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Chao CC, Lin MY, Chang CK. The Association Between Ocular Residual Astigmatism and the Efficacy of Astigmatism Correction Via Small Incision Lenticule Extraction (SMILE). Ophthalmol Ther 2023; 12:2631-2640. [PMID: 37470969 PMCID: PMC10441899 DOI: 10.1007/s40123-023-00766-1] [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: 04/27/2023] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Astigmatism correction after small-incision lenticule extraction (SMILE) surgery is affected by several factors, including ocular residual astigmatism (ORA), which accounts for the vector difference between refractive and corneal astigmatism. Previous studies revealed the relationship between ORA and astigmatism correction after laser-assisted in situ keratomileusis (LASIK). However, in SMILE surgery, no comprehensive study exploring the link between these two variables has been performed. We have therefore assessed the association between ORA and astigmatism correction after SMILE. METHODS This was a retrospective, single-centered study. Patients with myopia or myopic astigmatism who underwent SMILE surgery using the 500-kHz Visumax laser platform and were followed up for at least 3 months were included. Patients' demographic and clinical characteristics, such as visual acuity, refractive status and corneal tomography, were recorded. ORA was calculated using Alpins Statistical System for Ophthalmic Refractive Surgery Techniques (ASSORT) Ocular Residual Astigmatism calculator. RESULTS A total of 888 eyes (408 eyes from males and 480 eyes from females) from 444 patients (mean age [standard deviation] 32.4 ± 7.1 years) were included in our study. Mean (± SD) preoperative sphere and cylinder were - 5.45 ± 1.98 (range - 10.00-0.00) diopter (D) and - 0.89 ± 0.70 (range - 4.00-0.00) D, respectively. Calculated mean ORA was 0.68 ± 0.35 (range 0.07-3.53) D. Postoperative logMAR uncorrected visual acuity was 0.03 ± 0.31. Mean postoperative sphere and cylinder were - 0.10 ± 0.56 (range - 1.5 to 1.0) D and - 0.51 ± 0.37 (- 1.5 to 0.0) D, respectively. The Pearson correlation test revealed preoperative sphere, steep keratometry (steep-K) and ORA were statistically correlated with the amplitude of astigmatism correction (P < 0.001), and the generalized estimating equations analysis showed that ORA was negatively correlated with the amplitude of astigmatism correction (P < 0.001). CONCLUSION The results of our study suggest that preoperative higher ORA may be associated with a lower magnitude of astigmatism correction after SMILE surgery in patients with all levels of astigmatism preoperative. TRIAL REGISTRATION ClinicalTrials.gov: NCT05604872. Registered 3 November 2022-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT05604872.
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Affiliation(s)
- Chen-Cheng Chao
- Nobel Eye Institute, Taipei, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Meng-Yin Lin
- Department of Ophthalmology, Shuang Ho Hospital-Taipei Medical University, New Taipei City, Taiwan
- Department of Ophthalmology, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Gauvin M, Wallerstein A. mEYEstro software: an automatic tool for standardized refractive surgery outcomes reporting. BMC Ophthalmol 2023; 23:171. [PMID: 37085797 PMCID: PMC10120175 DOI: 10.1186/s12886-023-02904-6] [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] [Received: 10/31/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Standardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses. RESULTS The software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations. CONCLUSIONS mEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals.
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Affiliation(s)
- Mathieu Gauvin
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, McGill University, Montreal, QC, Canada
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada
| | - Avi Wallerstein
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada.
