ΔK7-5 (ΔK7-5 = K7mm - K5mm), and the epithelial thickness ΔET5-2 (ΔET5-2 = ET5mm - ET2mm) and ΔET7-5 (ΔET7-5= ET7mm - ET5mm). RESULTS Corneal curvature flattened in each region of the two groups (all p < 0.001) and gradually steepened during the follow-up period. The Trans-PRK group flattened more significantly within 2 mm and 5 mm, while the FS-LASIK group at 7 mm. Both groups of ΔK decreased over time. Both groups of ΔK5-2 and ΔK7-5 gradually decreased during the follow-up period (P5-2=0.025 and P7-5 < 0.001 for Trans-PRK, P5-2 = 0.011 and P7-5 < 0.001 for FS-LASIK). The corneal epithelium of the two groups gradually thickened during the follow-up period, with Trans-PRK significantly thickening in the central and peripheral regions and FS-LASIK in the central and paracentral regions. There is a significant correlation between the ΔK5-2 and ΔET5-2, ΔK7-5 and ΔET7-5 (all r > 0.37, p < 0.001). CONCLUSIONS All groups showed significant curvature flattening after surgery and gradually steepening during the follow-up period. The corneal epithelium thickness in both groups of 17 regions became thicker,. In contrast, Trans-PRK group showed more significant thickening to the periphery and the central 5 mm area of the FS-LASIK. This study indicates a significant positive correlation between differences in epithelial thickening in different regions and differences in curvature changes in the corresponding areas PRK, FS-LASIK, curvature, corneal epithelial thickness.
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Affiliation(s)
- Fan Yang
- Eye Institute and School of Optometry, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zheng Yang
- Eye Institute and School of Optometry, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Shaozhen Zhao
- Eye Institute and School of Optometry, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yue Huang
- Eye Institute and School of Optometry, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin Medical University Eye Hospital, Tianjin, China
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Huang Y, Zhan B, Han T, Zhou X. Effective optical zone following small incision lenticule extraction: a review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1657-1665. [PMID: 37851133 DOI: 10.1007/s00417-023-06263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/18/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
Small incision lenticule extraction (SMILE) is a "flapless" keratorefractive surgery with excellent safety, efficacy, stability, and predictability for myopia correction. A recent global multicenter study also reported good refractive outcomes for hyperopic SMILE. SMILE has shown advantages including improved biomechanical strength, fewer dry eye symptoms, less corneal denervation, and fewer surgery-induced higher-order aberrations over laser in situ keratomileusis (LASIK). However, night vision complaints, including glare, halos, and starbursts, could still occur after SMILE. These symptoms have been proven to be closely related to the effective optical zone (EOZ), which is defined as the achieved area of corneal ablation. A larger postoperative EOZ may indicate better visual quality, making EOZ an important safety parameter for keratorefractive surgeries. As SMILE has gained wider application globally, the EOZ following SMILE has also been increasingly studied in the field of refractive surgery. This review provides an update on topics related to the EOZ after SMILE, including its measurement and influencing factors, aiming to benefit the personalization of the surgical algorithm and ultimately improve the visual quality after the SMILE procedure.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Biyun Zhan
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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Wei C, Liu J, Zhang C, Liu JY, Lu YM. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis. J Fr Ophtalmol 2024; 47:104085. [PMID: 38377878 DOI: 10.1016/j.jfo.2024.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/18/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. METHODS A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta-analysis. RESULTS A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P=0.18), the proportion of eyes within±0.50 diopter of target refraction postoperatively (P=0.10), or the postoperative magnitude of cylinder (P=0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P=0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P=0.03) than SMILE. In terms of aberrations, higher order aberrations (P=0.46), spherical aberrations (P=0.22) and trefoil (P=0.56) were not statistically different, while WFG-LASIK induced less coma than SMILE surgery (P=0.02). CONCLUSION Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma.
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Affiliation(s)
- C Wei
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - C Zhang
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Y Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - Y M Lu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China.
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Mäkinen P, Nättinen J, Aapola U, Pietilä J, Uusitalo H. Comparison of early changes in tear film protein profiles after small incision lenticule extraction (SMILE) and femtosecond LASIK (FS-LASIK) surgery. Clin Proteomics 2024; 21:11. [PMID: 38368345 PMCID: PMC10874072 DOI: 10.1186/s12014-024-09460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (LASIK) are widely used surgical methods to correct myopia with comparable efficacy, predictability, and safety. We examined and compared the early changes of tear protein profiles after SMILE and FS-LASIK surgery in order to find possible differences in the initial corneal healing process. METHODS SMILE operations for 26 eyes were made with Visumax femtosecond laser. In FS-LASIK surgery for 30 eyes, the flaps were made with Ziemer FEMTO LDV Z6 femtosecond laser and stromal ablation with Wavelight EX500 excimer laser. Tear samples were collected preoperatively, and 1.5 h and 1 month postoperatively using glass microcapillary tubes. Tear protein identification and quantification were performed with sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS). RESULTS Immediately (1.5 h) after we found differences in 89 proteins after SMILE and in 123 after FS-LASIK operation compared to preoperative protein levels. Of these differentially expressed proteins, 48 proteins were common for both surgery types. There were, however, quantitative differences between SMILE and FS-LASIK. Upregulated proteins were mostly connected to inflammatory response and migration of the cells connected to immune system. One month after the operation protein expressions levels were returned to baseline levels with both surgical methods. CONCLUSIONS Our study showed that immediate changes in protein profiles after SMILE and FS-LASIK surgeries and differences between the methods are connected to inflammatory process, and the protein levels quickly return to the baseline within 1 month. The differences in protein profiles between the methods are probably associated with the different size of the epithelial wound induced.
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Affiliation(s)
- Petri Mäkinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland.
| | - Janika Nättinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Aapola
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Pietilä
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland
| | - Hannu Uusitalo
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- TAUH Eye Center, Tampere University Hospital, Tampere, Finland
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Yang X, Feng Q, Liu Q, Chen J, Wan P. Long-Term Visual Quality and Pupil Changes after Small-Incision Lenticule Extraction for Eyes without Preoperative Cylinder Refraction. J Ophthalmol 2024; 2024:8835585. [PMID: 38282962 PMCID: PMC10821807 DOI: 10.1155/2024/8835585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To investigate the long-term changes in visual quality and pupil size after small incision lenticule extraction (SMILE) for eyes without preoperative cylinder refraction. Methods Thirty-three myopic eyes (33 patients) without preoperative cylinder refraction were corrected using SMILE. Refractive outcomes, corneal curvature, aberrations, contrast sensitivity (CS), and pupil diameter were evaluated preoperatively, and 30 months postoperatively. Results The 30-month postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA, LogMAR) were -0.10 ± 0.09 and -0.14 ± 0.06, respectively, whereas the preoperative CDVA (LogMAR) was -0.07 ± 0.05. Cylinder refraction of -0.11 ± 0.21 D (ranging from -0.50 to 0.00) was observed at 30 months postoperatively, increasing from the preoperative cylinder refraction of 0.00 ± 0.00 D (P=0.004). Moreover, the centroid coordinates x, y of corneal anterior astigmatic vectors were -0.19 ± 0.22, 0.81 ± 0.33 at 30 months postoperatively, and 0.02 ± 0.28, 0.76 ± 0.51 preoperatively (Px < 0.001 and Py=0.810, respectively). Furthermore, a 15° axis change in the mean anterior corneal astigmatic vector was observed at 30 months postoperatively from the preoperative state, as measured by Pentacam. At 30 months postoperatively, the photopic Log CS reduced significantly with glare at three and six cycles/degrees (P < 0.001 and P=0.015, respectively), a decreased photopic pupil diameter (3.27 ± 0.55 mm vs. 3.10 ± 0.66 mm, P=0.030), and an increased Coma (Z31) and Trefoil (Z3-3) at 4 mm diameter area analysis. However, a significant linear regression relationship was only observed between changes in photopic pupil diameter and changes in photopic Log CS with glare at 12 cycles/degree (P=0.038 and β = 0.282). Conclusion Slight cylinder regression was observed with thicker corneal lenticular extraction after SMILE correction of nonastigmatic eyes 30 months postoperatively. This regression was mainly because of the axis changes in anterior corneal astigmatism power. Therefore, a cylinder nomogram modification of 0.25 to 0.50 D is considerable for correcting nonastigmatic myopic eyes with a predicted spherical lenticular thickness over 100 µm.
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Affiliation(s)
- Xiaonan Yang
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiting Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Quan Liu
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jianhui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Pengxia Wan
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
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Chen H, Yang S, Lee C, Hsueh Y, Huang J, Chang C. Differences in change of post-operative antioxidant levels between laser-assisted lenticule extraction and femtosecond laser in situ keratomileusis. J Cell Mol Med 2024; 28:e18069. [PMID: 38051678 PMCID: PMC10826428 DOI: 10.1111/jcmm.18069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/31/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
To evaluate the change of total antioxidant capacity (TAC) and ascorbic acid (AA) between femtosecond laser in situ keratomileusis (FS-LASIK) and laser-assisted lenticule extraction (LALEX). A prospective non-randomized study was conducted, and 33 and 75 eyes that had undergone FS-LASIK or LALEX surgeries were enrolled, respectively. The tear films near corneal incisions were collected, and the concentrations of TAC and AA were determined. The generalized linear mixed model was adopted to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) of TAC and AA between the two groups. The AA reduction was significant 1 month after the LALEX and FS-LASIK procedures (both p < 0.05), and the decrement in AA level was significantly larger in the FS-LASIK group compared to the LALEX group (p = 0.0002). In the subgroup analysis, the LALEX group demonstrated a lower decrement in TAC level in the individuals with dry eye disease (DED) than the FS-LASIK group (p = 0.0424), and the LALEX group demonstrated a significantly lower AA decrement in the participants with high myopia (p = 0.0165) and DED (p = 0.0043). The LALEX surgery causes lesser AA decrement compared to FS-LASIK surgery especially for the patients with DED.
