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Zhang S, Cui S, Liu L, Zou J, Wang P, Li Q, Shen P. Knowledge, attitudes, and practices toward femtosecond laser small incision lenticule extraction surgery and postoperative care among recipients. BMC Public Health 2024; 24:2611. [PMID: 39333996 PMCID: PMC11438242 DOI: 10.1186/s12889-024-20035-5] [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: 12/13/2023] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND To investigate the knowledge, attitudes, and practices (KAP) of individuals who underwent small incision lenticule extraction (SMILE) surgery and explore the influencing factors. METHODS This cross-sectional study was conducted from June 21, 2023, to August 13, 2023, at Xiangyang Central Hospital. The participants were patients who had undergone SMILE surgery. The self-designed questionnaire had a Cronbach's α = 0.849. Multivariable analyses were performed to determine the factors influencing the KAP scores. RESULTS Finally, 485 valid questionnaires were analyzed. The median knowledge score was 14 (/17, 82.4%; IQR: 12-15). The median attitude score was 15 (/20, 75.0%; IQR: 14-16). The median practice score was 48 (/60, 80.0%; IQR: 42-54). The knowledge scores correlated to the attitude (r = 0.323, P < 0.001) and practice (r = 0.202, P < 0.001) scores, while the attitude scores correlated to the practice scores (r = 0.065, P < 0.001). College diploma (OR = 0.299, 95%CI: 0.110-0.812, P = 0.018), myopia for < 2 years (OR = 0.177, 95%CI: 0.060-0.526), and not receiving proper eye training (OR = 0.588, 95%CI: 0.402-0.862) were independently associated with knowledge. Being 19-30 years old (OR = 0.421, 95%CI: 0.235-0.756), being ≥ 31 years old (OR = 0.259, 95%CI: 0.111-0.601), myopia for 2-5 years (OR = 0.476, 95%CI: 0.232-0.978), myopia for 5-10 years (OR = 0.480, 95%CI: 0.263-0.875), and moderate myopia in the right eye (OR = 1.745, 95%CI: 1.024-2.974) were independently associated with attitude. Female gender (OR = 1.826, 95%CI: 1.196-2.787), being ≥ 31 years (OR = 2.587, 95%CI: 1.113-6.014), college diploma (OR = 3.436, 95%CI: 1.366-8.641), bachelor's degree (OR = 2.826, 95%CI: 1.214-6.581), and not having proper eye training (OR = 0.458, 95%CI: 0.310-0.677) were independently associated with practice. CONCLUSIONS Patients who underwent SMILE had high KAP regarding SMILE. This study identified KAP items that would warrant education.
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Affiliation(s)
- Shaowei Zhang
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China
| | - Sha Cui
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China
| | - Lei Liu
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Juan Zou
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China
| | - Pengqi Wang
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China
| | - Qin Li
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China.
| | - Pincheng Shen
- Xiangyang Central Hospital, Affiliated Hospital to Hubei University of Arts and Science, Xiangyang, 441000, China.
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Lee CY, Lian LB, Chen HC, Huang CT, Huang JY, Yang SF, Chang CK. The outcomes of first-generation (visumax 500) and second-generation (Visumax 800) keratorefractive lenticule extraction surgeries for astigmatism. Sci Rep 2024; 14:22224. [PMID: 39333584 PMCID: PMC11436722 DOI: 10.1038/s41598-024-73303-0] [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: 05/14/2024] [Accepted: 09/16/2024] [Indexed: 09/29/2024] Open
Abstract
To evaluate the efficiency, predictability, and residual astigmatism between first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries in a prominent astigmatism population. A retrospective cohort study was conducted, and individuals who underwent first- and second-generation KLEx surgeries were enrolled. A total of 31 and 35 eyes were categorized into first and second KLEx groups, respectively. Visual acuity, refraction, topographic parameters, and surgical indices were recorded. Independent t tests were used to compare the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and residual astigmatism between the two groups. The difference in UDVA was not significant three months after KLEx surgery (P = 0.509), and the SEs three months after surgery also presented similar values between the two groups (P = 0.552). The first KLEx group demonstrated greater residual astigmatism than did the second KLEx group throughout the three-month follow-up period (all P < 0.05). The values of surgically induced astigmatism (SIA), difference vector (DV), magnitude of error (ME) and correction index (CoI) were significantly better in the second KLEx group via vector analysis (all P < 0.05). Old age, high steep keratometry (K), high topographic cylinder, large angle kappa, and a small optic zone were correlated with greater residual astigmatism in the first KLEx group (all P < 0.05), whereas only a small optic zone was significantly correlated with greater residual astigmatism in the second KLEx group (P = 0.047). The second-generation KLEx is correlated with a lower risk of residual astigmatism.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, Taipei, 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Le-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, Taipei, 100008, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Lee CY, Yang SF, Chen HC, Lian IB, Huang CT, Huang JY, Chang CK. The Risk Factors for Myopia Undercorrection in Second-Generation (Visumax 800) Keratorefractive Lenticule Extraction Surgery: A Retrospective Case-Control Study. Diagnostics (Basel) 2024; 14:1752. [PMID: 39202239 PMCID: PMC11354104 DOI: 10.3390/diagnostics14161752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/08/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
In this study, we aim to evaluate the risk factors of myopia undercorrection in recipients of second-generation keratorefractive lenticule extraction (KLEx) surgery. A retrospective case-control study was performed, and patients who received second-generation KLEx surgery were enrolled. The cases with myopia undercorrection were matched to non-myopia undercorrection cases with a 1:4 ratio according to age, and a total of 22 and 88 eyes were categorized into the undercorrection and control groups, respectively. Demographic, refractive, topographic, and surgical data were collected preoperatively. A generalized linear model was operated to evaluate the potential risk factors for myopia undercorrection. The uncorrected distance visual acuity (UDVA) at three months postoperation was significantly better in the control group (p = 0.006), and residual myopia and SE were significantly higher in the undercorrection group during the whole follow-up period (all p < 0.001). The UDVA value showed a trend of improvement in the control group (p < 0.001), and the changes to SE and residual myopia were significantly lower in the control group (both p < 0.001). Regarding the risk factors for myopia undercorrection in the whole population and the high-myopia population, a higher manifest sphere power, higher steep keratometry (K), higher topographic cylinder, lower central corneal thickness (CCT) at apex, higher CCT difference and lower residual stromal thickness (RST) correlated to myopia undercorrection (all p < 0.05). In the low-myopia population, only higher myopia and lower RST correlated to myopia undercorrection (both p < 0.05). In conclusion, a high-sphere power and irregular topographic pattern correlated to myopia undercorrection after the second KLEx surgery, especially for individuals with high myopia.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Nobel Eye Institute, Taipei 10041, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Chunghua 50007, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 10041, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 51591, Taiwan