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Elshahat A, Hamed AM, El Habbak AH, Tabl MA. Evaluation of Ocular Residual Astigmatism in Eyes with Myopia and Myopic Astigmatism and Its Interaction with Other Forms of Astigmatism. Clin Ophthalmol 2022; 16:4179-4190. [PMID: 36544897 PMCID: PMC9762676 DOI: 10.2147/opth.s393477] [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: 10/19/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the prevalence, magnitude, and direction of ocular residual astigmatism (ORA) in eyes with myopia and myopic astigmatism, and its interaction with refractive, anterior corneal, posterior corneal, and true net power astigmatism. Patients and Methods Refractive surgery candidates with myopia and myopic astigmatism were studied. Refractive astigmatism (RA) was measured using the Nidek® AR-310A autorefractometer. Anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), and true net power astigmatism (TNP) were measured using the Wavelight® Oculyzer II. Astigmatism was converted from polar to vector notation. ORA was calculated by vector subtraction of ACA from RA vertexed to corneal plane. Compensation factor (CF) was calculated as the ratio of ORA that compensates ACA for both J0 and J45. Results 154 eyes of 88 patients (mean age 31.7±7.1 years) were included. With-the-rule (WTR) astigmatism was the most common for both RA (55.6%) and ACA (74%), while against-the-rule (ATR) was the most common for PCA (87.7%) and ORA (74.0%). The axes of RA and ACA were within 10° of each other in 46.8% of the eyes, and within 30° of each other in 76.0%. The mean difference in value between the axis of RA and ACA was 25.6°. 71.4% of eyes in the study had an ORA ≥ 0.5D, 44.1% had ORA ≥ 0.75D and 26% had ORA ≥ 1D. There was a statistically significant difference between ACA and each of RA and TNP. Using TNP to calculate ORA instead of ACA reduced its magnitude. RA is positively correlated to ACA and more strongly to TNP. The most common pattern of compensation between ORA and ACA was under-compensation for J0 (49%) and same-axis-augmentation for J45 (35%). Conclusion ORA, PCA, and the interaction between ORA and ACA can affect results during refractive planning.
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Affiliation(s)
- Ahmed Elshahat
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Qalyopia, Egypt
| | - Abdelmonem M Hamed
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Qalyopia, Egypt,Correspondence: Abdelmonem M Hamed, Email
| | - Ashraf H El Habbak
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Qalyopia, Egypt
| | - Marwa Abdelshafy Tabl
- Department of Ophthalmology, Benha Faculty of Medicine, Benha University, Benha, Qalyopia, Egypt
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Sun L, Zhang X, Ding L, Shen Y, Qian Y, Zhou X. Influence of Ocular Residual Astigmatism on the Correction of Myopic Astigmatism by Toric Implantable Collamer Lens: A Comparative Study With Femtosecond Laser Small Incision Lenticule Extraction. Front Med (Lausanne) 2022; 9:828492. [PMID: 35770010 PMCID: PMC9234215 DOI: 10.3389/fmed.2022.828492] [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: 12/03/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the influence of the origin of astigmatism on the correction of myopic astigmatism by toric implantable collamer lens (TICL) and compare it with femtosecond laser small incision lenticule extraction (SMILE).MethodsOcular residual astigmatism (ORA) was determined by vector analysis using manifest refraction and Scheimpflug camera imaging of the anterior cornea. One-to-one matching between the TICL and SMILE groups was performed by preoperative manifest refractive astigmatism (RA) and ORA, tolerating a maximum difference of 0.50 diopter (D) for RA and 0.25 D for ORA. Patients of each group were further divided into groups according to ORA (high > 1.0 D; low ≤ 1.0 D). The baseline and 12-month postoperative data were analyzed. Data are expressed as mean ± standard deviation (SD). A value of p less than 0.05 was considered statistically significant.ResultsFor the TICL group, no significant differences in the postoperative RA, safety index, efficacy index, index of success (IOS), correction index (CI), and angle of error (AOE) were found between high (n = 36) and low ORA (n = 36) groups (Mann–Whitney U test, p > 0.05). For the SMILE group, the postoperative RA (high: −0.67 ± 0.43 D, low: −0.39 ± 0.29 D, Mann–Whitney U test, p = 0.003) and IOS (high: 0.50 ± 0.43, low: 0.25 ± 0.23, Mann–Whitney U test, p = 0.003) were greater in the high ORA group. When comparing TICL and SMILE groups, the mean postoperative RA (TICL: −0.48 ± 0.29 D, SMILE: −0.67 ± 0.43 D, Mann–Whitney U test, p = 0.03) and IOS (TICL: 0.32 ± 0.23, SMILE: 0.50 ± 0.43, Mann–Whitney U test, p = 0.03) were significantly higher in the SMILE group when the ORA was >1.0 D.ConclusionBoth TICL and SMILE are effective in correcting myopic astigmatism. ORA has a lesser effect on TICL than on SMILE.