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Affiliation(s)
- Hung‐Chi Chen
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Department of MedicineChang Gung University College of MedicineTaoyuanTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Shun‐Fa Yang
- Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
- Department of Medical ResearchChung Shan Medical University HospitalTaichungTaiwan
| | - Chia‐Yi Lee
- Institute of Medicine, Chung Shan Medical UniversityTaichungTaiwan
- Nobel Eye InstituteTaipeiTaiwan
- Department of Ophthalmology, Jen‐Ai Hospital Dali BranchTaichungTaiwan
| | - Yi‐Jen Hsueh
- Department of OphthalmologyChang Gung Memorial HospitalLinkouTaiwan
- Center for Tissue EngineeringChang Gung Memorial HospitalLinkouTaiwan
| | - Jing‐Yang Huang
- Department of Medical ResearchChung Shan Medical University HospitalTaichungTaiwan
| | - Chao‐Kai Chang
- Nobel Eye InstituteTaipeiTaiwan
- Department of OptometryDa‐Yeh UniversityChunghuaTaiwan
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Zhao Y, Zhao W, Wang J, Zhang Z, Zhou X, Zhao J. Characteristics of disk halo size and its correlation with lenticule quality in small incision lenticule extraction for moderate to high myopia. Graefes Arch Clin Exp Ophthalmol 2024; 262:313-321. [PMID: 37405512 PMCID: PMC10805804 DOI: 10.1007/s00417-023-06133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To investigate changes in disk halo size after small incision lenticule extraction (SMILE) and the correlation between halo size and lenticule quality in moderate to high myopia. METHODS Thirty eyes of 30 consecutive patients (mean age, 24.9 ± 4.5 years; mean spherical equivalent, -6.85 ± 1.18 D) undergoing SMILE were included in this prospective study. Lenticule surface quality was accessed with a scanning electron microscopy by a scoring system. Halo size was measured preoperatively and at 1, 3, and 6 months postoperatively. Multiple linear regression analysis was performed to explore associations between halo size and a range of factors, including lenticule quality. RESULTS Disk halo size increased slightly at 1 month and then recovered continually from 3 to 6 months postoperatively, with no difference between halo size during the preoperative period and at 6 months postoperatively (P > 0.05). One month after SMILE, halo size (1 cd/m2, 5 cd/m2) was associated only with uncorrected distance visual acuity (P ≤ 0.004). A halo size of 5 cd/m2 at 3 months postoperatively correlated with the anterior surface quality of the lenticule (P = 0.046). At 6 months postoperatively, a halo size of 1 cd/m2 was associated only with the baseline, accounting for 11.9% of the variability (P = 0.041); no correlations were found for the halo size of 5 cd/m2. CONCLUSIONS Disk halo size after SMILE was enlarged at an early stage postoperatively and subsequently declined to the baseline level during a 6-month follow-up. The quality of the lenticule surface influenced halo size changes in the early phase.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Wuxiao Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jifang Wang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhe Zhang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jing Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Zhang R, Yuan Y, Zhang Y, Chen Y. Subjective patient-reported visual quality after small-incision lenticule extraction and its correlation to the objective one. Int Ophthalmol 2023; 43:3935-3942. [PMID: 37410299 DOI: 10.1007/s10792-023-02794-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE The purpose of the study was to characterize the subjective visual quality and satisfaction following small-incision lenticule extraction (SMILE) and to identify its influential factors. SETTING Peking University Third Hospital, Beijing, China. DESIGN This was a retrospective observational study. METHODS Patients who had simultaneous binocular SMILE for myopia and myopic astigmatism were included 6 months postoperatively, and the patient-reported outcome questionnaire was employed for the assessment of visual quality in real-life situations. Examinations with SIRIUS combined corneal topography and tomography were performed including the parameters of Strehl ratio (SR), corneal higher-order aberrations (HOAs) within 6.0-mm area, kappa angel, and thinnest corneal thickness. Decentration and effective optical zone (EOZ) were measured based on a tangential pre-post-operation difference map. Binary logistic regression analysis was performed for predictors of patient-reported visual quality. RESULTS Clinical data from 97 cases were analyzed retrospectively. Overall satisfaction was 96.91% (94/97). Fluctuation in vision and glare is the most frequent and dominant visual symptoms. SR value increased non-significantly compared with preoperative (P> 0.05). A statistically significant (P < 0.05) increase in total HOAs, spherical aberration, and coma was noted. SR and HOAs were not correlated with the degree of visual symptoms (P > 0.05). No objective parameter was found to be associated with patient-reported visual quality after SMILE (P> 0.05). CONCLUSION The high patient-reported satisfaction confirmed the ideal effect on visual quality following SMILE in real-life situations, though some objective optical performances were not satisfying. It is very tolerant toward patients' conditions and mild deviations, and this study did not find factors affecting visual performances.
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Affiliation(s)
- Ruiyu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China.
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Lin Q, Shen Z, Zhou X. Intensive topical steroid regimen for enhanced very early recovery after small incision lenticule extraction. Int Ophthalmol 2023; 43:4097-4103. [PMID: 37561251 PMCID: PMC10520117 DOI: 10.1007/s10792-023-02827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality. METHODS A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24 h and one week after SMILE. RESULTS The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24 h and one week after SMILE (p > 0.05). CONCLUSION The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.
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Affiliation(s)
- Qinghong Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China
| | - Zhengwei Shen
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China.
- Department of Refractive Surgery, Wuhan Bright Eye Hospital, No.179 Zhongshan Road, Wuhan, 430000, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China.
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Li L, Yuan L, Yang K, Wu Y, Hua X, Wang Y, Yuan X. Comparative analysis of IOL power calculations in postoperative refractive surgery patients: a theoretical surgical model for FS-LASIK and SMILE procedures. BMC Ophthalmol 2023; 23:416. [PMID: 37845633 PMCID: PMC10578000 DOI: 10.1186/s12886-023-03164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND As the two most prevalent refractive surgeries in China, there is a substantial number of patients who have undergone Femtosecond Laser-assisted In Situ Keratomileusis (FS-LASIK) and Small Incision Lenticule Extraction (SMILE) procedures. However, there is still limited knowledge regarding the selection of intraocular lens (IOL) power calculation formulas for these patients with a history of FS-LASIK or SMILE. METHODS A total of 100 eyes from 50 postoperative refractive surgery patients were included in this prospective cohort study, with 25 individuals (50 eyes) having undergone FS-LASIK and 25 individuals (50 eyes) having undergone SMILE. We utilized a theoretical surgical model to simulate the IOL implantation process in postoperative FS-LASIK and SMILE patients. Subsequently, we performed comprehensive biological measurements both before and after the surgeries, encompassing demographic information, corneal biometric parameters, and axial length. Various formulas, including the Barrett Universal II (BUII) formula, as a baseline, were employed to calculate IOL power for the patients. RESULTS The Barrett True K (BTK) formula, demonstrated an mean absolute error (AE) within 0.5 D for both FS-LASIK and SMILE groups (0.28 ± 0.25 D and 0.36 ± 0.24 D, respectively). Notably, the FS-LASIK group showed 82% of results differing by less than 0.25 D compared to preoperative BUII results. The Barrett True K No History (BTKNH) formula, which also incorporates measured posterior corneal curvature, performed similarly to BTK in both groups. Additionally, the Masket formula, relying on refractive changes based on empirical experience, displayed promising potential for IOL calculations in SMILE patients compared with BTK (p = 0.411). CONCLUSION The study reveals the accuracy and stability of the BTK and BTKNH formulas for IOL power calculations in myopic FS-LASIK/SMILE patients. Moreover, the Masket formula shows encouraging results in SMILE patients. These findings contribute to enhancing the predictability and success of IOL power calculations in patients with a history of refractive surgery, providing valuable insights for clinical practice. Further research and larger sample sizes are warranted to validate and optimize the identified formulas for better patient outcomes.
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Affiliation(s)
- Liangpin Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
| | - Liyun Yuan
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Kun Yang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
| | - Yanan Wu
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China
| | - Xia Hua
- Tianjin Aier Eye Hospital, Tianjin University, Tianjin, 300190, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China.
| | - Xiaoyong Yuan
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China.
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin, 300020, China.
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Yang S, Huang T, Wang Y, Ning K, Long Q, Wang Z, Li Y, Chen D. Short-Term Impact of Different Corneal Incision Positions on Postoperative Astigmatism and Visual Quality After SMILE Surgery. Ophthalmol Ther 2023; 12:2453-2464. [PMID: 37328617 PMCID: PMC10441924 DOI: 10.1007/s40123-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the short-term impact of different incision positions on astigmatism and visual quality after small incision lenticule extraction (SMILE) surgery. METHODS This prospective study enrolled patients who decided to have SMILE to correct myopia. Patients were randomly allocated into three groups of different incision positions (group A, B, and C with incision position at 90°, 120°, and 150° respectively). Preoperative and postoperative visual acuity, spherical equivalent, and high-order aberrations (HOAs) were measured and compared among groups. Astigmatism was analyzed with the ASSORT Group Analysis Calculator based on the Alpins method. RESULTS A total of 148 eyes were included for analysis (48 eyes in group A, 50 eyes in group B, and 50 eyes in group C). At 1 month postoperatively, the mean uncorrected distance visual acuity (UDVA) logMAR in group A, B, and C was - 0.03, - 0.03, and - 0.04, respectively. The mean corrected distance visual acuity (CDVA) logMAR in group A, B, and C was - 0.03, - 0.04, and - 0.04, respectively (P > 0.05). The mean postoperative spherical equivalent (SE) values were - 0.01 ± 0.38, - 0.07 ± 0.39, and - 0.16 ± 0.49 (D) in group A, B, and C, respectively (P > 0.05). There was no statistically significant difference in preoperative and postoperative magnitude of astigmatism among different groups (P > 0.05). Significant differences were found in the distribution of astigmatism axis among the three groups at 1 day (P = 0.02) and 1 week (P = 0.02) postoperatively. However, such differences were no longer significant at 1 month after surgery (P > 0.05). No significant differences were found in HOAs among different groups 1 month after surgery (P > 0.05). CONCLUSION Different incision positions have no effect on postoperative astigmatism and visual quality 1 month after SMILE surgery, though differences were found in the distribution of the astigmatism axis within 1 week after the surgery.
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Affiliation(s)
- Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Tianze Huang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Yuchen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ken Ning
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Qing Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Zhonghai Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China.
