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Zhao Y, Fu D, Chen Z, Zhou X. Three-Year Follow-Up of Posterior Corneal Elevation in Thin Corneas After Small Incision Lenticule Extraction. Front Med (Lausanne) 2022; 9:758223. [PMID: 35186987 PMCID: PMC8854970 DOI: 10.3389/fmed.2022.758223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the changes in posterior corneal elevation in thin corneas after small incision lenticule extraction (SMILE). Methods In this prospective study, 97 eyes of 97 patients undergoing SMILE were recruited. Eyes were categorized into the following groups based on the preoperative minimum central corneal thickness (CCT): group A (37 eyes, 480–499 μm), group B (30 eyes, 500–529 μm), and group C (30 eyes, 530–560 μm). The posterior corneal surface was measured with a Pentacam over a 3-year follow-up period. Changes in the posterior corneal elevation at the central point (PCE), thinnest point (PTE), and predetermined area were measured. Results No iatrogenic keratectasia was observed during the follow-up period. The mean changes in PCE, PTE, and the inferior area in group A were 1.14 ± 3.40 μm, −0.11 ± 3.20 μm, and −0.26 ± 1.23 μm, respectively (P ≥ 0.125). Although statistically significant change in the central-4 mm area was noted, the value was quite small (0.98 ± 1.67 μm) and was not higher than that in the other two groups (P = 0.003). For all three groups, the elevation remained stable or showed a backward change in the central annulus, while there was a small forward displacement in the 6-mm optical zone. In group A, changes in elevation values yielded negative statistical correlations with residual bed thickness and CCT (P ≤ 0.006) (except for the inferior area, the 4-mm and 6-mm optical zone). Conclusions With a strict preoperative assessment, SMILE achieved good safety and efficacy in correcting myopia in thin corneas and enabled a stable posterior corneal surface over a 3-year follow-up period. Synopsis Careful preoperative assessment and suitable surgical design should be taken to ensure posterior corneal stability after SMILE in thin corneas.
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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), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (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
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- 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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Elsaadani IA, Hamed AM, Elshahat A, Heikal MA. Comparison of Refractive Outcomes in Small-Incision Lenticule Extraction Performed with One or Two Incisions. Clin Ophthalmol 2022; 16:281-291. [PMID: 35153473 PMCID: PMC8827643 DOI: 10.2147/opth.s352341] [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: 12/13/2021] [Accepted: 01/16/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To retrospectively compare the refractive outcomes between two groups of small-incision lenticule extraction (SMILE), one with a single incision and the second one with dual-incisions. Setting Ebsar Eye Center, Benha, Qalyopia, Egypt. Design A retrospective cohort study. Methods This study was made up of two groups (162 eyes each): all eyes in group 1 had one SMILE cut at 120°, and all eyes in group 2 had double SMILE incisions, the first incision at 120° and the second one at 270°. Refractive outcomes between the two groups were compared at 3, 6, and 12 months after surgery. Results The mean preoperative refractive spherical equivalent (MRSE) was −5.75 ± 2.59 D and −6.38 ± 2.18 D in group 1 and 2, respectively (P = 0.73), and a cylinder of 1.25 ± 0.83 D and 0.75 ± 0.81 D, respectively (P = 0.85). At 12 months postoperatively, in group 1, 162 eyes (100%) achieved a UCVA of 20/25, 154 eyes (95.06%) achieved a UCVA of 20/20, and 110 eyes (67.90%) achieved 20/16. In group 2, 162 eyes (100%) achieved a UCVA of 20/25, 156 eyes (96.29%) achieved a UCVA of 20/20, and 113 eyes (69.75%) achieved 20/16. The mean MRSE at 12 months postoperatively was −0.25 ± 0.33 D in group 1 and −0.5 ± 0.33 D in group 2 (P = 0.62). Conclusion Dual-incision SMILE is safe and effective as single-incision SMILE, with a predictable and stable effect in correcting myopia and myopic astigmatism.
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Affiliation(s)
| | - Abdelmonem Mahmoud Hamed
- Ophthalmology Department, Benha College of Medicine, Benha University, Benha, Qalyopia, Egypt
- Correspondence: Abdelmonem Mahmoud Hamed, Ophthalmology Department, Benha College of Medicine, Benha University, Alansar Tower, Science of College St, Benha, Qalopia, Egypt, Tel +201221640288, Email
| | - Ahmed Elshahat
- Ophthalmology Department, Benha College of Medicine, Benha University, Benha, Qalyopia, Egypt
| | - Mohamed Amin Heikal
- Ophthalmology Department, Benha College of Medicine, Benha University, Benha, Qalyopia, Egypt
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Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism. PLoS One 2021; 16:e0257667. [PMID: 34555080 PMCID: PMC8460088 DOI: 10.1371/journal.pone.0257667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/07/2021] [Indexed: 01/19/2023] Open
Abstract
Purpose To quantitatively evaluate outcomes after small incision lenticule extraction
(SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia
with astigmatism. Methods It’s a retrospective cohort study. Twenty-four eyes of 15 patients with more
than 0.75 diopters (D) of astigmatism in hyperopic eyes were enrolled in
this study. The hyperopic eye with astigmatism was first treated with SMILE
to correct astigmatism; then a lenticule was extracted from a donor myopic
eye and subsequently implanted into the hyperopic eye with astigmatism.