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Affiliation(s)
- Ling Sun
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoyu Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lan Ding
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Yishan Qian,
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Xingtao Zhou,
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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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Zhao J, Zhao J, Yang W, Sun L, Qian Y, Wang X, Zhou X. Influence of Ocular Residual Astigmatism and Target-Induced Astigmatism on the Efficacy of the Implantation of a Toric Implantable Collamer Lens With Central Hole for Myopic Astigmatism Correction. Front Med (Lausanne) 2022; 8:737358. [PMID: 35127737 PMCID: PMC8813979 DOI: 10.3389/fmed.2021.737358] [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: 07/06/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo investigate the effects of ocular residual astigmatism (ORA) and target-induced astigmatism (TIA) on the efficacy of toric implantable collamer lens (TICL) with central hole for myopic astigmatism correction.MethodsRetrospective case series. One hundred and eighteen eyes implanted with a TICL (V4c) from 118 patients were included. Subjective refraction and corneal topography were examined preoperatively, at 1 and 12 months postoperatively. The eyes were divided into the low-ORA ( ≤ 0.5 D) and high-ORA (>0.5 D) groups based on vector analysis, and into the low-TIA (≥0.75D and <2 D) and the high-TIA (≥2 D and ≤ 4 D) groups according to preoperative refractive astigmatism. Correction index (CI) and index of success (IOS) were compared between different groups.ResultsAll surgeries were uneventful, and no complications occurred during follow-up. At 1 and 12 months postoperatively, no significant differences were found in CI or IOS values between the high and low ORA groups, while significantly higher CI and lower IOS were detected in the high-TIA group than in the low-TIA group (P < 0.05). No significant difference was found in CI between 1 and 12 months postoperatively in either group (P > 0.05). However, significantly lower IOS was found at 12 months compared with 1 month postoperatively for each group (P < 0.05).ConclusionsToric implantable collamer lens (TICL) implantation is effective in correcting myopic astigmatism and is more effective in eyes with high TIA, while ORA has a minor effect.
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Affiliation(s)
- Jing Zhao
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jiao Zhao
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Wen Yang
- Department of Ophthalmology, The 3rd People's Hospital of Chengdu, Chengdu, China
| | - Ling Sun
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Xingtao Zhou
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Jun I, Kang DSY, Arba-Mosquera S, Reinstein DZ, Archer TJ, Jean SK, Kim EK, Seo KY, Lee HK, Kim TI. Comparison of clinical outcomes between vector planning and manifest refraction planning in SMILE for myopic astigmatism. J Cataract Refract Surg 2021; 46:1149-1158. [PMID: 32347695 DOI: 10.1097/j.jcrs.0000000000000100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA). SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Prospective, randomized, comparative case series. METHODS Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups. RESULTS The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (-0.22 ± 0.18 D and -0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group. CONCLUSIONS In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.