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Liu M, Song W, Gao W, Jiang L, Pan H, Luo D, Shi L. Impact of Latent Virus Infection in the Cornea on Corneal Healing after Small Incision Lenticule Extraction. Microorganisms 2023; 11:2441. [PMID: 37894101 PMCID: PMC10609374 DOI: 10.3390/microorganisms11102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of the present study is to analyze the impact of cornea virus latent infection on corneal healing after small incision lenticule extraction (SMILE) and predict the positive rate of virus latent infection in corneal stroma. A total of 279 patients who underwent SMILE were included in this study. Fluorescence quantitative PCR was used to detect virus infection in the lenticules, which were taken from the corneal stroma during SMILE. Herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) were detected. Postoperative visual acuity, spherical equivalent, intraocular pressure, corneal curvature (Kf and Ks), corneal transparency, and corneal staining were compared between the virus-positive group and the virus-negative group. The number of corneal stromal cells and inflammatory cells, corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal total branch density (CTBD), and corneal nerve fiber width (CNFW) were evaluated using an in vivo confocal microscope. Out of 240 herpes simplex virus (HSV) tested samples, 11 (4.58%) were positive, among which 5 (2.08%) were HSV-1-positive and 6 (2.50%) were HSV-2-positive. None of the 91 CMV- and EBV-tested samples were positive. There was no statistical significance in the postoperative visual acuity, spherical equivalent, intraocular pressure, Kf and Ks, corneal transparency, corneal staining, the number of corneal stromal cells and inflammatory cells, CNFD, CNBD, CNFL, CTBD, and CNFW between the virus-positive and virus-negative groups (p > 0.05). In conclusion, there is a certain proportion of latent HSV infection in the myopia population. Femtosecond lasers are less likely to activate a latent infection of HSV in the cornea. The latent infection of HSV has no significant impact on corneal healing after SMILE.
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Affiliation(s)
- Ming Liu
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Wenting Song
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Hefei 230001, China; (W.S.); (D.L.)
| | - Wen Gao
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Lili Jiang
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Hongbiao Pan
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
| | - Dan Luo
- Department of Ophthalmology, The First Affiliated Hospital of USTC, Hefei 230001, China; (W.S.); (D.L.)
| | - Lei Shi
- Department of Ophthalmology, Anhui Second Provincial People’s Hospital, Dangshan Road 1868, Hefei 230041, China (W.G.); (L.J.); (H.P.)
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Shen Y, Wang J, Zhou X, Yu Z, Hong J, Le Q. Impact of Dry Eye Disease on the Uncorrected Distance Visual Acuity after Small Incision Lenticule Extraction. J Clin Med 2023; 12:6179. [PMID: 37834823 PMCID: PMC10573338 DOI: 10.3390/jcm12196179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to explore the impact of dry eye disease (DED) on the uncorrected distance visual acuity (UDVA) and refractive status after small incision lenticule extraction (SMILE). This prospective cohort study enrolled 29 patients (DED group, 11 eyes; non-DED group, 18 eyes) who underwent SMILE in our center from July to September 2022. The examinations on DED, refractive status and UDVA were performed before surgery, and on day 7 and 20 after surgery. The results showed that on day 20 after SMILE, subjects in the non-DED group reported greater changes of ocular surface disease index value increase and tear-film breakup time reduction compared to baseline than those in the DED group (p < 0.001 and p = 0.048, respectively). Compared to preoperative status, DED patients had greater improvements of UDVA and better optometric outcomes on day 20 after surgery than non-DED subjects (p = 0.008 and 0.026, respectively). Multiple linear regression analysis showed age, contact lens daily wearing time, and tear meniscus height before surgery were of the highest value to predict UDVA on day 20 after SMILE in contact lens wearers (p = 0.006, 0.010 and 0.043, respectively). In conclusion, preoperative tear function could affect UDVA after SMILE. The impact of DED on UDVA and refraction should be taken into consideration before surgery.
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Affiliation(s)
- Yan Shen
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
| | - Jiajia Wang
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
| | - Xingtao Zhou
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Zhiqiang Yu
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Jiaxu Hong
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Qihua Le
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
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Yang F, Dong Y, Bai C, Alzogool M, Wang Y. Bibliometric and visualized analysis of myopic corneal refractive surgery research: from 1979 to 2022. Front Med (Lausanne) 2023; 10:1141438. [PMID: 37575980 PMCID: PMC10416457 DOI: 10.3389/fmed.2023.1141438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Myopic corneal refractive surgery is one of the most prevalent ophthalmic procedures for correcting ametropia. This study aimed to perform a bibliometric analysis of research in the field of corneal refractive surgery over the past 40 years in order to describe the current international status and to identify most influential factors, while highlighting research hotspots. Methods A bibliometric analysis based on the Web of Science Core Collection (WoSCC) was used to analyze the publication trends in research related to myopic corneal refractive surgery. VOSviewer v.1.6.10 was used to construct the knowledge map in order to visualize the publications, distribution of countries, international collaborations, author productivity, source journals, cited references, keywords, and research hotspots in this field. Results A total of 4,680 publications on myopic corneal refractive surgery published between 1979 and 2022 were retrieved. The United States has published the most papers, with Emory University contributing to the most citations. The Journal of Cataract and Refractive Surgery published the greatest number of articles, and the top 10 cited references mainly focused on outcomes and wound healing in refractive surgery. Previous research emphasized "radial keratotomy (RK)" and excimer laser-associated operation methods. The keywords containing femtosecond (FS) laser associated with "small incision lenticule extraction (SMILE)" and its "safety" had higher burst strength, indicating a shift of operation methods and coinciding with the global trends in refractive surgery. The document citation network was clustered into five groups: (1) outcomes of refractive surgery: (2) preoperative examinations for refractive surgery were as follows: (3) complications of myopic corneal refractive surgery; (4) corneal wound healing and cytobiology research related to photorefractive laser keratotomy; and (5) biomechanics of myopic corneal refractive surgery. Conclusion The bibliometric analysis in this study may provide scholars with valuable to information and help them better understand the global trends in myopic corneal refractive surgery research frontiers. Two stages of rapid development occurred around 1991 and 2013, shortly after the innovation of PRK and SMILE surgical techniques. The most cited articles mainly focused on corneal wound healing, clinical outcomes, ocular aberration, corneal ectasia, and corneal topography, representing the safety of the new techniques.
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Affiliation(s)
- Fang Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yi Dong
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Chen Bai
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Mohammad Alzogool
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
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Liu S, Yu L, Zhao Y, Zhou X. Changes in the posterior corneal surface after femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) performed into a pocket (SMI-LIKE) or under a flap (FS-LIKE). EYE AND VISION (LONDON, ENGLAND) 2023; 10:23. [PMID: 37122005 PMCID: PMC10150533 DOI: 10.1186/s40662-023-00337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/16/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND To compare the changes in posterior corneal surface after small-incision lenticule intrastromal keratoplasty (SMI-LIKE) and femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) for hyperopia correction. METHODS In this prospective comparative randomized study, 23 eyes with hyperopia were recruited. Eyes were categorized into two groups-SMI-LIKE group (11 eyes) and FS-LIKE group (12 eyes). Lenticules from myopia small incision lenticule extraction were implanted into a pocket (SMI-LIKE group) or at a depth of 100 µm under a flap (FS-LIKE group). Posterior corneal elevations in the center, mid-periphery, and periphery, as well as mean keratometry of the posterior corneal surface (Kmb) were measured using a Pentacam over a three-month follow-up. RESULTS All surgeries were completed successfully and no complications occurred. At one day postoperatively, there was a slight backward change with SMI-LIKE and a forward change with FS-LIKE in the central region of the posterior corneal elevation. Conversely, the peripheral area showed forward displacement in SMI-LIKE and an apparent backward change in FS-LIKE. The mid-peripheral regions manifested a backward change after the procedure throughout the entire follow-up in both groups. Kmb exhibited flattening at one month postoperatively and subsequently returned to its original level at three months after SMI-LIKE while in FS-LIKE, Kmb steepened after lenticule implantation with a significant change noted at one day postoperatively (P = 0.001). CONCLUSIONS Posterior corneal surface after SMI-LIKE and FS-LIKE exhibited different change patterns in various corneal regions, with the most prominent change occurring at one day postoperatively during the three-month follow-up. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-ONC-16008300. Registered on Apr 18th, 2016. http://www.chictr.org.cn/edit.aspx?pid=14090&htm=4.
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Affiliation(s)
- Shengtao Liu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Lanhui Yu
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
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He Y, Ma BS, Zeng JH, Ma DJ. Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery. Front Bioeng Biotechnol 2023; 11:1144455. [PMID: 37091331 PMCID: PMC10117965 DOI: 10.3389/fbioe.2023.1144455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The cornea is the main refractive medium of the human eye, and its clarity is critical to visual acuity. Corneal optical density (COD) is an important index to describe corneal transparency. Intact corneal epithelial and endothelial cells, regular arrangement of collagen fibers in the stroma, and normal substance metabolism are all integral for the cornea to maintain its transparency. In the last two decades, the Pentacam Scheimpflug imaging system has emerged as a breakthrough for the measurement of COD (also called corneal densitometry). It has been found that a wide variety of factors such as age, refractive status, and corneal diseases can affect COD. Different corneal refractive surgery methods also change COD in different corneal regions and layers and affect visual acuity following the surgery. Thus, COD has gradually become a significant indicator to evaluate corneal health, one on which the attention of clinicians has been increasingly focused.
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Affiliation(s)
- Ye He
- Changsha Aier Eye Hospital, Changsha, China
| | - Bo-Sheng Ma
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Hao Zeng
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Dai-Jin Ma
- Changsha Aier Eye Hospital, Changsha, China
- *Correspondence: Dai-Jin Ma,
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Song YW, Cui MF, Feng Y, Qu M, Gao Y, He R. Comparative study of functional optical zone: small incision lenticule extraction versus femtosecond laser assisted excimer laser keratomileusis. Int J Ophthalmol 2023; 16:238-244. [PMID: 36816223 PMCID: PMC9922620 DOI: 10.18240/ijo.2023.02.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/29/2022] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the size of functional optical zone (FOZ) after small incision lenticule extraction (SMILE) versus femtosecond laser assisted excimer laser keratomileusis (FS-LASIK) for myopia correction and potential associated factors for FOZ. METHODS A total of 133 patients who received corneal refractive surgery in our hospital between November 2018 and July 2021 were retrospectively enrolled. There were 63 patients (123 eyes) in SMILE group and 70 patients (139 eyes) in FS-LASIK group. The size of FOZ was measured using Pentacam 3-dementional anterior segment analyzer before and 3mo after surgery, so as to analyze postoperative achieved functional optical zone (AFOZ) and its contributing parameters. RESULTS When planned functional optical zone (PFOZ) was 6.5 mm for both groups, AFOZ was 1.45±0.27 and 1.67±0.25 mm smaller than preoperative FOZ in SMILE group and FS-LASIK group 3mo after surgery. AFOZ in SMILE group was significantly larger than that in FS-LASIK group (P<0.001). Variation of FOZ was negatively correlated with preoperative spherical equivalent (SE) and positively correlated with variation of mean keratometry value (ΔKm), variation of spherical aberration (ΔSA), and variation of Q-value (ΔQ, all P<0.001) in both groups. Multiple variable linear regression equations were ΔFOZ=1.354-0.1×pre-SE+0.336×ΔQ+1.462×ΔSA in SMILE group and ΔFOZ=1.512+0.137×ΔQ+0.468×ΔSA in FS-LASIK group. CONCLUSION AFOZ is significantly smaller than preoperative FOZ in both SMILE and FS-LASIK groups. With the same PFOZ, larger AFOZ is achieved in SMILE group than in FS-LASIK group.
