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Clinical Outcomes After SMILE and Femtosecond Laser-Assisted LASIK for Myopia and Myopic Astigmatism. Cornea 2016; 35:210-6. [DOI: 10.1097/ico.0000000000000707] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miruna N, Andrei F, Mircea Vasile F, Eugen R. Smile--the next generation of laser vision correction. Rom J Ophthalmol 2016; 60:6-8. [PMID: 27220224 PMCID: PMC5712922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our paper is an introduction in this new generation of Laser vision correction, called SMILE. It also reveals our experience in the past year, since we started to perform this new procedure in our patients. Small Incision Lenticule Extraction technique is the 3rd generation of Laser vision correction that completely redefines refractive surgery. Being performed entirely with femtosecond laser, SMILE is tissue preserving and very gentle for the eye. In 2011, it was launched internationally. We have started with SMILE in October 2014. Since then, we have performed more than 200 procedures, with the range of corrected diopters between -2 and -10 and astigmatism between -2 and -5. In the near future, hyperopic diopters will be corrected with SMILE.
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Liu R, Zhao J, Xu Y, Li M, Niu L, Liu H, Sun L, Chu R, Zhou X. Femtosecond Laser-Assisted Corneal Small Incision Allogenic Intrastromal Lenticule Implantation in Monkeys: A Pilot Study. Invest Ophthalmol Vis Sci 2015; 56:3715-20. [PMID: 26047173 DOI: 10.1167/iovs.14-15296] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Lenticule implantation can be used to correct vision problems. However, it is significantly restrained by the sources of autologous lenticules. The aim of the present study was to investigate the feasibility and effects of femtosecond laser-assisted corneal small incision allogenic intrastromal lenticule implantation (AILI) in monkeys. METHODS Six healthy adult monkeys were included in this study. Femtosecond lenticule extraction (-4.0 diopter [D] correction, 5.0-mm optical zone) was performed in one eye of two monkeys and both eyes of one monkey. Each extracted refractive lenticule was allogenically transplanted into a femtosecond laser-created corneal stromal pocket in one eye of the other two monkeys and one monkey's both eyes. Pre- and postoperative (1 or 3 days, 1 month, and 6 months) slit lamp microscopy, corneal topography, anterior segment optical coherence tomography, and in vivo confocal microscopy were performed. RESULTS Corneal edema occurred in the early postoperative days with a large number of hyperreflective particles around the borders. Corneal tissue edema gradually decreased. Nerve fiber regeneration could be detected in the lenticule layer at 6 months. Overall, 3.27 ± 1.2 D corneal power was increased at 6 months, accounting for 82% of the intended correction. At the same time point, corneal stroma was 69 ± 11 μm thicker than preoperative ones and was roughly equal to the maximum thickness of implanted lenticules. No significant complications were observed. CONCLUSIONS The AILI technique seems to be feasible and safe for increasing corneal stromal thickness and changing corneal refractive power, which may provide a useful method for treatment of keratoectasia, presbyopia, and hyperopia.
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Affiliation(s)
- Rui Liu
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Ye Xu
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Meiyan Li
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lingling Niu
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | | | - Ling Sun
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Renyuan Chu
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xingtao Zhou
- Key Laboratory of Myopia Ministry of Health, Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
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Effect of Intraoperative Corneal Stromal Pocket Irrigation in Small Incision Lenticule Extraction. BIOMED RESEARCH INTERNATIONAL 2015; 2015:928608. [PMID: 26273659 PMCID: PMC4530243 DOI: 10.1155/2015/928608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 11/17/2022]
Abstract
This study aimed at evaluating the effect of intraoperative corneal pocket irrigation in small incision lenticule extraction (SMILE) and compares it to that in femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Sixteen rabbit eyes underwent a SMILE procedure, with 8 eyes having corneal pocket irrigation, while the other 8 eyes were without irrigation. Another 16 eyes underwent a FS-LASIK procedure for comparison, with 8 eyes having flap irrigation, while the other 8 eyes were without irrigation. The results showed that the changes in the total corneal thickness, anterior and posterior lamellar thickness, measured by the anterior segment optical coherence tomography, were comparable between the SMILE with and without irrigation groups, suggesting that the irrigation did not lead to significant changes in the corneal thickness. However, at postoperative 8 hours, in vivo confocal microscopy showed that the interface reflectivity in the SMILE with irrigation group was significantly higher than that in other three groups. The presence of interface fluid was further confirmed by the identification of fluid pockets with undulated collagen shown on histological section in the post-SMILE with irrigation eyes. Our findings might contribute to the occurrence of post-SMILE delayed immediate visual quality recovery and further clinical study is required.