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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024; 35:278-283. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Lee CY, Lian IB, Chen HC, Huang CT, Huang JY, Yang SF, Chang CK. The Efficiency, Predictability, and Safety of First-Generation (Visumax 500) and Second-Generation (Visumax 800) Keratorefractive Lenticule Extraction Surgeries: Real-World Experiences. Life (Basel) 2024; 14:804. [PMID: 39063559 PMCID: PMC11278263 DOI: 10.3390/life14070804] [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: 06/01/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
We aimed to evaluate the postoperative visual and refractive outcomes between the first- and second-generation keratorefractive lenticule extraction (KLEx) surgeries. A retrospective cohort study was conducted and patients who had received first- and second-generation KLEx surgeries were enrolled. A total of 80 and 80 eyes were categorized into the first and second KLEx groups after exclusion, respectively. The primary outcomes were the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), and safety indexes. An independent t-test and generalized estimate equation were implemented to compare the primary outcomes between the two groups. After the KLEx surgery, the UDVA showed no significant difference between the two groups throughout the study period (all p > 0.05), and the postoperative SE and safety index were also statistically identical between the two groups during the follow-up interval (all p > 0.05). There was a similar trend of visual recovery between the two groups (aOR: 0.967; 95% CI: 0.892-1.143; p = 0.844), while the amplitude of the SE change was significantly lower in the second KLEx group (aOR: 0.760; 95% CI: 0.615-0.837; p = 0.005). Nine and two unintended initial dissection of the posterior plane (UIDPP) occurred intraoperatively in the first and second KLEx groups, respectively, and the second group showed a lower risk of UIDPP (p = 0.032). In conclusion, the efficiency, predictability, and safety are similar between first- and second-generation KLEx surgeries.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 402, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
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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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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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Gan ATL, Fenwick EK, Ang M, Mehta JS, Lamoureux EL. Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes. J Cataract Refract Surg 2023; 49:305-311. [PMID: 36730347 DOI: 10.1097/j.jcrs.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE-LASIK (BSSL) surgery. SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective cohort study. METHODS 2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared. RESULTS At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, "using sunglasses" (β: -20.6, 95% CI, -34.3 to -6.9), "reliance on refractive correction" (-23.1, 95% CI, -40.9 to -5.4), and "medical complications from optical correction" (β: -14.8, 95% CI, -27.9 to -1.7). Emotional well-being (overall), and items "feeling able to do things" (β: 11.0, 95% CI, 1.6-20.4) and "feeling eager to try new things" (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3. CONCLUSIONS Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE-LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
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Affiliation(s)
- Alfred T L Gan
- From the Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Gan, Fenwick, Ang, Mehta, Lamoureux); Duke-NUS Medical School, Singapore (Fenwick, Ang, Mehta, Lamoureux); National University of Singapore, Singapore (Lamoureux); Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Australia (Lamoureux)
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Menon J. Refractive Corneal surgeries: A Review. KERALA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/kjo.kjo_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Samir A, Lotfy A, Heikal MA, Abdelrahman Elsayed AM. Small Incision Lenticule Extraction for Correction of Pediatric Unilateral Anisometropic Myopia. J Refract Surg 2021; 37:510-515. [PMID: 34388076 DOI: 10.3928/1081597x-20210506-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of femtosecond laser small incision lenticule extraction (SMILE) on treating unilateral myopic anisometropia in children with spectacles or contact lens intolerance. METHODS This was a retrospective study that included children with unilateral myopic anisometropic amblyopia who underwent a SMILE procedure at Alpha Vision Center, Zagazig, Egypt, from January 2014 to December 2016. RESULTS One hundred twenty-four eyes of 124 patients were included in this study. The postoperative corrected distance visual acuity (CDVA) at the 3-month and 1-, 2-, 3-, and 4-year follow-up visits improved significantly (P < .05) compared to the preoperative CDVA, indicating the safety of the procedure. At the 3-month postoperative visit, 23% of cases showed improvement of one or more lines of CDVA, whereas only 2% of cases showed a decline of only one line. Moreover, the postoperative uncorrected distance visual acuity compared favorably to the preoperative CDVA, denoting the efficacy of the refractive correction. The spherical equivalent was within ±0.50 diopters of the intended correction in 75% of the cases and within ±1.00 diopters in 89% of the cases. The intraoperative complications were scarce and relatively innocuous. CONCLUSIONS SMILE is a safe and effective alternative method for correcting myopic anisometropic amblyopia in children with spectacles or contact lens intolerance with good refractive results. A larger study with longer follow-up periods is necessary to determine the long-term effects of SMILE. [J Refract Surg. 2021;37(8):510-515.].