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Affiliation(s)
- Yao-Wen Song
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Meng-Fan Cui
- The First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yi Feng
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Min Qu
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Yan Gao
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Rui He
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
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22
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Mao X, Ji S, Chen H, Dai J. Comparison of Postoperative Safety, Efficacy, and Visual Quality after SMILE for Myopic Patients with Different Corneal Thicknesses. Curr Eye Res 2023; 48:18-24. [PMID: 36285731 DOI: 10.1080/02713683.2022.2117382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the safety, efficacy, and visual quality of small incision lenticule extraction (SMILE) in different corneal thickness patients with myopia or myopic astigmatism. METHODS This prospective cohort study included 191 right eyes of 191 patients. Eyes were divided into three groups according to preoperative central corneal thickness (CCT) (Preoperative central corneal thickness (CCT) was the group indicator.) There were 31 eyes in the thin cornea group (CCT ≤500 um (μm), TC), 94 eyes in the moderate corneal thickness group (CCT ≥501 um (μm) and ≤550 um (μm), MD) and 66 eyes in the thick cornea group (CCT ≥550 um (μm), TK). Comparisons in uncorrected (UDVA) and best-corrected distance visual acuity (BDVA), manifest refractive spherical equivalent (SE), preoperative mesopic/photopic contrast sensitivity (CS), ocular higher-order aberrations (HOAs) at a 6mm analytical pupil diameter, and visual quality questionnaires were made (performed) among the three groups during the postoperative six months. Subgroup analyses were made based on preoperative SE. RESULTS The safety indices at six months were 1.15 ± 0.18, 1.14 ± 0.17, and 1.18 ± 0.17, respectively (p = 0.374), and the efficacy indices at six months were 1.07 ± 0.25, 1.12 ± 0.22, and 1.11 ± 0.21, respectively (p = 0.599). The postoperative SE was -0.07 ± 0.52D, -0.14 ± 0.38D, and -0.05 ± 0.46D after SMILE in the three groups, respectively (p = 0.376). No significant difference was found in mesopic/photopic CS, HOAs, and visual quality among different corneal thickness groups and SE groups. Postoperative SE and efficacy indices were the lowest in thin cornea eyes with ultra-high myopia (over -9.00 D). CONCLUSIONS SMILE provides comparable safety, efficacy, and visual quality results in different corneal thickness patients. Those with myopia higher than -9.00 D had less efficacy after surgery, especially in thin cornea patients.
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Affiliation(s)
- Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Shunmei Ji
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Han Chen
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Fujian Provincial Hospital, Fujian, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
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23
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In vivo confocal microscopy of sub-basal corneal nerves and corneal densitometry after three kinds of refractive procedures for high myopia. Int Ophthalmol 2022; 43:925-935. [PMID: 36153757 DOI: 10.1007/s10792-022-02494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To observe corneal nerve fibers and densitometry after small incision lenticule extraction (SMILE), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and laser-assisted subepithelial keratomileusis (LASEK) for high myopia. METHODS This is a prospective, cross-sectional research study. Patients with high myopia (equivalent spherical lens: -6.00 and -11.00D) who underwent laser corneal refractive surgery were divided into three groups: SMILE, FS-LASIK and LASEK. Scheimpflug imaging of corneal nerves in five areas was observed by confocal microscopy before and 6, 12 months after surgery. Corneal densitometry was measured by Pentacam anterior segment analysis system. RESULTS Overall, 59 patients were enrolled. The nerve density in the central area did not recover to the preoperative level in three groups until 12 months. The density and length of corneal nerves in central and lower area were better in the SMILE group 6 months postoperatively (p = 0.01), while nerve density did not differ significantly among three groups 12 months postoperatively (p = 0.18). Nerve fibers in central and temporal region were wider in LASEK than that in other two groups at 6- and 12-month follow-up. Corneal densitometry in the central 6 mm diameter was significantly higher in the LASEK group compared with other two groups 6 months postoperatively (p = 0.04). Twelve months postoperatively, corneal densitometry in range of all zone was lower in SMILE than in FS-LASIK and LASEK (p = 0.01, 0.03, 0.04). CONCLUSIONS Compared with FS-LASIK and LASEK, SMILE-treated eyes with high myopia had certain advantages in nerve density, length and nerve connection way and had better corneal transparency after operation.
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Zhu L, Ji Y, Yang X, Lu X, Wu Q, Wang Q, Xia J, Li M, Hu K, Wan W. Corneal morphological changes after small incision lenticule extraction for myopic anisometropia. Front Med (Lausanne) 2022; 9:977586. [PMID: 36091674 PMCID: PMC9449128 DOI: 10.3389/fmed.2022.977586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis research aims to study the corneal morphological changes in adult patients with myopic anisometropia after small incision lenticule extraction (SMILE) and the safety, efficacy, and predictability of clinical outcomes.MethodsThis was a prospective cohort study. Patients with myopic anisometropia [refractive difference >2.0 diopters (D)] were included in this study who underwent SMILE at our hospital from September 2019 to March 2021. For the two eyes of each patient, the one with higher myopia was defined as group A, and the fellow eye was group B. The follow-up time points were set as 1 week, 1 month, 3 months, and 6 months after the surgery. The data collected were uncorrected and best-corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), efficacy and safety indexes, posterior corneal elevation (PCE), anterior and posterior corneal radius of curvature in the 3 mm area at the center of the thinnest point of the cornea (ARC and PRC), and higher-order aberrations (HOAs).ResultsThe study included 36 patients (72 eyes), and the mean age was 25.2 ± 6.4 years. The preoperative SEs were −6.45 ± 1.25 D in group A and −3.76 ± 1.29 D in group B. Six months after surgery, the SEs in groups A and B were −0.09 ± 0.50 D and 0.07 ± 0.47 (P = 0.059), respectively. The efficacy indexes were 1.06 ± 0.16 in group A and 1.07 ± 0.14 in group B (P = 0.750). The safety indexes were 1.08 ± 0.14 in group A and 1.12 ± 0.15 in group B (P = 0.173). The PCE was significantly reduced at 6 months after surgery in pagebreak both groups (P < 0.05). The ARC was significantly higher than before the surgery (P < 0.05) in the two groups. The two groups showed significant increases in total HOAs, coma 90°, and spherical aberrations (P < 0.05).ConclusionSMILE is predictable, effective, and safe in correcting myopic anisometropia. The postoperative changes in HOAs are characteristic.
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Cui L, Xue W, Yao W, Huang X, Xue W, Wang Y, Li S, Zhao L, Zou H. Quantitative changes in iris and retinal blood flow after femtosecond laser-assisted in situ keratomileusis and small-incision lenticule extraction. Front Med (Lausanne) 2022; 9:862195. [PMID: 35991655 PMCID: PMC9388900 DOI: 10.3389/fmed.2022.862195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo investigate the quantitative changes in iris and retinal blood flow indices after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE).MethodsSeventy-nine patients who underwent FS-LASIK or SMILE were enrolled between July 2020 and September 2020. Participants were followed-up 1 day pre-operatively and 1 week, 1 month, 3 months post-operatively. Optical coherence tomography angiography (OCTA) was used to acquire and quantify the iris and retinal blood flow indices.ResultsThe iris vessel area density (VAD) and vessel skeleton density (VSD) decreased on post-operative day 1 but recovered on day 7. In both cases, the pupil diameter was positively associated with the post-operative iris blood flow indices (p = 0.0013, p = 0.0002). The retinal VAD and VSD in the superficial and deep capillary plexuses decreased after surgery and failed to recover after 90 days. The SMILE group showed significantly lower iris and retinal blood flow indices than the FS-LASIK group. For both procedures, axial length (p = 0.0345, p = 0.0499), spherical equivalence (p = 0.0063, p = 0.0070), and suction duration (p = 0.0025, p = 0.0130) were negatively correlated with the post-operative VAD and VSD.ConclusionsThe SMILE and FS-LASIK procedures induced a short-term decrease in the iris and retinal blood flow indices, although patients finally showed full visual recovery. This phenomenon should be carefully considered, especially in patients prone to anterior segment lesions.
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Affiliation(s)
- Lipu Cui
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Wenwen Xue
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Wenbo Yao
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Xinhui Huang
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Wen Xue
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Yulan Wang
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Shanshan Li
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Liquan Zhao
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
| | - Haidong Zou
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Eye Diseases Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai, China
- *Correspondence: Haidong Zou
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Zhang D, Tian L, Zhang H, Zheng Y, Fu C, Zhai C, Jie Y, Li L. Differences of Corneal Biomechanics Among Thin Normal Cornea, Forme-Fruste Keratoconus, and Cornea After SMILE. Front Bioeng Biotechnol 2022; 10:861924. [PMID: 35646859 PMCID: PMC9136087 DOI: 10.3389/fbioe.2022.861924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To compare the corneal biomechanics of thin normal cornea (TNC) with thinnest corneal thickness (TCT) (≤500 µm), forme-fruste keratoconus (FFKC) and cornea after small incision lenticule extraction (Post-SMILE) had their central corneal thickness (CCT) matched by Corneal Visualization Scheimpflug Technology (Corvis ST).Methods: CCT were matched in 23 eyes with FFKC, 23 eyes by SMILE in 3 months post-operatively, and 23 TNC eyes. The differences in corneal biomechanics by Corvis ST among the three groups were compared.Results: There was no significant difference in CCT among the three groups, and the biomechanically corrected intraocular pressure (bIOP) did not differ significantly among the three groups (all p > 0.05). There were significant differences in most DCR parameters between pre- and post-operatively (all p < 0.05). Compared with TNC, the values of corneal deflection amplitude during the first applanation (A1DA), length at the first applanation (A1L), corneal deflection amplitude during the second applanation (A2DA), and maximum deformation amplitude (DA) decreased in 3 months after SMILE (all p < 0.05), these values increased in the FFKC (all p < 0.05).Conclusion: The majority of the DCR parameters were different among the three groups. The parameters A1DA, A1L, A2DA, and DA may be different between TNC and Post-SMILE, TNC and FFKC, and Post-SMILE and FFKC.