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Affiliation(s)
- Ikhyun Jun
- From the Department of Ophthalmology (Jun, E. K. Kim, Seo, Lee, T.-i. Kim), The Institute of Vision Research, Department of Ophthalmology (Jun, E.K. Kim, T.-i. Kim), Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Eyereum Eye Clinic (Kang, Jean), Seoul, South Korea; Research and Development (Arba-Mosquera), Biomedical Engineering Office, SCHWIND eye-tech-solutions, Kleinostheim, Germany; London Vision Clinic (Reinstein, Archer), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, NY, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Biomedical Science Research Institute, University of Ulster (Reinstein, Archer), Coleraine, Northern Ireland
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Kim BK, Chung YT. Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for high astigmatism. BMC Ophthalmol 2021; 21:23. [PMID: 33422053 PMCID: PMC7796618 DOI: 10.1186/s12886-020-01756-8] [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: 07/15/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism. Methods This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method. Results Twenty-four months after the combined procedure, the average spherical equivalent was reduced from − 6.56 ± 2.38 D to − 0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to − 0.02 ± 0.09 and from − 0.03 ± 0.07 D to − 0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was − 5.48 ± 1.17 D, which was reduced to − 2.27 ± 0.97 D and − 0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p < 0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.
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Affiliation(s)
- Bu Ki Kim
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Republic of Korea
| | - Young Taek Chung
- Onnuri Eye Hospital, 325, Baekje-daero, Wansan-gu, Jeonju-si, Jeollabuk-do, Republic of Korea.
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Wallerstein A, Gauvin M, Qi SR, Cohen M. Effect of the Vectorial Difference Between Manifest Refractive Astigmatism and Anterior Corneal Astigmatism on Topography-Guided LASIK Outcomes. J Refract Surg 2020; 36:449-458. [DOI: 10.3928/1081597x-20200609-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 11/20/2022]
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Small-Incision Lenticule Extraction (SMILE) for the Correction of Myopia with Astigmatism: Outcomes of the United States Food and Drug Administration Premarket Approval Clinical Trial. Ophthalmology 2020; 127:1020-1034. [PMID: 32173114 DOI: 10.1016/j.ophtha.2020.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To present outcomes of the United States Food and Drug Administration premarket approval clinical trial of small-incision lenticule extraction (SMILE) for the correction of myopia and astigmatism. DESIGN Prospective, multicenter clinical trial. PARTICIPANTS The study included 357 eyes of 357 patients treated with SMILE (50 for myopia and 307 for myopia with astigmatism). Preoperative sphere ranged between -1.00 and -10.00 diopters (D), with manifest spherical equivalent (MSE) of up to -11.50 D and refractive cylinder of up to -3.00 D. METHODS -Participants were followed up for 12 months. Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), stability of the manifest refraction, and vector analysis of refractive cylinder are presented for the 307 eyes treated for myopia with astigmatism. Adverse events (AEs) are presented for all 357 eyes. MAIN OUTCOME MEASURES Corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction, astigmatic outcomes, and adverse events. RESULTS Of the 307 astigmatic eyes enrolled in the study, 304 were treated successfully. In 3 eyes, the procedure was aborted because of intraoperative suction loss. The mean MSE reduced from -5.39±2.30 D at baseline to -0.01±0.24 D at 12 months. Of all eyes, 95.3% were within 0.50 D of emmetropia at 12 months. The percentage of eyes with UDVA of 20/20 or better was 89.0%. No loss of 2 or more lines of CDVA was observed at the 12-month visit. The refractive cylinder reduced from -1.53±0.70 D at baseline to -0.18±0.31 D at 12 months. The mean correction ratio of refractive cylinder was 0.96±0.16 and a slight undercorrection was apparent for higher attempted corrections of astigmatism. Three intraoperative AEs associated with difficult lenticule removal and resultant cap tear occurred, and all resolved without sequelae at postoperative day 1. During the postoperative period, 8 AEs were recorded, but none of them had significant consequences. CONCLUSIONS Small-incision lenticule extraction for the treatment of myopia and astigmatism was safe and effective, and the reported AEs had no significant impact on visual acuity. Slight undercorrection of refractive cylinder requires further attention.