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Chin JY, Lin MTY, Lee IXY, Mehta JS, Liu YC. Tear Neuromediator and Corneal Denervation Following SMILE. J Refract Surg 2021; 37:516-523. [PMID: 34388069 DOI: 10.3928/1081597x-20210423-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the changes in tear neuromediators and corneal subbasal nerve plexus following small incision lenticule extraction (SMILE) and to study its association with different refractive power of corrections. METHODS Thirty patients were included for tear neuromediator analysis (40 eyes) and corneal nerve analysis using in vivo confocal microscopy scans (20 eyes). Tear samples were collected preoperatively and 1 week and 1, 3, 6, and 12 months postoperatively and analyzed for the substance P, calcitonin gene-related peptide (CGRP), and nerve growth factor (NGF) concentrations using the enzyme-linked immunosor-bent assay (ELISA). RESULTS Corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), and corneal nerve branch density (CNBD) decreased significantly postoperatively, then gradually increased from 3 months onward, but did not recover to the baseline levels at 12 months. Tear substance P and CGRP levels remained stable over 12 months. Tear NGF levels demonstrated a small peak at 1 week before decreasing significantly compared to preoperative levels at 6 months (P = .03) and 12 months (P = .007). The 1-month reduction in CNFL, tear substance P, and CGRP concentrations were significantly correlated with the corrected spherical equivalent (SE) (r = 0.71 for CNFL; r = -0.33 to -0.52 at different time points for substance P and CGRP, respectively, all P < .05). Compared to the low to moderate myopia group, the high myopia group (corrected SE greater than -6.00 diopters) had a significantly greater decrease in CNFD, significantly higher tear substance P concentrations at 1 week, 1 month, and 6 months, and significantly higher tear CGRP concentrations at 1 and 6 months. CONCLUSIONS These results provide new insight into the neurobiological responses and their potential implications in corneal nerve damage and recovery after SMILE. High myopia treatment was associated with greater corneal denervation and neuroinflammation. [J Refract Surg. 2021;37(8):516-523.].
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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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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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Clinical outcomes of immediate transepithelial photorefractive keratectomy after suction loss during small-incision lenticule extraction. J Cataract Refract Surg 2020; 46:756-761. [DOI: 10.1097/j.jcrs.0000000000000123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li H, Peng Y, Chen M, Tian L, Li D, Zhang F. Six modes of corneal topography for evaluation of ablation zones after small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis. Graefes Arch Clin Exp Ophthalmol 2020; 258:1555-1563. [PMID: 32328759 DOI: 10.1007/s00417-020-04674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the ablation zone diameter (AZD) using six modes of corneal topography after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia and to compare the programmed and postoperative AZDs METHODS: This retrospective comparative study included 86 right eyes in 86 patients who underwent SMILE or FS-LASIK at the Shandong Eye Institute between June 2016 and August 2017. Data were collected preoperatively and at 1, 3, and 6 months postoperatively using the Pentacam system. The AZD was determined using six modes of corneal topography: postoperative axial curvature topography (PACT), postoperative tangential curvature topography (PTCT), difference-axial curvature topography (DACT), difference-tangential curvature topography (DTCT), postoperative front elevation topography (PFET), and difference-corneal thickness topography (DCTT). The difference between the programmed and postoperative AZDs was compared between the groups of two surgical procedures. RESULTS At 3 months, the AZDs measured by PTCT, DTCT, and PFET after SMILE showed a significant decrease, while the AZD by DACT revealed an increase (P < 0.001), and the AZDs measured by PACT, PTCT, DACT, DTCT, PFET, and DCTT after FS-LASIK were all significantly decreased (P < 0.001), as compared with the programmed ablation zone values. The AZDs measured by DACT and DTCT after 3 months were larger in the SMILE group (P < 0.001); likewise, the differences between the programmed and postoperative AZDs were lower in the SMILE group (P < 0.001). Furthermore, PACT, PTCT, DACT, DTCT, and PFET indicated acceptable inter-observer reliability (ICC > 0.75). CONCLUSIONS In the treatment of myopia, the achieved topographic ablation zones after FS-LASIK were smaller than the theoretically designed ones. The AZDs after SMILE were larger than those after FS-LASIK, with an equivalent programmed value. The DACT may be more suitable for measuring postoperative ablation zones in clinic with clearer borders and favorable repeatability. This method may be potential for the measurement of ablation zones and further research on the visual quality after refractive surgery.
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Affiliation(s)
- Hua Li
- Department of Ophthalmology, Qilu Medical College of Shandong University, Jinan, 250012, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Yusu Peng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Min Chen
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China.
| | - Le Tian
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Dewei Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Feifei Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
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Han SB, Liu YC, Mohamed-Noriega K, Mehta JS. Application of Femtosecond Laser in Anterior Segment Surgery. J Ophthalmol 2020; 2020:8263408. [PMID: 32351726 PMCID: PMC7171667 DOI: 10.1155/2020/8263408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karim Mohamed-Noriega
- Department of Ophthalmology, University Hospital, Faculty of Medicine, Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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: 33] [Impact Index Per Article: 8.3] [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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Schallhorn JM, Seifert S, Schallhorn SC. SMILE, Topography-Guided LASIK, and Wavefront-Guided LASIK: Review of Clinical Outcomes in Premarket Approval FDA Studies. J Refract Surg 2019; 35:690-698. [DOI: 10.3928/1081597x-20190930-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
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Chiam NP, Mehta JS. Comparing Patient-Reported Outcomes of Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction: A Review. Asia Pac J Ophthalmol (Phila) 2019; 8:377-384. [PMID: 31478935 PMCID: PMC6784778 DOI: 10.1097/apo.0000000000000258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) are popular refractive surgeries. The objective refractive outcomes of LASIK and SMILE have been studied extensively; both procedures have comparable safety, efficacy, and predictability. However, owing to various psychosocial factors, refractive patients may report dissatisfaction despite good postoperative vision. Hence the importance of studies on subjective patient-reported outcomes. This review discusses the role of psychometric-technique-based validated questionnaires when evaluating subjective outcomes. It also summarizes the literature on patient-reported outcomes for LASIK and SMILE. DESIGN A literature search was performed on PubMed database to identify studies that have assessed patient-reported outcomes for LASIK and SMILE. RESULTS Several studies have looked into patient-reported outcome measures for LASIK, but the number of equivalent studies for SMILE is limited. Questionnaires (validated and non-validated) are used to evaluate patient-reported outcomes. Validated questionnaires are designed based on psychometric techniques, such as Classic Test Theory, Item Response Theory, and Rasch analysis. The Quality of Life Impact of Refractive Correction (QIRC) questionnaire, a validated questionnaire administered to both LASIK and SMILE patients, suggests that both groups have comparable vision-related quality of life in the first few months postoperatively; but SMILE might confer a slight advantage in the later postoperative period (postoperative month 6). CONCLUSIONS Future LASIK-SMILE comparative studies utilizing standardized validated questionnaires for patient-reported outcome measures with longer follow-up durations would be a welcome contribution to this important aspect of refractive surgery.