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Affiliation(s)
- Di Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Lei Tian
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Tongren Hospital, Beihang University and Capital Medical University, Beijing, China
| | - Haixia Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Yan Zheng
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caiyun Fu
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changbin Zhai
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
| | - Ying Jie
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
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Jabbarvand M, Khodaparast M, Moravvej Z, Shahraki K, Ahmadi H, Shahraki K, Jamali A, Narooie-Noori F. Vector analysis of moderate to high myopic astigmatism after small-incision lenticule extraction (SMILE): 12-month follow-up. Eur J Ophthalmol 2022; 32:3312-3320. [PMID: 35175136 DOI: 10.1177/11206721221080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism. STUDY DESIGN Prospective interventional case series. METHODS This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of - 0.5 D or more and astigmatism between - 1.0 D and -5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. RESULTS The preoperative mean spherical equivalent was -5.48 ± 2.17 D (range - 1.75 to - 10.00 D) and the mean cylinder was -2.02 ± 1.09 D (range - 1.00 to - 5.00 D). The mean postoperative cylinder value was -0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. CONCLUSION SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Mehdi Khodaparast
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Zahra Moravvej
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Eye Research Center, Eye Department, Amiralmomenin Hospital, School of Medicine, 37554Guilan University of Medical Sciences, Rasht, Iran
| | - Kianoush Shahraki
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Hanie Ahmadi
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Department of Ophthalmology, 92948Mazandaran University of Medical sciences, Sari, Iran
| | - Kourosh Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
| | - Foroozan Narooie-Noori
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
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Zhang D, Qin X, Zhang H, Li L. Time-varying regularity of changes in biomechanical properties of the corneas after removal of anterior corneal tissue. Biomed Eng Online 2021; 20:113. [PMID: 34801040 PMCID: PMC8606087 DOI: 10.1186/s12938-021-00948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background The corneal biomechanical properties with the prolongation of time after corneal refractive surgery are important for providing a mechanical basis for the occurrence of clinical phenomena such as iatrogenic keratectasia and refractive regression. The aim of this study was to explore the changes of corneal elastic modulus, and stress relaxation properties from the 6-month follow-up observations of rabbits after a removal of anterior corneal tissue in simulation to corneal refractive surgery. Methods The anterior corneal tissue, 6 mm in diameter and 30–50% of the original corneal thickness, the left eye of the rabbit was removed, and the right eye was kept as the control. The rabbits were normally raised and nursed for 6 months, during which corneal morphology data, and both of corneal hysteresis (CH) and corneal resistance factor (CRF) were gathered. Uniaxial tensile tests of corneal strips were performed at months 1, 3, and 6 from 7 animals, and corneal collagen fibrils were observed at months 1, 3, and 6 from 1 rabbit, respectively. Results Compared with the control group, there were statistical differences in the curvature radius at week 2 and month 3, and both CH and CRF at months 1, 2, and 6 in experiment group; there were statistical differences in elastic modulus at 1, 3, and month 6, and stress relaxation degree at month 3 in experiment group. The differences in corneal elastic modulus, stress relaxation degree and the total number of collagen fibrils between experiment and control groups varied gradually with time, and showed significant changes at the 3rd month after the treatment. Conclusions Corneas after a removal of anterior corneal tissue undergo dynamic changes in corneal morphology and biomechanical properties. The first 3 months after treatment could be a critical period. The variation of corneal biomechanical properties is worth considering in predicting corneal deformation after a removal of anterior corneal tissue.
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Affiliation(s)
- Di Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Xiao Qin
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Haixia Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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Three-Year Clinical Outcomes and Posterior Corneal Elevation Change After Small Incision Lenticule Extraction in Suspicious Corneas. J Cataract Refract Surg 2021; 48:771-777. [PMID: 34670943 DOI: 10.1097/j.jcrs.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the long-term clinical outcomes and change in posterior corneal elevation after small incision lenticule extraction (SMILE) in eyes with suspicious tomographic features. SETTING Hospital clinic. DESIGN Retrospective, case-controlled, observational. METHODS This study included 43 patients with suspicious corneas (group A), defined by corneal morphology and a final D score from a Scheimpflug camera (Pentacam), and 43 patients with normal corneal topography (group B). Refraction, visual acuity, and posterior corneal elevation over a 6-mm central diameter, including posterior central elevation (PCE), posterior elevation at the thinnest point (PTE) and posterior maximal elevation (PME), were measured preoperatively and at 6, 12, and 36 months postoperatively. RESULTS The preoperative spherical equivalent was -5.51±1.33 D in group A and -5.41±1.19 D in group B. Postoperative uncorrected distance visual acuity was 20/20 or better in 39/43 eyes (91%) in group A and 41/43 eyes (95%) in group B (P=0.160); all eyes in both groups remained stable or had gained corrected distance visual acuity. The mean change in PCE, PTE and PME at 3 years was -1.22±2.65 μm, -1.21±2.70 μm and -1.00±5.09 μm, respectively, in group A and -1.76±3.25 μm, -1.60±3.33 μm and -1.56±5.01 μm in Group B, indicating a tendency for backward displacement of the posterior surface while the between-group difference was not statistically significant (P=0.154, P=0.547, P=0.319). CONCLUSIONS Refraction, visual outcomes, and posterior corneal shift seem comparable between corneas with normal and suspicious tomographic features three years after SMILE. More long-term studies are warranted to corroborate the findings of this study.
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Kim BK, Chung YT. Changes in Intraocular Pressure and Factors that Influence such Changes after FS-LASIK and SMILE. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.10.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We compared the intraocular pressure (IOP) changes and the relationships thereof with corneal biomechanics after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).Methods: A total of 234 eyes of 117 patients who underwent FS-LASIK surgery and 244 eyes of 122 patients who underwent SMILE surgery were included in this retrospective study. Data were collected preoperatively, and at 1, 3, and 6 months postoperatively, including IOP measured via non-contract tonometry, central corneal thickness (CCT), and mean keratometry (Km), flat keratometry (Kf), and steep keratometry (Ks) data obtained using a dual Scheimpflug analyzer. Between-group differences were compared. Simple linear regression analysis was used to determine the relationship between changes in the IOP and the various parameters.Results: The IOP changes were 5.41 ± 2.28 mmHg in the FS-LASIK group and 4.77 ± 2.38 mmHg in the SMILE group, thus significantly different (p = 0.004). The IOP did not change significantly from 1 to 6 months after FS-LASIK but increased significantly from 12.07 ± 1.77 mmHg at 3 months postoperatively to 12.77 ± 1.89 mmHg at 6 months postoperatively after SMILE (p = 0.002). All of the preoperative spherical equivalent and IOP, and changes in the Km, Kf, Ks, and CCT, were significantly associated with the IOP changes in both groups. The preoperative IOP evidenced the strongest relationship with the IOP changes in both groups (R2 = 0.414 in the FS-LASIK group, R2 = 0.292 in the SMILE group).Conclusions: The IOP fell significantly after FS-LASIK and SMILE surgery, significantly more so after FS-LASIK than SMILE. The preoperative IOP exhibited the greatest influence on the IOP decreases after both FS-LASIK and SMILE.
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Zhao W, Han T, Li M, Sekundo W, Aruma A, Zhou X. Nighttime Symptoms After Monocular SMILE: A Contralateral Eye Study. Ophthalmol Ther 2021; 10:1033-1044. [PMID: 34559401 PMCID: PMC8589907 DOI: 10.1007/s40123-021-00396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To investigate nighttime symptoms in patients with myopic anisometropia after monocular small incision lenticule extraction (SMILE) surgery. Methods Thirty-six patients who had undergone monocular SMILE more than 6 months previously were recruited at the Eye & ENT Hospital of Fudan University. The average age at surgery was 25.4 ± 6.1 years. Preoperative spherical equivalent (SE) was −3.77 ± 1.56 D in SMILE-treated eyes and −0.08 ± 0.66 D in unoperated eyes. Main measurements included uncorrected and corrected distance visual acuity, manifest refraction, halo radius, contrast sensitivity, nighttime symptoms, and patient satisfaction. Results The mean follow-up time was 13.9 ± 3.4 months. The efficacy and safety indexes were 1.18 and 1.28, respectively. The halo radius was not significantly different between SMILE-treated and unoperated eyes under luminance conditions of 1, 5, and 100 cd/m2 (P = 0.055). No significant differences were observed in contrast sensitivity at all spatial frequencies between eyes under both uncorrected and corrected conditions (all P > 0.05). None of the patients reported moderate or severe symptoms at night. Mild symptoms (glare, halo, starburst) were reported and binocularly equal in 13 patients, whereas four patients reported better night vision in SMILE-treated eyes than unoperated eyes, and one of them experienced mild night vision disturbance. The overall satisfaction score was 9.39 ± 0.80. Conclusions The disk halo size and contrast sensitivity in SMILE-treated eyes were similar to those in unoperated eyes, and nighttime symptoms almost completely resolved after SMILE.
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Affiliation(s)
- Wuxiao Zhao
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Walter Sekundo
- Department of Ophthalmology, Phillips University of Marburg, Marburg, Germany
| | - Aruma Aruma
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
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Charpentier S, Keilani C, Maréchal M, Friang C, De Faria A, Froussart-Maille F, Delbarre M. Corneal haze post photorefractive keratectomy. J Fr Ophtalmol 2021; 44:1425-1438. [PMID: 34538661 DOI: 10.1016/j.jfo.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
Corneal haze represents subepithelial corneal fibrosis, a manifestation of a pathological healing process. It occurs as a result of an epithelial-stromal lesion involving a break in the epithelial barrier. It is an inflammatory response that involves the migration, multiplication and differentiation of keratocytes into mature myofibroblasts, causing loss of corneal transparency. Although it is a transient phenomenon, this complication is feared following refractive photokeratectomy (PRK), because it can cause alterations in the quality of vision, refractive regression and decreased visual acuity. The severity of these symptoms is correlated with the severity of the corneal haze, which can be assessed clinically or by objective means such as corneal densitometry measurement. The frequency and severity of corneal haze increase with the depth of photoablation in PRK and are therefore increased during the treatment of severe ametropia. Considering that no consensus exists, the application of mitomycin C (MMC) intraoperatively and topical corticosteroids postoperatively are conventionally used to inhibit collagen synthesis, sometimes in combination with various protocols depending on the center or surgeon. This review of the literature reports the current knowledge on corneal haze, in order to better understand it and optimise its prevention in the context of a decreased MMC supply, which has occurred in the past and could recur in the future.