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Chow SS, Chow LL, Lee CZ, Chan TC. Astigmatism Correction Using SMILE. Asia Pac J Ophthalmol (Phila) 2019; 8:391-396. [PMID: 31490198 PMCID: PMC6784860 DOI: 10.1097/01.apo.0000580140.74826.f5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022] Open
Abstract
Small incision lenticule extraction (SMILE) was introduced in the recent decade for the treatment of myopia and myopic astigmatism. This flap-free technique has a high efficacy and safety profile and also carries potential advantages over laser in situ keratomileusis such as a better corneal biomechanical stability, reduction in dry eyes rate, and the avoidance of flap complications. However, there have been concerns regarding the precision of astigmatism correction that undercorrection has been reported to be apparent. Various factors that affect astigmatism correction have been identified in the literature. The purpose of this review is to discuss the factors that affect astigmatism correction in SMILE and several techniques to improve the refractive outcomes.
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Affiliation(s)
- Sharon S.W. Chow
- Department of Ophthalmology, Grantham Hospital, Hong Kong, China
| | | | - Chester Z. Lee
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tommy C.Y. Chan
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Chan TCY, Wan KH, Zhang L, Wang Y. Impact of ocular residual astigmatism on predictability of myopic astigmatism correction after small-incision lenticule extraction. J Cataract Refract Surg 2019; 45:525-526. [PMID: 30947856 DOI: 10.1016/j.jcrs.2019.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
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Taneri S, Kießler S, Rost A, Schultz T, Dick BH. Small-incision lenticule extraction for the correction of myopic astigmatism. J Cataract Refract Surg 2019; 45:62-71. [DOI: 10.1016/j.jcrs.2018.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
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Piñero DP, Teus MA. Clinical outcomes of small-incision lenticule extraction and femtosecond laser-assisted wavefront-guided laser in situ keratomileusis. J Cataract Refract Surg 2018; 42:1078-93. [PMID: 27492109 DOI: 10.1016/j.jcrs.2016.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Small-incision lenticule extraction and wavefront-guided femtosecond-assisted laser in situ keratomileusis (LASIK) provide good visual outcomes and an efficacious correction of myopia or myopic astigmatism with similar levels of safety. Some differences in predictability and the percentage of eyes gaining lines of corrected distance visual acuity are present. A higher level of coma is present after small-incision lenticule extraction, with no clear differences between techniques in spherical aberration. Better contrast sensitivity is achieved in the early postoperative period after wavefront-guided femtosecond laser-assisted LASIK, possibly because of less intrastromal light backscattering and Bowman layer microdistortions. Corneal sensitivity decreased less after small-incision lenticule extraction because of less severe decrease in subbasal nerve density, which has a significant effect on symptomatology and dry-eye tests (P < .05). Significant corneal biomechanical changes occurred after both techniques (P < .05), with no scientific evidence supporting the superiority of 1 technique over the other. FINANCIAL DISCLOSURE Dr. Piñero received an unrestricted educational grant from Abbott Medical Optics, Inc. Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David P Piñero
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain.
| | - Miguel A Teus
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain
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Gauvin M, Wallerstein A. AstigMATIC: an automatic tool for standard astigmatism vector analysis. BMC Ophthalmol 2018; 18:255. [PMID: 30241474 PMCID: PMC6151063 DOI: 10.1186/s12886-018-0920-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Standardization for reporting medical outcomes facilitates clinical study comparisons and has a fundamental role on research reproducibility. In this context, we present AstigMATIC, a free standalone application for automated standardized astigmatism vector analyses in corneal and intraocular refractive surgeries. AstigMATIC uses a simple graphical user interface (GUI) and allows the simultaneous display and analysis of astigmatism magnitude and axis. Results The software produces the four following standard graphs according to the standards of the Alpins Method; 1-Target-Induced Astigmatism Vector, 2-Surgically-Induced Astigmatism Vector, 3-Difference Vector and 4-Correction Index. Vector means with X and Y standard deviations are automatically calculated and displayed on the corresponding single-angle vector plots (0 to 180°). Data points are entered into a simplified GUI with no need for command line input. The standard graphs can be easily exported as high-resolution TIFF images for figures to use in production and presentations. Conclusions AstigMATIC software enables the user to easily and efficiently analyze vectorial astigmatism outcomes using the standardized Alpins Method for post-surgical astigmatism. AstigMATIC and the demonstration datasets are available to download from http://www.lasikmd.com/media/astigmatic.