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Chan TCY, Ng ALK, Cheng GPM, Wang Z, Ye C, Woo VCP, Tham CCY, Jhanji V. Vector analysis of astigmatic correction after small-incision lenticule extraction and femtosecond-assisted LASIK for low to moderate myopic astigmatism. Br J Ophthalmol 2015. [DOI: 10.1136/bjophthalmol-2015-307238] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Li X, Wang Y, Dou R. Aberration compensation between anterior and posterior corneal surfaces after Small incision lenticule extraction and Femtosecond laser-assisted laser in-situ keratomileusis. Ophthalmic Physiol Opt 2015; 35:540-51. [PMID: 26087672 DOI: 10.1111/opo.12226] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the aberration compensation between anterior and posterior corneal surfaces after SMILE and FS-LASIK. METHODS Fifty-five subjects (55 eyes) undergoing SMILE and 51 subjects (51 eyes) undergoing FS-LASIK were enrolled in this study. Wavefront aberrations of anterior and posterior corneal surfaces and the whole cornea at 6 mm in diameter were measured using a Scheimpflug Camera preoperatively and one, three and 6 months postoperatively. The compensation factor (CF), where CF = 1 - (aberration of the whole cornea/aberration of anterior corneal surface), was calculated. RESULTS Spherical aberration of the posterior surface and the whole cornea remained stable after SMILE. However, spherical aberration of posterior surface increased significantly at 6 months in the FS-LASIK group. The total higher-order aberration (tHOA) of the anterior surface and the whole cornea was lower at 6 months than at one and 3 months (p = 0.001 and 0.001, respectively) in the FS-LASIK group. Meanwhile, in the SMILE group, no significant difference in tHOA was found between various postoperative time points. There were significant decreases in the CF of tHOA compared with preoperative values in both groups. The CF of spherical aberration reduced significantly in both groups at 3 and 6 mm in diameter one, three and 6 months postoperatively. Significant decreases in the CF of vertical coma were found at three and 6 months postoperatively in the FS-LASIK group compared with preoperative values at 6 mm in diameter (p = 0.021 and 0.008, respectively). The change in CF (ΔCF) of spherical aberration was smaller in the SMILE group than in the FS-LASIK group at one and 3 months postoperatively (p = 0.003 and p < 0.0001, respectively). The ΔCF of spherical aberration was significantly lower in moderately myopic subjects than in subjects with high myopia at 1 month in the SMILE group (p = 0.041) and at one, three and 6 months in the FS-LASIK group (p = 0.014, 0.020, and 0.004, respectively). CONCLUSIONS The posterior corneal surface plays an important role in compensating for spherical aberration of the anterior corneal surface. The compensation mechanisms of spherical aberration and higher-order aberration between anterior and posterior corneal surfaces were disrupted by the SMILE and the FS-LASIK procedures. The change in the CF of spherical aberration was smaller in the SMILE group compared with the FS-LASIK group, especially in subjects with high myopia.
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Affiliation(s)
- Xiaojing Li
- Refractive Surgery Center, Tianjin Eye Hospital, Tianjin, China
| | - Yan Wang
- Refractive Surgery Center, Tianjin Eye Hospital, Tianjin, China
| | - Rui Dou
- Refractive Surgery Center, Tianjin Eye Hospital, Tianjin, China
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Abstract
Corneal photorefractive surgery is currently performed by ablation of corneal stroma under the stromal flap. A stromal flap is created using a femtosecond (FS) laser or mechanical microkeratome, although the FS laser procedure is considered safer and more accurate. This review assesses and compares the use of FS laser versus mechanical microkeratome ablation for corneal stromal characteristics mainly examined by histology and cellular biological responses. Supporting data from our studies, using corneas of enucleated porcine eye globes, are included in this review. Histological analysis and experimental studies of cellular/tissue responses to FS laser irradiation should be further investigated, and the equipment used to perform these techniques should be improved.