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Affiliation(s)
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
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20
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Wang Y, Ma J, Zhang L, Zou H, Li J, Zhang Y, Jhanji V. Postoperative Corneal Complications in Small Incision Lenticule Extraction: Long-Term Study. J Refract Surg 2019; 35:146-152. [PMID: 30855091 DOI: 10.3928/1081597x-20190118-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the incidence and clinical results of corneal complications after small incision lenticule extraction (SMILE). METHODS A retrospective cohort study including 3,223 patients (6,373 eyes) who were treated for myopia or myopic astigmatism was conducted. Postoperative corneal complications were recorded. Postoperative follow-up visits were scheduled on days 1 and 7 and months 1, 3, 6, and 12. RESULTS Of the 6,373 cases, 432 eyes (6.8%) developed at least one corneal complication postoperatively. These included punctate epithelial erosions (3.26%), diffuse lamellar keratitis (DLK) (2.17%), corneal infiltrates (0.39%), interface debris/secretion (0.30%), interface haze (0.17%), interface foreign body (0.24%), corneal striae (0.14%), corneal edema (0.09%), and epithelial ingrowth (0.02%). Of cases with corneal complications, 308 (71.3%) had an uncorrected distance visual acuity (UDVA) of better than 20/25 and 49 (11.3%) eyes lost two or more lines of corrected distance visual acuity (CDVA) on the first day after surgery. By 3 months, only 2 eyes (0.9%) had lost two or more lines of CDVA. At 6 months, 1 eye (1.0%) did not achieve a UDVA of 20/25 as a result of stage 3 DLK, but achieved 20/20 by 1 year. The postoperative spherical equivalent in cases without complications was lower than that in cases with complications at 1 day and 1 and 3 months (P = .001, .011, and .001, respectively), but there was no statistical difference at 6 and 12 months. CONCLUSIONS In this large cohort study, a variety of corneal complications were noted after SMILE. Although some of these complications may temporarily affect visual recovery, most resolve with appropriate treatment. [J Refract Surg. 2019;35(3):146-152.].
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Klokova OA, Sakhnov SN, Geydenrikh MS, Damashauskas RO. Quality of life after refractive surgery: ReLEx SMILE vs Femto-LASIK. Clin Ophthalmol 2019; 13:561-570. [PMID: 30988598 PMCID: PMC6440445 DOI: 10.2147/opth.s170277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The safety and effectiveness of complex myopic astigmatism correction using ReLEx SMILE or Femto-LASIK techniques have been well established. The purpose of the current study is to compare quality of life (QoL) outcomes following ReLEx SMILE or Femto-LASIK procedures in parallel with functional vision and anatomic outcomes of treated eyes. Patients and methods This prospective, consecutive series included 118 patients, 18–43 years of age, out of which 56 underwent ReLEx SMILE and 62 underwent Femto-LASIK surgery for correction of myopic astigmatism. All patients underwent standard comprehensive ophthalmic examinations, and additionally, completed The Quality of Life Impact of Refractive Correction Questionnaire to determine the impact the vision-correction treatment had on their QoL. Results In both treatment groups, the postoperative refractive outcomes were comparable, with visual acuity improvements for both groups noted the day following surgery. After laser correction of complex myopic astigmatism using Femto-LASIK and ReLEx SMILE methods, the overall QoL indicators are statistically significant (P<0.01) exceeding preoperative values 1 month after the operation and reaching the maximum values by the end of the observation period (P<0.0001). Conclusion The results of the study suggest that patients require some time to adapt to their new visual function and its impact on their daily living, delaying detectable improvements in QoL. Moreover, these results may suggest a higher satisfaction trend and long-term QoL in patients undergoing ReLEx SMILE in comparison to Femto-LASIK. Long-term results from the study demonstrated high patient satisfaction with both methods.
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Wang KJ, Wang WW, Tsai CL, Wang IJ. Intraocular pressure changes in eyes with small incision lenticules and laser in situ keratomileusis. Clin Exp Optom 2018; 102:399-405. [PMID: 30556213 DOI: 10.1111/cxo.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Measuring intraocular pressure after refractive surgery is a challenge in the diagnosis, evaluation, and treatment of glaucoma. Intraocular pressure characteristics after laser in situ keratomileusis (LASIK) are well known. However, intraocular pressure measurement and characteristics after small incision lenticule extraction (SMILE) are still unknown, providing an interesting point of comparison in terms of biomechanical differences from LASIK. METHODS An intraocular pressure analytical model utilising fluid dynamics (simulating air puff) was developed using OpenFoam and Scilab. In addition, solid mechanics (simulating the deformation of the corneal structure) and a ray-tracing technique (simulating applanation detection) simulated by a previously established air-puff Tonovue tonometer were used to simulate post-SMILE and post-LASIK intraocular pressure. RESULTS Based on the proposed model, while at a myopic correction of zero dioptres the difference in intraocular pressure before and after SMILE was 0 mmHg, whereas the difference before and after LASIK was -2.2 mmHg. This trend was observed with a myopic correction up to 12 dioptres. CONCLUSION In a numerical simulation, differences in intraocular pressure in LASIK and SMILE largely resulted from the completeness of the Bowman's membrane resulting from cap or flap creation.