Patients were examined preoperatively and 1 day, 1 week, 1,3 months and 1
year after surgery. The main outcome measures were the uncorrected and
corrected distance visual acuity (UDVA and CDVA), uncorrected near visual
acuity (UNVA), spherical equivalent (SE), corneal topography, anterior
segment optical coherence topography (OCT) and ocular response analyzer
(ORA) parameters: corneal hysteresis (CH) and corneal resistance factor
(CRF). Repeated–measures analyses of variance (ANOVA) and post hoc tests
were used to analyze data of different follow-up visits. Results The mean preoperative cylinder was 1.95±1.04(D). The UDVA (from 0.37±0.23 to
0.09±0.09), UNVA (from 0.49±0.21 to 0.08±0.06), SE (from +7.42±3.12 to
-0.75±0.79) and astigmatism (+1.95±1.04 to -0.65±0.63) postoperatively were
obviously better than those before surgery. Five eyes (26.3%) gained one
line of CDVA, and 3 eyes (15.8%) gained two lines of CDVA one year after
surgery compared with preoperative levels. The average corneal curvature was
changed from (43.19±4.37) D to (49.19±3.87) D one year after surgery. The
anterior segment OCT images of corneas with lenticule inlays at each
follow-up visit showed that the implanted lenticule was shaped like a
crescent in the corneal stroma. The CH and CRF didn’t change significantly
after surgery (p = 0.189 and p = 0.107respectively). Conclusions SMILE combined with intrastromal lenticule inlay can be used to correct high
hyperopia with astigmatism with good safety, efficacy and
reproducibility.
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Zhao PF, Hu YB, Wang Y, Fu CY, Zhang J, Zhai CB. Comparison of correcting myopia and astigmatism with SMILE or FS-LASIK and postoperative higher-order aberrations. Int J Ophthalmol 2021; 14:523-528. [PMID: 33875942 DOI: 10.18240/ijo.2021.04.07] [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: 11/02/2020] [Accepted: 12/25/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the effect of myopia and astigmatism correction and postoperative change in higher-order aberration as results of receiving small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS A prospective and non-randomized controlled study was conducted. The subjects are divided into two groups according to different operations received: 229 eyes of 116 patients in the SMILE group and 168 eyes of 86 patients in the FS-LASIK group. All subjects were followed up for 3mo by monitoring their uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalent, higher-order aberrations, and the preoperative and postoperative complications. RESULTS At 1wk, 1, and 3mo post-surgery, 224 eyes (97.8%), 227 eyes (99.1%) and 229 eyes (100%) had UCVA≥20/20 in the SMILE group, while 165 eyes (98.2%), 167 eyes (99.4%) and 167 eyes (99.4%) had UCVA≥20/20 in the FS-LASIK group, respectively (χ 2=0.146, 2.135, and 1.124; all P>0.05). BCVA reduction was not observed in both groups at 1 and 3mo of post-surgery (χ 2=0.734 and 1.898, P>0.05). There was no statistically significant difference in the spherical equivalent between the two groups at 1 and 3mo post-surgery, though the percentage of the spherical equivalent within ±0.50 D at 3mo post-surgery was 98% in the SMILE group, which was higher than that of the FS-LASIK group (92%, χ 2=1.872, P>0.05). The root mean square (RMS) values of total high-order aberration, coma, and spherical aberration of the two groups increased significantly in the early postoperative period and decreased after 3mo, but the values were still higher than the preoperative levels (P<0.05); there was no significant difference between the two groups in the RMS values of total higher-order aberrations and specific higher-order aberrations (P>0.05). The incidence of complications in the SMILE group was lower than that in the FS-LASIK group (χ 2=14.52, P<0.05). CONCLUSION SMILE and FS-LASIK can effectively treat myopia, significantly improve visual acuity, and increase the total high-order aberration, spherical aberration, and coma. The incidence of complications after SMILE is relatively low.