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Affiliation(s)
- S Charpentier
- Service d'ophtalmologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé Cedex, France.
| | - C Keilani
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France
| | - M Maréchal
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - C Friang
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - A De Faria
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
| | - F Froussart-Maille
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France; École du Val-de-Grâce, 1, place Alphonse Laveran, 75230 Paris Cedex 05, France
| | - M Delbarre
- Service ophtalmologie, hôpital d'instruction des armées Percy, BP 406, 92141 Clamart Cedex, France; Centre principal d'expertise du personnel naviguant, BP 406, 92141 Clamart Cedex, France
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Age-related differences in corneal nerve regeneration after SMILE and the mechanism revealed by metabolomics. Exp Eye Res 2021; 209:108665. [PMID: 34118276 DOI: 10.1016/j.exer.2021.108665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effect of age on wound healing after small incision lenticule extraction (SMILE) and the underlying metabolomic mechanisms. METHODS This prospective study was conducted on 216 patients in four groups: the 18-20 (n = 38, Group I), 21-30 (n = 84, Group Ⅱ), 31-40 (n = 58, Group Ⅲ), and 41-50 (n = 36, Group IV) age groups. The density of corneal epithelial wing cells, basal cells, corneal stromal cells, endothelial cells and corneal nerves were examined with a laser confocal microscope (HRT III-RCM) before and 1 month, 3 month, 6 month and 1 year after SMILE. The central nerve fiber length (CNFL), the central corneal nerve fibre density (CNFD), and the central corneal nerve branch density (CNBD) were analyzed by Nero J. The corneal stroma lenticules were obtained from SMILE to analyze metabolites by high-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry (HPLC-QTOF-MS). RESULTS The density of corneal wing epithelial cells and basal epithelial cells have no significant difference among the four groups. The CNFL was 21.90 ± 1.68 mm/mm2 in Group Ⅰ and 21.63 ± 2.09 mm/mm2 in Group Ⅱ after 1 year of SMILE, which represented a return to the preoperative level, whereas the CNFL of Group Ⅲ (19.40 ± 0.98 mm/mm2) and Group Ⅳ (18.94 ± 0.72 mm/mm2) were lower than that preoperation (P ˂0.01). CNFL repair had a negative correlation with age after surgery (Pearson's R = -0.572, P ˂0.01). The CNFD and the CNBD showed the same trend with the CNFL (Pearson's R = -0.602 and -0.531, P ˂0.05). Through screening the significantly different metabolites between the 18-30 age group (including Group I and Group Ⅱ) and other two groups, 6 common remarkably different metabolites were identified. Meanwhile, 5 unique different metabolites were identified only between the 18-30 age group and the 31-40 age group. Six unique different metabolites were identified only between the 18-30 age group and the 41-50 age group. CONCLUSION Corneal nerve repair after SMILE was significantly affected by age. The identified age-associated differences in metabolites were mainly related to inflammation, oxidation, nerve protection and regeneration.
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Kwak JJ, Jun I, Kim EK, Seo KY, Kim TI. Clinical Outcomes of Small Incision Lenticule Extraction in Myopia: Study of Vector Parameters and Corneal Aberrations. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:76-84. [PMID: 32037752 PMCID: PMC7010474 DOI: 10.3341/kjo.2019.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 10/17/2019] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To investigate clinical outcomes of small incision lenticule extraction (SMILE) including vector parameters and corneal aberrations in myopic patients. METHODS This retrospective, observational case series included 57 eyes (29 patients) that received treatment for myopia using SMILE. Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1 and 3 months after surgery. We analyzed the safety, efficacy, vector parameters, and corneal aberrations at 3 months after surgery. RESULTS Preoperatively, mean manifest refraction spherical equivalent refraction was -4.94 ± 1.94 D (range, -8.25 to 0 diopters [D]), and the cylinder was -1.14 ± 0.82 D (range, -3 to 0 D). Mean manifest refraction spherical equivalent improved to -0.10 ± 0.23 D at 3 months postoperatively, when uncorrected distance visual acuity was 20 / 20 or better in 55 (96%) eyes. The linear regression model of target induced astigmatism vector versus surgically induced astigmatism vector exhibited slopes and coefficients (R²) of 0.9618 and 0.9748, respectively (y = 0.9618x + 0.0006, R² = 0.9748). While total corneal root mean square higher order aberrations, coma and trefoil showed statistically significant increase, spherical aberration did not show statistically significant change after SMILE. CONCLUSIONS SMILE has proven to be effective and safe for correcting myopia and astigmatism. We showed that SMILE did not induce spherical aberrations. A small increase in postoperative corneal higher order aberration may be associated with increase in coma and trefoil.
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Affiliation(s)
- Jay Jiyong Kwak
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Jiang Z, Wang H, Luo DQ, Chen J. Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction. Int J Ophthalmol 2021; 14:737-743. [PMID: 34012890 DOI: 10.18240/ijo.2021.05.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare clinical outcomes and refractive stability of implantable collamer lens (ICL) implantation and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia correction. METHODS The Optical Quality Analysis System (OQAS) was used to evaluate clinical outcomes objectively after operation for high myopia correction. We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety index, efficacy index, spherical equivalent, modulation transfer function (MTF) cutoff frequency, strehl ratio (SR) and objective scatter index (OSI). RESULTS At 1y postoperatively, the safety indices were 1.33±0.27 in ICL group, and 1.17±0.24 in FS-LASIK group. 39.58% in the ICL group and 27.59% in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA. The efficacy indices were 1.28±0.22 in ICL group, and 1.13±0.26 in FS-LASIK group. The changes of spherical equivalent from 1wk to 1y postoperatively was -0.12±0.37 D in ICL group, and -0.79±0.58 D in FS-LASIK group (P<0.05). Spherical equivalent within ±0.50 D was achieved in 97.92% in ICL group and 68.97% in FS-LASIK group. MTF cutoff frequency were higher with ICL as compared to FS-LASIK (P<0.05) at each postoperative follow-up stage; for postoperative 1mo later, SR was statistically significant difference between two groups (P<0.05); with no statistically significant difference in OSI between two groups (P>0.05) in postoperative 3mo later. CONCLUSION ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction. ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.
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Affiliation(s)
- Zheng Jiang
- Medical College, Hunan Normal University, Changsha 410006, Hunan Province, China
| | - Hua Wang
- Center for Ophthalmic Optics, Hunan Provincial People's Hospital; the First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan Province, China
| | - Dong-Qiang Luo
- Center for Ophthalmic Optics, Hunan Provincial People's Hospital; the First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan Province, China
| | - Jiao Chen
- Center for Ophthalmic Optics, Hunan Provincial People's Hospital; the First Affiliated Hospital of Hunan Normal University, Changsha 410005, Hunan Province, China
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Zheng K, Han T, Han Y, Liu F, Zhou X. Analysis of factors associated with unintended initial dissection of the posterior plane during small incision lenticule extraction. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:785. [PMID: 34268398 PMCID: PMC8246199 DOI: 10.21037/atm-20-6759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
Background To investigate potential risk factors for unintended initial dissection of the posterior plane in the initial learning curve of small incision lenticule extraction (SMILE). Methods Data were derived from consecutive 263 eyes of 136 patients who underwent SMILE at the beginning of the surgeon's learning curve. Probabilities of unintended initial dissection of the posterior plane in left and right eyes were analyzed. Preoperative sphere, cylinder, spherical equivalent (SE), J0, J45, lenticular diameter, lenticular thickness, corneal thickness, and axial length were assessed between eyes in which posterior plane dissection was unintended and those in which it was not. Results Unintended initial dissection of the posterior plane occurred in 29 eyes, corresponding to an incidence rate of 11.03%. The probability of difficulty in plane dissection in the left eye was significantly higher than that in the right eye (P=0.003). Significant differences were found in sphere (T =2.8, P=0.006), SE (T =2.37, P=0.019), J0 (T =2.05, P=0.043) and axial length (T =-2.79, P=0.006) between eyes with and without unintended initial dissection of the posterior plane. Conclusions In the present study, difficulty in plane dissection during SMILE was encountered significantly more often in left eyes for a right-hand doctor, and in eyes with low SE or high J0 values. Special attention should be paid to prevent unintended initial dissection of the posterior plane in such situations.
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Affiliation(s)
- Ke Zheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yinan Han
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Fang Liu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Dan Z, Xiao-fei H, Yue Z, Guang Y, Xie-he K, Cui-hong Z, Jue H, Yan-ting Y, Jie L, Xiao-peng M. Effects of auricular point sticking on dry eye in myopia patients after SMILE surgery: a prospective randomized controlled clinical trial. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2021. [DOI: 10.1007/s11726-021-1238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yang LJ, Liu X, Mi SJ, Sun L, Chen MX. Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism. Int J Ophthalmol 2021; 14:423-429. [PMID: 33747820 PMCID: PMC7930544 DOI: 10.18240/ijo.2021.03.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the quality outcomes of vision at early phase after topography-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK-CV) and small incision lenticule extraction (SMILE) in treatment of myopia and myopic astigmatism. METHODS Retrospective comparative analysis of 49 patients that underwent FS-LASIK (n=23) or SMILE (n=26) procedure for myopia and myopic astigmatism between April and September in 2019. Pre- and postoperative uncorrected visual acuity (UCVA), spherical equivalent refraction (SEQ), cylindrical refraction, contrast sensitivity function (CSF), and corneal higher-order aberrations (HOAs) were evaluated. Independent t-test was used for inter-group comparison, while repeated measures ANOVA was used to analyze changes at different time points. RESULTS In both groups, 100% of the eyes obtained a UCVA of 20/20 or better at 1wk, 1, and 3mo postoperatively. At 1d and 3mo postoperatively, UCVA was better in FS-LASIK-CV group than in SMILE group. At 1wk postoperatively, SEQ was lower in SMILE group than in FS-LASIK-CV group (P=0.006). At 3mo postoperatively, the SEQ reached target refraction in both groups. The residual astigmatism was reduced in both groups without intergroup difference (P>0.05). At 3mo postoperatively, the spherical aberration and coma under 6 mm pupil size were higher than preoperative levels in both groups (P<0.05). However, the increase in the corneal HOAs in the FS-LASIK-CV group was less than the SMILE group (P<0.05). At 3mo postoperatively, the logCS were better than preoperative levels under scotopic conditions without glare and scotopic conditions with glare in both groups (P<0.05). At 1 and 3mo postoperatively, under scotopic conditions without glare and scotopic conditions with glare, FS-LASIK-CV group showed more improvement in logCS at two spatial frequencies (12.0 c/d and 18.0 c/d; P<0.05). CONCLUSION Both FS-LASIK-CV and SMILE demonstrate to be safe, effective, and predictable in treatment of myopia and myopic astigmatism. Early postoperative improvement in UCVA and CSF at high spatial frequency under scotopic conditions were better after FS-LASIK-CV than SMILE.