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Affiliation(s)
| | - Wai W Wang
- Crystalvue Medical Corporation, Taoyuan, Taiwan
| | | | - I-Jong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Influence of Incision Size on Dry Eye Symptoms in the Small Incision Lenticule Extraction Procedure. Cornea 2018; 38:18-23. [PMID: 30308580 DOI: 10.1097/ico.0000000000001782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the influence of incision size on dry eye symptoms in the small incision lenticule extraction (SMILE) procedure. METHODS Ninety-four eyes of 47 patients with myopia and/or myopic astigmatism who had undergone the SMILE procedure were enrolled in this study. The patients were divided into 3 groups according to the incision size (2, 3, and 4 mm) applied during the SMILE procedure. RESULTS There were no significant differences among the groups in respect to age and sex (P values 0.251 and 0.974, respectively) and in respect to preoperative, postoperative first day, first week, first month, third month, and sixth month values of the Ocular Surface Disease Index score, tear break-up time, ST1, and staining grades. CONCLUSIONS There was no difference in dry eye symptoms with 2-, 3-, and 4-mm incisions. In the learning period of SMILE surgery, larger incision sites can be used to make the procedure easier.
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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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Song YJ, Kim S, Yoon GJ. Case series: Use of stromal lenticule as patch graft. Am J Ophthalmol Case Rep 2018; 12:79-82. [PMID: 30302418 PMCID: PMC6174828 DOI: 10.1016/j.ajoc.2018.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To introduce cases of the use, as patch grafts, of stromal lenticules obtained by small incision lenticule extraction (SMILE) surgery. Observations Case 1 was a 79-year-old man who presented with Ahmed-valve-tube exposure in his left eye. His uncorrected visual acuity (UCVA) was 20/40, best-corrected visual acuity (BCVA) 20/32, and intraocular pressure (IOP) 11 mmHg. He was treated with stromal lenticule patch that had been extracted by SMILE surgery. The patch was positioned underneath of the conjunctiva and sutured to it. At postoperative 8 months, the graft site was well maintained without Ahmed valve-tube exposure, the UCVA was 20/32, BCVA 20/20, and IOP 12 mmHg. Case 2 was a 60-year-old man who presented with Ahmed-valve-tube exposure in his right eye. His UCVA was finger-count (FC) 30 cm, his BCVA 20/125, and his IOP 14 mmHg. He was treated with stromal lenticule patch by the same method as employed in case 1. At postoperative 10 days, tube re-exposure and displacement of the Ahmed valve external plate toward the limbus area occurred due to loosening of the anchoring suture. So, we removed the Ahmed valve device, which had been implanted in the supero-temporal area, and performed new Ahmed valve implantation, with a stromal lenticule flap instead of a partial scleral flap, in the supero-nasal area. As of 6 months post-reoperation, the patient was stable, with UCVA 20/200, BCVA 20/40 and IOP 13 mmHg. Case 3 was a 74-year-old man who presented with bullous keratopathy in his right eye, which was blind. Due to severe adhesions, his conjunctiva could not cover the entire cornea. Therefore, we performed a stromal lenticule patch graft with conjunctival advance flap. At postoperative 3 months, the patient's right eye was stable, without displacement or melting of the lenticule graft. Conclusions & importance It is suggested that the stromal lenticule, with its biocompatibility, sufficient strength, ease of handling and low cost, is a useful patch graft for various therapeutic purposes in the ophthalmic field.
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Affiliation(s)
- Yong Ju Song
- Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea
| | - Sumi Kim
- Department of Dentistry, Hallym University Gangnam Sacred Heart Hospital, Seoul, South Korea
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Han T, Xu Y, Han X, Zeng L, Shang J, Chen X, Zhou X. Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism. Br J Ophthalmol 2018; 103:565-568. [PMID: 30061116 PMCID: PMC6691872 DOI: 10.1136/bjophthalmol-2018-312140] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
Aims To compare long-term clinical outcomes following small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism correction. Methods In this retrospective study, we enrolled a total of 101 patients (101 eyes) who underwent SMILE or FS-LASIK 3 years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction and corneal wavefront aberrations. Results No significant differences in patient characteristics were found between the two groups. At the 3-year follow-up, UDVA was better than or equal to 20/20 in 90% and 85% (p=0.540) of the eyes; the efficacy indexes were 1.05±0.19 and 1.01±0.21 in the SMILE and FS-LASIK groups, respectively (p=0.352). Safety indexes were 1.19±0.17 and 1.15±0.20 in the SMILE and FS-LASIK groups, respectively (p=0.307). Eighty per cent and 65% of eyes were within ±0.50 D of the attempted spherical equivalent correction after SMILE and FS-LASIK, respectively (p=0.164). Vector analysis revealed no significant differences in astigmatic correction between the two groups (p>0.05). Surgically induced spherical aberration was higher in the FS-LASIK group than in the SMILE group (p<0.001). Conclusion Long-term follow-up analysis suggested that both SMILE and FS-LASIK were safe and equally effective for myopic and astigmatic correction.