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Affiliation(s)
- Peng-Fei Zhao
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Ya-Bin Hu
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Yue Wang
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Cai-Yun Fu
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Jing Zhang
- Beijing Vision Optometry, Beijing 100191, China.,College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China
| | - Chang-Bin Zhai
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
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Xia F, Qin B, Shang J, Chen Z, Zhou X, Zhao J, Wang X, Zhou X. Four-Year Outcomes of Small Incision Lenticule Extraction for Extreme High Myopia and Myopic Astigmatism. Front Med (Lausanne) 2020; 7:575779. [PMID: 33313044 PMCID: PMC7703695 DOI: 10.3389/fmed.2020.575779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the long-term safety, efficacy, predictability, and stability of small incision lenticule extraction (SMILE) for the treatment of high myopia and myopic astigmatism >−10.0 D. Methods: This was a prospective study that incorporated 35 consecutive patients (35 eyes) undergoing SMILE from September 2015 to March 2016. These patients had a mean preoperative spherical equivalent refraction of −10.06 ± 0.64 D. Patients were followed over a 4-year period and assessed for outcomes including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and corneal topography. Results: At 4 years post-SMILE, respective efficacy and safety indices were 1.01 ± 0.19 and 1.07 ± 0.15. In total, 97% of operated eyes achieved an UDVA of 20/25 or better. ≥1 line was gained for 9 eyes (26%), with 25 eyes (71%) remaining stable. Twenty-four (69%) and 33 (94%) eyes, respectively, were within ±0.50 D and ±1.0 D of target refraction. From 3 months to 4 years postoperatively, a mean refractive regression of −0.22 D (−0.06 D per year) was detected, whereas no significant changes in mean corneal back curvature or posterior central elevation were detected (P = 0.617 and 0.754, respectively). We detected significant increases in higher-order aberrations (HOAs) of the anterior and total cornea (all P < 0.001), with spherical aberrations and vertical coma being particularly common, whereas posterior corneal HOA remained fairly stable (all P < 0.05). Conclusion: SMILE is a safe, effective, predictable, and stable means of correcting high myopia and myopic astigmatism over a 4-year postoperative period.
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Affiliation(s)
- Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Bing Qin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,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, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Primavera L, Canto-Cerdan M, Alio JL, Alio Del Barrio JL. Influence of age on small incision lenticule extraction outcomes. Br J Ophthalmol 2020; 106:341-348. [PMID: 33208352 DOI: 10.1136/bjophthalmol-2020-316865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/27/2020] [Accepted: 10/31/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the influence of patient's age at the time of surgery on small incision lenticule extraction (SMILE) refractive outcomes. METHODS This is a retrospective, consecutive, comparative study. We compared the refractive outcomes after myopic SMILE from two groups of patients divided by age (patients ≤35 and ≥40 years old). All eyes were evaluated preoperatively and at 1 and 6 months postoperatively. Main outcome measures were differences on efficacy, safety, predictability and astigmatic changes by vector analysis with ASSORT software between both study groups. RESULTS 102 matched eyes of 53 patients were included. Preoperatively, we evidenced no differences in the mean SE or astigmatism between groups. However, 6 months postoperatively we observed a significantly worse mean astigmatism (p=0.019), while not regarding SE, in the older population, with a trend towards undercorrection of the refractive cylinder in the ≥40 group. We also observed a statistically significant difference in the efficacy (0.86-1 month and 0.97-6 months in ≥40group vs 0.97-1 month and 1.07-6 months in the ≤35 group; p=0.003) and safety indexes (0.93-1 month and 1.04-6 months in ≥40 group vs 1.0-1 month and 1.11-6 months in the ≤35 group; p=0.008) at 6 months among groups. CONCLUSIONS Post-SMILE refractive outcomes in those patients over 40 years of age, although acceptable, are not as good as those obtained in younger patients, showing a significantly lower efficacy and safety indexes, and poorer astigmatic outcomes, with a tendency towards undercorrection. We hypothetise that the increased corneal stroma stiffness in the aged group modifies the post-SMILE corneal stroma remodelling capacity, thus affecting the SMILE refractive and visual response.
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Affiliation(s)
- Laura Primavera
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Mario Canto-Cerdan
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain.,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alio Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain .,Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
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Long-Term Refractive Outcome of Small Incision Lenticule Extraction in Very High Myopia: Erratum. Cornea 2020; 39:e28. [DOI: 10.1097/ico.0000000000002474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdelwahab S, Hamed A, Elshahat A, Rashad S, Elfauyomi M. Outcomes of Small Incision Lenticule Extraction with Dual-Incisions in Myopic Patients. Clin Ophthalmol 2020; 14:3067-3074. [PMID: 33116359 PMCID: PMC7548326 DOI: 10.2147/opth.s270032] [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: 07/08/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) with dual-incisions in myopic patients. Setting Ebsar Eye center, Benha, Qalyopia, Egypt. Design Single-center, retrospective, COHORT study. Patients and Methods The study was conducted as a retrospective non-comparative analysis of the records of 105 eyes of 53 patients treated by the SMILE with a dual-incisions technique for a mean spherical myopic error of -5.05 ± 1.93 D (range: -1.38 to -9.0 D) with or without astigmatism and the mean astigmatism of -0.90 ± 0.83 D. The mean LogMAR corrected distance visual acuity (CDVA) was -0.04 ± 0.07. Results One month after surgery, the mean refractive error was -0.03 ± 0.56 D (range: 0.88 to -1.50 D), and the mean postoperative astigmatism was 0.20 ± 0.31 D. The mean LogMAR UDVA was 0.07 ± 0.18 in the last follow-up visit, 12 months after surgery. At the end of the follow-up period, approximately 91.43% of patients had unchanged CDVA or gained one or more lines, 8.57% lost one line of CDVA, and 0.0% lost 2 lines. Conclusion SMILE with dual-incisions is effective and safe, with a stable and predictable outcome for correction of myopia and myopic astigmatism.
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