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Affiliation(s)
- Lin-Juan Yang
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xuan Liu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Sheng-Jian Mi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Le Sun
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Meng-Xin Chen
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Zhao Y, Qian Y, Chen X, Zhou X, Qin B, Zhou X. Comparison of posterior corneal elevation after SMILE and FS-LASIK in correcting myopia over -9.0 diopters. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:373. [PMID: 33842594 PMCID: PMC8033304 DOI: 10.21037/atm-20-5165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare the changes in posterior corneal elevation after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in correcting myopia over -9 diopters (D). Methods In this prospective comparative study, 82 eyes of 82 patients scheduled for refractive correction were recruited. Eyes were randomly assigned to the SMILE group (45 eyes, -10.43±0.92 D) or FS-LASIK group (37 eyes, -10.97±1.37 D). The posterior corneal surface was measured using a Scheimpflug camera (Pentacam, Oculus, Germany) preoperatively and at 1 day, 1 month, and 6 months after surgery. Posterior corneal elevation in the central point and central 4-mm area, and in various optical zones above the best-fit sphere, was analyzed. A P value of less than 0.05 was considered statistically significant. Results All surgeries were completed successfully. The safety index and efficacy index were 1.20 and 1.00, respectively, in the SMILE group, and was 1.10 and 0.90, respectively, in the FS-LASIK group. No significant difference existed in all analyzed data before and at 6 months after surgery in both the SMILE group and the FS-LASIK group. Changes in posterior corneal elevation after FS-LASIK were greater than after SMILE, with no statistical significance (P≥0.07). In the SMILE group, residual bed thickness was found to be moderately negatively correlated with changes in the elevation in the central area (P≤0.045); whereas it was positively correlated in the peripheral area (P=0.002). Conclusions SMILE and FS-LASIK presented stable posterior corneal surface in correction of myopia over -9.0 D at the follow-up visit of 6 months.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xun Chen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Bing Qin
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Liu J, Tonk RS, Huang AM, Han E, Karp CL, Zeng M, Zou H, Zheng Y, Luo W, Sha X, Liu Z. Transient effect of suction on the retinal neurovasculature in myopic patients after small-incision lenticule extraction. J Cataract Refract Surg 2021; 46:250-259. [PMID: 32126039 DOI: 10.1016/j.jcrs.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To characterize retinal neurovasculature changes after small-incision lenticule extraction (SMILE) in myopic patients. SETTING Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, China. DESIGN Prospective interventional study. METHODS The corrected distance visual acuity/uncorrected distance visual acuity, corrected intraocular pressure (CIOP), and corneal tomography were evaluated at baseline (PRE), postoperative day (POD) 1, and POD 7. Ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were measured. The vessel area densities (VADs, %), vessel skeleton densities (VSDs, %), vessel diameter index (VDI), and fractal dimensions (Dbox) of the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were measured in a circular area (ϕ 2.5 mm) centered on the fovea. RESULTS A total of 38 myopic patients were recruited. The GCIPL thickness was increased after SMILE at POD 1 and POD 7 (P < .01) but no significant changes in the pRNFL thickness. The VAD, VSD, and Dbox of the SVP were decreased at POD 1 (P < .01), but not at POD 7. The VDI in small vessels of the SVP and DVP was decreased at POD 1 (P < .05) and increased at POD 7 (P < .05). Changes in CIOP were positively correlated with changes in the GCIPL thickness. Changes in CIOP were negatively correlated with changes in the VAD of small vessels and the Dbox of total vessels in the DVP. Changes in CIOP were negatively correlated with the VSD and VDI of small vessels in the DVP and changes in the VDI of big vessels in the SVP. CONCLUSIONS The transient fluctuations in the retinal neurovasculature after SMILE may represent a characteristic homeostasis pattern in patients after refractive surgery.
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Affiliation(s)
- Jiayan Liu
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University (Liu, Zeng, Zou, Zheng, Luo, Sha, Liu), Department of Ophthalmology, the Sixth Affiliated Hospital of Guangzhou Medical University (Liu), Qingyuan, China; and Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Tonk, Huang, Han, Karp), Miami, Florida, USA
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Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for high myopia. J Cataract Refract Surg 2021; 46:419-427. [PMID: 32142040 DOI: 10.1097/j.jcrs.0000000000000075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism. SETTING The Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective case series. METHODS Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (-6.00 to -8.75 diopters [D]) and extremely high myopia (≥-9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism. RESULTS This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01). CONCLUSIONS SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
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Sharma B, Soni D, Saxena H, Stevenson LJ, Karkhur S, Takkar B, Vajpayee RB. Impact of corneal refractive surgery on the precorneal tear film. Indian J Ophthalmol 2020; 68:2804-2812. [PMID: 33229655 PMCID: PMC7856956 DOI: 10.4103/ijo.ijo_2296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/28/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Corneal refractive surgeries are one of the commonly performed procedures for correction of refractive errors. Tear film abnormality is the most common postoperative complication of corneal refractive surgeries. Consequently, these procedures represent a clinically significant cause of dry eye disease. The mechanisms which lead to dry eye disease include corneal sensory nerve dysfunction, ocular surface desiccation, glandular apoptosis and ocular surface inflammation. Although transient tear film abnormalities occur in almost all patients following surgery, patients with pre-existing dry eye symptoms or dry eye disease are at significant risk of developing more severe or long-term ocular surface disease. As such, careful patient selection and preoperative evaluation is essential to ensuring successful surgical outcomes. This is particularly important with LASIK which has the strongest association with dry eye disease. Appropriate surface lubrication and anti-inflammatory therapy remains the cornerstone treatment. Timely and effective management is important to facilitate visual rehabilitation and reduce the risk of secondary complications. In this review we describe the causes, pathophysiology, risk factors, manifestations, and management of tear film dysfunction and dry eye disease following corneal refractive surgery.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Louis J Stevenson
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rasik B Vajpayee
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
- Cornea Unit, Vision Eye Institute, Melbourne, Victoria, Australia
- Cornea and Cataract Surgery Unit, University of Melbourne, Melbourne, Victoria, Australia
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Wei R, Li M, Yang W, Shen Y, Zhao Y, Fu D, Shang J, Zhang J, Choi J, Zhou X. Corneal Densitometry After Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser-Assisted LASIK (FS-LASIK): 5-Year Prospective Comparative Study. Front Med (Lausanne) 2020; 7:521078. [PMID: 33240901 PMCID: PMC7681246 DOI: 10.3389/fmed.2020.521078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate long-term changes in corneal densitometry (CD) following small incision lenticule extraction (SMILE) vs. femtosecond laser-assisted LASIK (FS-LASIK) in patients with myopia or myopic astigmatism. Methods: Prospective analysis was performed in 66 eyes of 38 patients (13 males) who underwent SMILE and 54 eyes of 29 patients (5 males) who underwent FS-LASIK. In all patients, an ocular examination was performed preoperatively, and at 6–12 months and 5 years postoperatively. CD was obtained with the Pentacam Scheimpflug imaging system at the 0–2-mm, 2–6-mm, and 6–10-mm zones of the cornea at depth of anterior 120 μm, midcornea, and posterior 60 μm. Correlation analysis was performed between postoperative change in CD and other variables such as age, type of surgery, central corneal thickness, spherical equivalent, lenticule thickness/ablation depth, and changes in wavefront aberrations. Results: At postoperative 6–12 months, a significant reduction at several corneal zones in the FS-LASIK cohort (P < 0.05) was observed. In the SMILE cohort, no significant change in CD relative to baseline was observed. However, at 5 years postoperatively, in both groups, a significant decrease in CD was observed in three zones of three layers (all P < 0.001). The change in CD was similar between groups at postoperative 6–12 months, but at 5 years the magnitude of change was significantly smaller in SMILE than FS-LASIK in the anterior and central layers (all P < 0.05). Conclusion: CD with the Scheimpflug imaging system showed a significant decrease at 5 years after SMILE or FS-LASIK, and the change was significantly less pronounced after SMILE.