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Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. EYE AND VISION (LONDON, ENGLAND) 2014; 1:3. [PMID: 26605350 PMCID: PMC4604118 DOI: 10.1186/s40662-014-0003-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Abstract
This review summarizes the current status of the small incision lenticule extraction (SMILE) procedure. Following the early work by Sekundo et al. and Shah et al., SMILE has become increasingly popular. The accuracy of the creation of the lenticule with the VisuMax femtosecond laser (Carl Zeiss Meditec) has been verified using very high-frequency (VHF) digital ultrasound and optical coherence tomography (OCT). Visual and refractive outcomes have been shown to be similar to those achieved with laser in situ keratomileusis (LASIK), notably in a large population reported by Hjortdal, Vestergaard et al. Safety in terms of the change in corrected distance visual acuity (CDVA) has also been shown to be similar to LASIK. It was expected that there would be less postoperative dry eye after SMILE compared to LASIK because the anterior stroma is disturbed only by the small incision, meaning that the anterior corneal nerves should be less affected. A number of studies have demonstrated a lower reduction and faster recovery of corneal sensation after SMILE than LASIK. Some studies have also used confocal microscopy to demonstrate a lower decrease in subbasal nerve fiber density after SMILE than LASIK. The potential biomechanical advantages of SMILE have been modeled by Reinstein et al. based on the non-linearity of tensile strength through the stroma. Studies have reported a similar change in Ocular Response Analyzer (Reichert) parameters after SMILE and LASIK, however, these have previously been shown to be unreliable as a representation of corneal biomechanics. Retreatment options after SMILE are discussed. Tissue addition applications of the SMILE procedure are also discussed including the potential for cryo-preservation of the lenticule for later reimplantation (Mohamed-Noriega, Angunawela, Lim et al.), and a new procedure referred to as endokeratophakia in which a myopic SMILE lenticule is implanted into a hyperopic patient (Pradhan et al.). Finally, studies reporting microdistortions in Bowman's layer and corneal wound healing responses are also described.
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Affiliation(s)
- Dan Z Reinstein
- />London Vision Clinic, 138 Harley Street, London, W1G 7LA UK
- />Department of Ophthalmology, Columbia University Medical Center, New York, NY USA
- />Centre Hospitalier National d’Ophtalmologie, Paris, France
| | | | - Marine Gobbe
- />London Vision Clinic, 138 Harley Street, London, W1G 7LA UK
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Early changes in ocular surface and tear inflammatory mediators after small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis. PLoS One 2014; 9:e107370. [PMID: 25211490 PMCID: PMC4161422 DOI: 10.1371/journal.pone.0107370] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To characterize the early ocular-surface changes or tear inflammatory-mediators levels following small-incision lenticule extraction (ReLEx smile) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS Forty-seven myopic subjects were recruited for this prospective study. Fifteen underwent ReLEx smile and thirty-two underwent FS-LASIK. Corneal fluorescein (FL) staining, tear break-up time (TBUT), Schirmer I test (SIT), ocular surface disease index (OSDI) and central corneal sensitivity were evaluated in all participants. Tears were collected and analyzed for interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nerve growth factor (NGF) and intercellular adhesion molecule-1 (ICAM-1) levels using multiplex magnetic beads. All measurements were preformed preoperatively and 1 day, 1 week, 1 month and 3 months postoperatively. RESULTS FL scores in ReLEx smile group were lower than those of FS-LASIK group 1 week postoperatively (P = 0.010). Compared to the FS-LASIK group, longer TBUT were observed in ReLEx smile group 1 month (P = 0.029) and 3 months (P = 0.045) postoperatively. No significant differences were found in tear secretion for the two groups (P>0.05). OSDI scores were higher in FS-LASIK group 1 month after surgery (P = 0.020). Higher central corneal sensitivity was observed in ReLEx smile group 1 week, 1 month and 3 months (P<0.05) postoperatively. Compared to FS-LASIK group, lower and faster recovery of IL-6 and NGF levels in tears was observed in ReLEx smile group postoperatively (P<0.05). Tears TNF-α and ICAM-1 concentrations were not significantly different between the two groups at any follow-up time (P>0.05). Moreover, IL-6 and NGF levels correlated with ocular surface changes after ReLEx smile or FS-LASIK. CONCLUSIONS In the early postoperative period, ReLEx smile results in milder ocular surface changes than FS-LASIK. Furthermore, the tear inflammatory mediators IL-6 and NGF may play a crucial role in the ocular surface healing process following ReLEx smile and FS-LASIK.