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Affiliation(s)
- Tian Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Ye Xu
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xiao Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Li Zeng
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Jianmin Shang
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xun Chen
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xingtao Zhou
- The Key Lab of Myopia, Ministry of Health, Shanghai, China .,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
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Jun I, Kang DSY, Reinstein DZ, Arba-Mosquera S, Archer TJ, Seo KY, Kim TI. Clinical Outcomes of SMILE With a Triple Centration Technique and Corneal Wavefront-Guided Transepithelial PRK in High Astigmatism. J Refract Surg 2018. [PMID: 29522224 DOI: 10.3928/1081597x-20180104-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To comparatively investigate the clinical outcomes, vector parameters, and corneal aberrations of small incision lenticule extraction (SMILE) with a triple centration technique and corneal wavefront-guided transepithelial photorefractive keratectomy (PRK) for the correction of high astigmatism. METHODS This retrospective, comparative case series study included 89 eyes (89 patients) that received treatment for myopia with high astigmatism (≥ 2.50 diopters) using SMILE with a triple centration technique (SMILE group; 45 eyes) and corneal wavefront-guided transepithelial PRK (transepithelial PRK group; 44 eyes). Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1, 3, and 6 months after surgery. The safety, efficacy, vector parameters, and corneal aberrations at 6 months after surgery were compared between the two groups. RESULTS At 6 months after surgery, the transepithelial PRK and SMILE groups exhibited comparable mean uncorrected distance visual acuities (-0.06 ± 0.07 and -0.05 ± 0.07 logMAR, respectively), safety, efficacy, and predictability of refractive and visual outcomes. There was a slight but statistically significant difference in the correction index between the transepithelial PRK and SMILE groups (0.96 ± 0.11 and 0.91 ± 0.10, respectively). Whereas the transepithelial PRK group exhibited increased corneal spherical aberration and significantly reduced corneal coma and trefoil, no changes in aberrometric values were noted in the SMILE group. CONCLUSIONS Both SMILE with a triple centration technique and corneal wavefront-guided transepithelial PRK are effective and provide predictable outcomes for the correction of high myopic astigmatism, although slight undercorrection was observed in the SMILE group. The triple centration technique was helpful in astigmatism correction by SMILE. [J Refract Surg. 2018;34(3):156-163.].
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Shajari M, Wanner E, Rusev V, Mir Mohi Sefat S, Mayer WJ, Kohnen T, Priglinger S, Kook D. Corneal Densitometry after Femtosecond Laser-Assisted In Situ Keratomileusis (Fs-LASIK) and Small Incision Lenticule Extraction (SMILE). Curr Eye Res 2018. [PMID: 29537886 DOI: 10.1080/02713683.2018.1431288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare corneal densitometry values after Femtosecond Laser-Assisted In Situ Keratomileusis (Fs-LASIK) and Small Incision Lenticule Extraction (SMILE) using Scheimpflug Imaging. METHODS Our retrospective clinical trial included a total of 146 eyes where 57 eyes underwent Fs-LASIK and 89 eyes underwent SMILE. Examinations with a Pentacam Scheimpflug device (Oculus, Wetzlar, Germany) were performed before surgery, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Detailed data of all four concentric optical zones were acquired - central 0-2 mm, 2-6 mm, 6-10 mm and 10-12 mm. The cornea was divided into anterior 120 µm, middle and posterior 60 µm sections. Values were analyzed during follow-up comparing Fs-LASIK and SMILE. RESULTS No statistically significant differences in corneal density were detected. The central 0-2 mm anterior area demonstrated a mean 1-year value of 17.99 grayscale units (GSU) ± 0.89 (range 16.60-19.50) after Fs-LASIK versus 17.96 GSU ± 0.98 (range 16.40-20.00) after SMILE. Three months after surgery there was a slight temporary density increase in the 6-10 mm anterior annulus in the LASIK group - 22.19 (SD = 3.99, range: 15.60-30.50) compared to SMILE - 20.39 (SD = 3.79, range 14.70-36.30). CONCLUSION There were no statistically significant short or long-term differences in postoperative corneal densitometry after LASIK and SMILE, demonstrating SMILE is not inferior in this regard. Known delayed visual acuity recovery after SMILE in relation to LASIK could not be correlated with changes in corneal density.
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Affiliation(s)
- Mehdi Shajari
- a Department of Ophthalmology , Goethe University , Frankfurt , Germany
| | - Emanuel Wanner
- b Department of Ophthalmology , Ludwig Maximilians University , Munich , Germany
| | - Vladimir Rusev
- a Department of Ophthalmology , Goethe University , Frankfurt , Germany
| | | | - Wolfgang J Mayer
- b Department of Ophthalmology , Ludwig Maximilians University , Munich , Germany
| | - Thomas Kohnen
- a Department of Ophthalmology , Goethe University , Frankfurt , Germany
| | - Siegfried Priglinger
- b Department of Ophthalmology , Ludwig Maximilians University , Munich , Germany
| | - Daniel Kook
- c Smile Eyes Eye Clinic Munich Airport , Munich , Germany
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Hosny M, Aboalazayem F, El Shiwy H, Salem M. Comparison of different intraocular pressure measurement techniques in normal eyes and post small incision lenticule extraction. Clin Ophthalmol 2017; 11:1309-1314. [PMID: 28761329 PMCID: PMC5522824 DOI: 10.2147/opth.s132578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to determine the accuracy of intraocular pressure (IOP) measurement after small incision lenticule extraction (SMILE) using Goldmann applanation tonometry (GAT) and ocular response analyzer (ORA). Methods This is a prospective clinical study that was conducted on 30 eyes in the interval between February 2016 and September 2016. The age of the patients ranged between 19 and 40 years. The patients underwent SMILE surgery using the femto laser. IOP was measured preoperatively and 1 month postoperatively by both techniques, the GAT and the ORA. Results GAT recorded lower values than ORA values (IOPcc) preoperatively and postoperatively and the difference was statistically significant. Both GAT and ORA IOP measurements decreased after SMILE. There was no statistically significant correlation between the changes in the GAT and ORA readings and the postoperative corneal pachymetry or the lenticule thickness. Both corneal hysteresis and corneal resistance factor showed significant decline after the procedure, which correlated with the lenticule thickness. Conclusion SMILE causes significant reduction in IOP measurement by ORA and GAT. Corneal biomechanics decreases following SMILE and this correlates with lenticule thickness.