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Affiliation(s)
- Ruoyan Wei
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Shen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Joanne Choi
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, United States
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Asif MI, Bafna RK, Mehta JS, Reddy J, Titiyal JS, Maharana PK, Sharma N. Complications of small incision lenticule extraction. Indian J Ophthalmol 2020; 68:2711-2722. [PMID: 33229647 PMCID: PMC7856979 DOI: 10.4103/ijo.ijo_3258_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
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Affiliation(s)
- Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jodhbir Singh Mehta
- Singapore Eye Research Institute; Singapore National Eye Centre, 168751; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Jagadesh Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Alio Del Barrio JL, Parafita-Fernandez A, Canto-Cerdan M, Alio JL, Teus M. Evolution of corneal thickness and optical density after laser in situ keratomileusis versus small incision lenticule extraction for myopia correction. Br J Ophthalmol 2020; 105:1656-1660. [PMID: 32980816 DOI: 10.1136/bjophthalmol-2020-316601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/19/2020] [Accepted: 09/06/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the thickness and stromal optical density (OD) evolution of the flap and cap after femtosecond (FS-LASIK; Visumax) and small incision lenticule extraction (SMILE), respectively, for myopia correction. METHODS A prospective study comprising 78 eyes (n=39 per group) was performed. Anterior segment optical coherence tomography (MS39) images were collected at each postoperative visit (1 day, 1 week and 1 and 3 months) and flap/cap thicknesses were measured. Using ImageJ software, three regions were defined to measure OD (in grayscale units: flap/cap stroma, residual stromal bed (RSB) and all stroma (including flap/cap-stroma, surgical interface and RSB). RESULTS Mean central thickness significantly increased during the 3-month follow-up in both LASIK (5.43±4.23 μm; p=0.0118) and SMILE (2.76±5.61 μm; p=0.0118), with differences between both techniques statistically significant (p=0.020). All OD values showed a statistically significant reduction during SMILE follow-up: cap 48.96±5.55 versus 44.95±5.41 (p=0.19×10-6), RSB 50.26±7.06 versus 45.42±7.53 (p=0.00005), total stroma 50.34±6.49 versus 45.46±6.96 (p=0.5×10-5) at 1 day and 3 months, respectively, whereas no statistically significant changes were found during LASIK follow-up. No significant differences were observed in OD values between both techniques at any time point, although SMILE showed a tendency for higher OD values than LASIK within the first postoperative month. Visumax presented a tendency for thicker caps than target (11.48±7.85 μm), but not for flaps (2.73±8.93 μm) (p=0.00003). CONCLUSIONS Both LASIK flaps and SMILE caps show a significant postoperative rethickening. SMILE corneas present higher optical densities than LASIK corneas in the early postoperative period, with a significant decrease thereafter and up to 3 months. These findings correlate with the delayed visual recovery observed after SMILE.
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Affiliation(s)
- Jorge Luis Alio Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, VISSUM (Grupo Miranza), Alicante, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Alberto Parafita-Fernandez
- Ophthalmology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain.,Clínica Oftalmológica Dr Parafita, Ribeira, A Coruña, Spain
| | - Mario Canto-Cerdan
- Cornea, Cataract and Refractive Surgery Unit, VISSUM (Grupo Miranza), Alicante, Spain
| | - Jorge L Alio
- Cornea, Cataract and Refractive Surgery Unit, VISSUM (Grupo Miranza), Alicante, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Miguel Teus
- Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain .,Clínica Novovisión, Madrid, Spain
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46
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Fu D, Zhao Y, Zhou X. Corneal Biomechanical Properties after Small Incision Lenticule Extraction Surgery on Thin Cornea. Curr Eye Res 2020; 46:168-173. [PMID: 32643431 DOI: 10.1080/02713683.2020.1792507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore the biomechanical changes in thin corneas after the small incision lenticule extraction (SMILE) surgery. METHODS This prospective survey screened patients scheduled for the SMILE surgery from November 2017 to March 2018. Patients with thin corneas (central corneal thickness [CCT] ≤500 μm) and those with normal corneal thickness (CCT > 500 μm) were enrolled. Corneal biomechanics were examined by the ocular response analyser and Corvis ST, preoperatively and at 1 day, 3 weeks, and 3 months postoperatively. RESULTS Twenty-seven patients (46 eyes) with mean spherical equivalent of -5.1 ± 1.7 D were assigned to the thin cornea group, and 28 (45 eyes) cases with mean spherical equation of -5.3 ± 1.8 D were assigned to the control group. Safety and efficacy did not differ between the two age- and refraction-matched groups (safety index, 1.15 ± 0.14 vs 1.14 ± 0.17 [P = .7]; efficacy index, 1.11 ± 0.13 vs 1.16 ± 0.22 [P = .2]). All biomechanical parameters changed significantly after SMILE. The thin cornea group showed less decrease in the second applanation time (A2 Time), stiffness parameters at first applanation (SP-A1). Pooling data from two groups, lower CCT was correlated with less A2 Time change (r = 0.37, P < .01) and less SP-A1 change (r = -0.33, P < .01). Less bIOP change was correlated with higher residual stromal thickness index and thicker CCT (P = .003, R2 = 0.12). CONCLUSION Over a short-term observation period, less corneal biomechanic deterioration may have contributed to the safety of SMILE on thin cornea.
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Affiliation(s)
- Dan Fu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, China.,NHC Key Laboratory of Myopic (Fudan University) , Shanghai, China.,Shanghai Research Centre of Ophthalmology and Optometry , Shanghai, China
| | - Yu Zhao
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, China.,NHC Key Laboratory of Myopic (Fudan University) , Shanghai, China.,Shanghai Research Centre of Ophthalmology and Optometry , Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai, China.,NHC Key Laboratory of Myopic (Fudan University) , Shanghai, China.,Shanghai Research Centre of Ophthalmology and Optometry , Shanghai, China
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47
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Wilson SE. Biology of keratorefractive surgery- PRK, PTK, LASIK, SMILE, inlays and other refractive procedures. Exp Eye Res 2020; 198:108136. [PMID: 32653492 DOI: 10.1016/j.exer.2020.108136] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
The outcomes of refractive surgical procedures to improve uncorrected vision in patients-including photorefractive keratectomy (PRK), laser in-situ keratomileusis (LASIK), Small Incision Lenticule Extraction (SMILE) and corneal inlay procedures-is in large part determined by the corneal wound healing response after surgery. The wound healing response varies depending on the type of surgery, the level of intended correction of refractive error, the post-operative inflammatory response, generation of opacity producing myofibroblasts and likely poorly understood genetic factors. This article details what is known about these specific wound healing responses that include apoptosis of keratocytes and myofibroblasts, mitosis of corneal fibroblasts and myofibroblast precursors, the development of myofibroblasts from keratocyte-derived corneal fibroblasts and bone marrow-derived fibrocytes, deposition of disordered extracellular matrix by corneal fibroblasts and myofibroblasts, healing of the epithelial injury, and regeneration of the epithelial basement membrane. Problems with epithelial and stromal cellular viability and function that are altered by corneal inlays are also discussed. A better understanding of the wound healing response in refractive surgical procedures is likely to lead to better treatments to improve outcomes, limit complications of keratorefractive surgical procedures, and improve the safety and efficiency of refractive surgical procedures.
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Affiliation(s)
- Steven E Wilson
- Cole Eye Institute, I-32, Cleveland Clinic, 9500, Euclid Ave, Cleveland, OH, United States.
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48
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The best optical zone for small-incision lenticule extraction in high myopic patients. J Cataract Refract Surg 2020; 46:1302-1307. [PMID: 32569029 DOI: 10.1097/j.jcrs.0000000000000282] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Small-incision lenticule extraction (SMILE) is an effective and safe procedure for the correction of myopia due to minimally invasive and noncorneal flap surgery. However, the SMILE procedure has certain requirements for corneal cap thickness, attempted refractive correction, residual stromal bed thickness, and optical zone diameter, which sometimes make surgeons hesitant to choose SMILE or other refractive surgeries. The requirements limit its use in patients with high myopia. The purpose of this review was to find the optimal parameters of SMILE through discussing the best optical zone for high myopic patients, the visual quality of different optical zones, the choice of corneal cap thickness, and their effects on corneal biomechanical parameters, so surgeons can provide reference recommendations for patients with high myopia in choosing a reasonable and safe procedure.
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49
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Yam GHF, Riau AK, Funderburgh ML, Mehta JS, Jhanji V. Keratocyte biology. Exp Eye Res 2020; 196:108062. [PMID: 32442558 DOI: 10.1016/j.exer.2020.108062] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
The study of corneal stromal keratocytes is motivated by its strong association with corneal health and visual function. They play a dominant role in the maintenance of corneal homeostasis and transparency through the production of collagens, proteoglycans and corneal crystallins. Trauma-induced apoptosis of keratocytes and replacement by fibroblasts and myofibroblasts disrupt the stromal matrix organization, resulting in corneal haze formation and vision loss. It is, therefore, important to understand the biology and behaviours of keratocytes and the associated stromal cell types (like fibroblasts, myofibroblasts, stromal stem cells) in wound healing, corneal pathologies (including keratoconus, keratitis, endothelial disorders) as well as different ophthalmic situations (such as collagen crosslinking/photodynamic treatment, keratoplasty and refractive surgery, and topical medications). The recent development of ex vivo propagation of keratocytes and stromal stem cells, and their translational applications, either via stromal injection or incorporated in bioscaffold, have been shown to restore the corneal transparency and regenerate native stromal tissue in animal models of corneal haze and other disorders.
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Affiliation(s)
- Gary H F Yam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Andri K Riau
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | | | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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Liu L, Cheng W, Wu D, Chen L, Yu S, Zuo T, Zhang L, Yang K, Li H, Zhang H, Wei P, Ng ALK, Cheng GPM, Woo VCP, Yin J, Chiu K, Wang Y. The Differential Expression of Cytokines and Growth Factors After SMILE Compared With FS-LASIK in Rabbits. Invest Ophthalmol Vis Sci 2020; 61:55. [PMID: 32460319 PMCID: PMC7405797 DOI: 10.1167/iovs.61.5.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the differential expression of cytokines and growth factors in the cornea and aqueous humor after small incision lenticule extraction (SMILE) compared with femtosecond LASIK (FS-LASIK) using rabbit model. Methods Sixteen eyes of 16 rabbits in each group underwent SMILE or FS-LASIK with refractive correction of −6.00 DS/−1.00 DC. Eight additional rabbits served as controls. Pre- and 24 hours, 1 week, 1 month, and 3 months postoperatively, slit-lamp and anterior segment optical coherence tomography were performed, followed by cornea and aqueous humor collection. Apoptosis and proliferation were evaluated with TUNEL assay and Ki-67 immunostaining, respectively. The mRNA and protein expression of cytokines and growth factors was determined by RT-qPCR and Western blotting, respectively. Cytokine levels in the aqueous humor were detected with ELISA. Results Compared with FS-LASIK, SMILE induced less apoptosis and proliferation in the cornea within 1 week postoperatively. Levels of IL-1β, TNF-α, and EGFR in the cornea were significantly increased after FS-LASIK compared with SMILE within 24 hours. Levels of IL-8 in the aqueous humor remained elevated until 1 week after FS-LASIK but not SMILE. TGF-β1 level was elevated up to 1 month after both procedures, while BFGF level was kept high within 1 month after SMILE but not FS-LASIK. Conclusions SMILE could induce significantly less acute inflammation than FS-LASIK in the cornea and aqueous humor. The differential expression of TGF-β1 and BFGF between two procedures until 1 month might contribute to the post-SMILE delayed recovery and underline the importance of continued treatment postoperatively.
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