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Mastropasqua L, Calienno R, Lanzini M, Colasante M, Mastropasqua A, Mattei PA, Nubile M. Evaluation of corneal biomechanical properties modification after small incision lenticule extraction using Scheimpflug-based noncontact tonometer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:290619. [PMID: 25309907 PMCID: PMC4163343 DOI: 10.1155/2014/290619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify the effect of small incision lenticule extraction (SMILE) on the corneal biomechanics using Scheimpflug noncontact tonometer (Corvis ST). METHODS Twenty eyes of twenty patients, evaluated as eligible for surgery, with high myopia and/or moderate myopic astigmatism, underwent small incision lenticule extraction (SMILE). All patients underwent Corvis ST preoperatively and postoperatively after 1 week, and 1 and 3 months to observe alterations of corneal biomechanical properties. The main outcome measures were Deformation Amplitude, 1st-AT, and 2nd-AT. The relationship between the amount of stroma removed and the percentage variation of the measured parameters from baseline was evaluated with generalized linear model from each time point. For completeness also intraocular pressure (IOP), central corneal thickness (CCT), and their variations after surgery were evaluated. RESULTS The ratio between the amount of removed refractive error and, respectively, changes of Deformation Amplitude, 1st-AT, and 2nd-AT were significantly modified at the 1st week after surgery (P = 0.005; P = 0.001; P = 0.024). At 1 and 3 months these values did not show statistically significant alterations. Intraocular pressure and central corneal thickness showed statistically significant changes during follow-up. CONCLUSIONS No significant modifications in biomechanical properties were observed after SMILE so this procedure could induce only minimal transient alterations of corneal biomechanics.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Roberta Calienno
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Manuela Lanzini
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Martina Colasante
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | | | - Peter A. Mattei
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Mario Nubile
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
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Ganesh S, Gupta R. Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism. J Refract Surg 2014; 30:590-6. [DOI: 10.3928/1081597x-20140814-02] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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112
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Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an overview and update on recent literature regarding ocular surface disease and corneal refractive surgery. RECENT FINDINGS Studies involving ocular surface disease and/or keratorefractive (corneal) surgery published found on the Medline database were included in the report. Studies focused on mechanisms of refractive surgery induced dry eye disease, surgical options, including modification of technique, to prevent dry eye, and postoperative dry eye prevention and management by way of both established and novel therapies. SUMMARY By understanding the mechanisms of postoperative dry eye as well as patient risk factors for dry eye, patient satisfaction and surgical outcomes can be maximized. Patients identified as having an increased risk for postoperative dry eye may benefit from surgical techniques such as small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (LASIK). Employing well known therapies such as preserved and nonpreserved artificial tears, nutritional supplements, topical cyclosporins, punctal plugs and autologus serum as well as novel therapies such as insulin-like growth factor 1, neuropeptides and acupuncture could provide improve outcomes and, if started early, could allow more patients to be candidates for corneal refractive surgery.
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Shen Y, Chen Z, Knorz MC, Li M, Zhao J, Zhou X. Comparison of Corneal Deformation Parameters After SMILE, LASEK, and Femtosecond Laser-Assisted LASIK. J Refract Surg 2014; 30:310-8. [DOI: 10.3928/1081597x-20140422-01] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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