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Affiliation(s)
- Mohamed Hosny
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | | | - Hoda El Shiwy
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | - Mohsen Salem
- Department of Ophthalmology, Cairo University, Giza, Egypt
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Liu T, Zhu X, Chen K, Bai J. Visual outcomes after balanced salt solution infiltration during lenticule separation in small-incision lenticule extraction for myopic astigmatism. Medicine (Baltimore) 2017; 96:e7409. [PMID: 28746183 PMCID: PMC5627809 DOI: 10.1097/md.0000000000007409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 12/28/2022] Open
Abstract
To evaluate the refractive outcomes of balanced salt solution infiltration during small-incision lenticule extraction (SMILE).This randomized prospective study enrolled 52 patients (104 eyes) with myopic astigmatism. Patients underwent SMILE to correct the myopic astigmatism in Daping Hospital of the Third Military Medical University between January and July 2013. One eye of each patient received traditional SMILE (control group) and the other received a modified SMILE procedure (liquid infiltration group). The corrected distance visual acuity (CDVA), postoperative uncorrected distance visual acuity (UDVA), refraction, wavefront aberration, intraocular pressure (IOP), modulation transfer function (MTF) cut-off frequency, and objective scattering index (OSI) were evaluated.UDVA in the liquid infiltration group was significantly higher than that in the control group at 1 day postoperatively, but not at 1 month after surgery. Moreover, OSI and MTF cut-off frequency in the liquid infiltration group were higher than those in the control group at early follow-up. However, no significant intergroup difference was observed in the OSI and MTF cut-off frequency at 3 months after surgery. In addition, the predictability was better in the liquid infiltration group than in the control group. The changes of horizontal coma in the liquid infiltration group were lesser than those in the control group. However, no intergroup difference was observed in the reduction of IOP at 1 month after surgery.The modified SMILE procedure results in better visual outcomes than did the traditional SMILE procedure when used for treating myopic astigmatism.
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Cai WT, Liu QY, Ren CD, Wei QQ, Liu JL, Wang QY, Du YR, He MM, Yu J. Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis: a Meta-analysis. Int J Ophthalmol 2017; 10:632-638. [PMID: 28503439 DOI: 10.18240/ijo.2017.04.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS The Meta-analysis was performed using RevMan 5.3. We searched on PubMed from inception to March 2016. Summary weighted mean difference (WMD) and 95% confidence intervals (CIs) were used to analyze the datum. Random-effects or fixed-effects models were chosen up to between-study heterogeneity. The main outcomes were composed of the Ocular Surface Disease Index (OSDI) scores, tear film break-up time (TBUT), Schirmer Test and corneal sensitivity. RESULTS Eight eligible studies including 772 eyes (386 in SMILE group and 386 in FS-LASIK group) were identified. The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively. There were significant differences between the two groups in OSDI scores at one and three months postoperatively, in TBUT at one and three months postoperatively, in corneal sensitivity at one week, about one month and three months postoperatively. However, there was no significant difference observed in Schirmer Test at the follow-up periods. CONCLUSION Compare to FS-LASIK, dry eye and the corneal sensitivity recover better in the SMILE group, in first three months after the surgery.
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Affiliation(s)
- Wen-Ting Cai
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qing-Yu Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Cheng-Da Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qing-Quan Wei
- Nanchang University, Nanchang 330031, Jiangxi Province, China
| | - Jun-Ling Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qian-Yi Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Ya-Ru Du
- Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Meng-Mei He
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Jing Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
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Sequential segmental terminal lenticular side-cut dissection for safe and effective small-incision lenticule extraction in thin lenticules. J Cataract Refract Surg 2017; 43:443-448. [DOI: 10.1016/j.jcrs.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
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Schiefer U, Kraus C, Baumbach P, Ungewiß J, Michels R. Refractive errors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:693-702. [PMID: 27839543 PMCID: PMC5143802 DOI: 10.3238/arztebl.2016.0693] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 02/26/2016] [Accepted: 07/19/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND All over the world, refractive errors are among the most frequently occuring treatable distur - bances of visual function. Ametropias have a prevalence of nearly 70% among adults in Germany and are thus of great epidemiologic and socio-economic relevance. METHODS In the light of their own clinical experience, the authors review pertinent articles retrieved by a selective literature search employing the terms "ametropia, "anisometropia," "refraction," "visual acuity," and epidemiology." RESULTS In 2011, only 31% of persons over age 16 in Germany did not use any kind of visual aid; 63.4% wore eyeglasses and 5.3% wore contact lenses. Refractive errors were the most common reason for consulting an ophthalmologist, accounting for 21.1% of all outpatient visits. A pinhole aperture (stenopeic slit) is a suitable instrument for the basic diagnostic evaluation of impaired visual function due to optical factors. Spherical refractive errors (myopia and hyperopia), cylindrical refractive errors (astigmatism), unequal refractive errors in the two eyes (anisometropia), and the typical optical disturbance of old age (presbyopia) cause specific functional limitations and can be detected by a physician who does not need to be an ophthalmologist. CONCLUSION Simple functional tests can be used in everyday clinical practice to determine quickly, easily, and safely whether the patient is suffering from a benign and easily correctable type of visual impairment, or whether there are other, more serious underlying causes.