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Affiliation(s)
| | - Avi Wallerstein
- LASIK MD, Montreal, QC, Canada. .,Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, QC, Canada.
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Yildiz BK, Urdem U, Goksel Ulas M, Yildirim Y, Agca A, Fazil K, Aygit ED, Taskapili M, Demirok A. Correction of myopic astigmatism by small incision lenticule extraction: does laterality matter? Lasers Med Sci 2018; 34:311-316. [DOI: 10.1007/s10103-018-2591-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/13/2018] [Indexed: 12/01/2022]
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Arbelaez MC, Alpins N, Verma S, Stamatelatos G, Arbelaez JG, Arba-Mosquera S. Clinical outcomes of laser in situ keratomileusis with an aberration-neutral profile centered on the corneal vertex comparing vector planning with manifest refraction planning for the treatment of myopic astigmatism. J Cataract Refract Surg 2017; 43:1504-1514. [DOI: 10.1016/j.jcrs.2017.07.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/08/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022]
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Evaluating internal and ocular residual astigmatism in Chinese myopic children. Jpn J Ophthalmol 2017; 61:494-504. [PMID: 28983803 DOI: 10.1007/s10384-017-0532-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the nature of internal astigmatism (IA) and ocular residual astigmatism (ORA) in Chinese myopic children and to identify factors that may influence IA and ORA. METHODS A total of 206 eyes of 206 myopic children (97 boys and 109 girls; 10.95 ± 2.2 years) were enrolled in this cross sectional study. Total ocular astigmatism (TOA), anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA) and total corneal astigmatism (TCA) were measured directly using either a Hartmann-Shack wavefront sensor or a Pentacam. IA and ORA were calculated by Fourier vector analyses (the definitions of IA and ORA are: IA = TOA - ACA - PCA, ORA = TOA - ACA). Spearman or Pearson correlation was adopted to detect multiple factors that may influence IA and ORA, which were then predicted by linear regressions. Modified compensation factors were applied to evaluate the inter-relationship between corneal astigmatism and ORA. RESULTS While the mean values of IA and ORA were -0.52 DC × 94.8° and -0.63 DC × 93.0°, respectively, the percentage of ORA power over 1.00 D was as high as 28.64%. Full or under-compensation of ACA by ORA predominated in the enrolled subjects. The mean ORA J0 and J45 were -0.311 ± 0.236 and -0.032 ± 0.156 D, respectively, negatively correlated with the corresponding ACA components (J0: r = -0.276, J45: r = -0.616, p < 0.001). While age was not correlated with either IA or ORA (p > 0.1), the power of IA or ORA was correlated inversely with the axial length (IA: r = -0.193, p = 0.005; ORA: r = -0.169, p = 0.015) and positively with the spherical equivalent refraction (IA r = 0.195, p = 0.005; ORA r = 0.213, p = 0.002) and power of corneal astigmatism (IA-ACA: r = 0.302, IA-TCA: r = 0.368, ORA-ACA: r = 0.334, ORA-TCA: r = 0.293). Girls had larger IA powers than boys (0.741 ± 0.345 D vs 0.651 ± 0.340, p = 0.036). CONCLUSIONS Full or under-compensation of ACA by ORA is common in Chinese myopic children, and the compensation efficiency may decrease with age. Among Chinese children with myopia, a larger ORA is more prevalent with less myopia and greater corneal astigmatism.
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Torky MA, Alzafiri YA. Visual and refractive outcomes of small-incision lenticule extraction in mild, moderate, and high myopia: Six-month results. J Cataract Refract Surg 2017; 43:459-465. [DOI: 10.1016/j.jcrs.2017.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/13/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022]
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