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Affiliation(s)
- Ulrich Schiefer
- Aalen University of Applied Sciences, Competence Center Vision Research, Study Program Ophthalmic Optics
- Department of Ophthalmology, Tübingen University Hospital, Tübingen
| | - Christina Kraus
- Aalen University of Applied Sciences, Competence Center Vision Research, Study Program Ophthalmic Optics
| | - Peter Baumbach
- Aalen University of Applied Sciences, Competence Center Vision Research, Study Program Ophthalmic Optics
| | - Judith Ungewiß
- Aalen University of Applied Sciences, Competence Center Vision Research, Study Program Ophthalmic Optics
- Department of Ophthalmology, Tübingen University Hospital, Tübingen
| | - Ralf Michels
- Aalen University of Applied Sciences, Competence Center Vision Research, Study Program Ophthalmic Optics
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Jacob S, Nariani A, Figus M, Agarwal A, Agarwal A. White ring sign for uneventful lenticule separation in small-incision lenticule extraction. J Cataract Refract Surg 2016; 42:1251-1254. [PMID: 27697241 DOI: 10.1016/j.jcrs.2016.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 10/20/2022]
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Shen Z, Shi K, Yu Y, Yu X, Lin Y, Yao K. Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK) for Myopia: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0158176. [PMID: 27367803 PMCID: PMC4930219 DOI: 10.1371/journal.pone.0158176] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The goal of this study was to compare small incision lenticule extraction (SMILE) with femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for treating myopia. METHODS The CENTRAL, EMBASE, PubMed databases and a Chinese database (SinoMed) were searched in May of 2016. Twelve studies with 1,076 eyes, which included three randomized controlled trials (RCTs) and nine cohorts, met our inclusion criteria. The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group framework. Data were extracted and analysed at three to six months postoperatively. Primary outcome measures included a loss of one or more lines of best spectacle corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA) of 20/20 or better, mean logMAR UCVA, postoperative mean spherical equivalent (SE) and postoperative refraction within ±1.0 D of the target refraction. Secondary outcome measures included ocular surface disease index (OSDI), tear breakup time (TBUT) and Schirmer's 1 test (S1T) as dry eye parameters, along with corneal sensitivity. RESULTS The overall quality of evidence was considered to be low to very low. Pooled results revealed no significant differences between the two groups with regard to a loss of one or more lines in the BSCVA (OR 1.71; 95% CI: 0.81, 3.63; P = 0.16), UCVA of 20/20 or better (OR 0.71; 95% CI: 0.44, 1.15; P = 0.16), logMAR UCVA (MD 0.00; 95% CI: -0.03, 0.04; P = 0.87), postoperative refractive SE (MD -0.00; 95% CI: -0.05, 0.05; P = 0.97) or postoperative refraction within ±1.0 D of the target refraction (OR 0.78; 95% CI: 0.22, 2.77; P = 0.70) within six months postoperatively. The pooled analysis also indicated that the FS-LASIK group suffered more severely from dry eye symptoms (OSDI; MD -6.68; 95% CI: -11.76, -2.00; P = 0.006) and lower corneal sensitivity (MD 12.40; 95% CI: 10.23, 14.56; P < 0.00001) at six months postoperatively. CONCLUSIONS In conclusion, both FS-LASIK and SMILE are safe, effective and predictable surgical options for treating myopia. However, dry eye symptoms and loss of corneal sensitivity may occur less frequently after SMILE than after FS-LASIK.
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Affiliation(s)
- Zeren Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Keda Shi
- Department of Gastroenterology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinhui Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoning Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuchen Lin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Decellularization of human stromal refractive lenticules for corneal tissue engineering. Sci Rep 2016; 6:26339. [PMID: 27210519 PMCID: PMC4876320 DOI: 10.1038/srep26339] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/27/2016] [Indexed: 11/13/2022] Open
Abstract
Small incision lenticule extraction (SMILE) becomes a procedure to correct myopia. The extracted lenticule can be used for other clinical scenarios. To prepare for allogeneic implantation, lenticule decellularization with preserved optical property, stromal architecture and chemistry would be necessary. We evaluated different methods to decellularize thin human corneal stromal lenticules created by femtosecond laser. Treatment with 0.1% sodium dodecylsulfate (SDS) followed by extensive washes was the most efficient protocol to remove cellular and nuclear materials. Empty cell space was found inside the stroma, which displayed aligned collagen fibril architecture similar to native stroma. The SDS-based method was superior to other treatments with hyperosmotic 1.5 M sodium chloride, 0.1% Triton X-100 and nucleases (from 2 to 10 U/ml DNase and RNase) in preserving extracellular matrix content (collagens, glycoproteins and glycosaminoglycans). The stromal transparency and light transmittance was indifferent to untreated lenticules. In vitro recellularization showed that the SDS-treated lenticules supported corneal stromal fibroblast growth. In vivo re-implantation into a rabbit stromal pocket further revealed the safety and biocompatibility of SDS-decellularized lenticules without short- and long-term rejection risk. Our results concluded that femtosecond laser-derived human stromal lenticules decellularized by 0.1% SDS could generate a transplantable bioscaffold with native-like stromal architecture and chemistry.
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Chan C, Lawless M, Sutton G, Versace P, Hodge C. Small incision lenticule extraction (SMILE) in 2015. Clin Exp Optom 2016; 99:204-12. [PMID: 27156103 DOI: 10.1111/cxo.12380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022] Open
Abstract
Small incision lenticule extraction (SMILE) represents a recent addition to the refractive surgeon's range of procedures. Although there remains a number of similarities to existing techniques in terms of patient selection and treatment parameters, consideration is required to optimise patient outcomes and satisfaction. Here, we review the selection criteria, contraindications, indications and existing published safety and efficacy outcomes.
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Affiliation(s)
- Colin Chan
- Vision Eye Institute, Chatswood, New South Wales, Australia
| | - Michael Lawless
- Vision Eye Institute, Chatswood, New South Wales, Australia.,Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gerard Sutton
- Vision Eye Institute, Chatswood, New South Wales, Australia.,Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Chris Hodge
- Vision Eye Institute, Chatswood, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia
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Piñero-Llorens DP, Murueta-Goyena Larrañaga A, Hanneken L. Visual outcomes and complications of small-incision lenticule extraction: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1131610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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