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Moshirfar M, Zhang S, Pandya S, Stoakes IM, Hoopes PC. Incidence and Management of Epithelial-Related Complications After SMILE. Clin Ophthalmol 2023; 17:2777-2789. [PMID: 37750098 PMCID: PMC10518173 DOI: 10.2147/opth.s426547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE). Patients and Methods A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups. Results Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively). Conclusion In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Stephanie Zhang
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Shreya Pandya
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Isabella M Stoakes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
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Zhang R, Zhang Y, Yuan Y, Chen Y. Comparison of objective and subjective visual quality after flapless laser vision correction for mild to moderate myopia: SMILE vs PRK. Graefes Arch Clin Exp Ophthalmol 2023; 261:1731-1741. [PMID: 36652015 DOI: 10.1007/s00417-022-05937-7] [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: 07/04/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the differences in surgical results and the objective and subjective quality of vision (QoV) of patients after small incision lenticule extraction (SMILE) versus alcohol-assisted photorefractive keratectomy (PRK). METHODS Medical records of patients treated with SMILE and PRK were retrospectively examined. Visual quality, biometric parameters, Strehl ratio (SR), and corneal higher-order aberrations (HOAs) within a 6.0 mm area were recorded. The effective optical zone (EOZ) and decentration were measured using a tangential pre-post operation difference map. Subjective QoV and operation satisfaction were evaluated 6 months postoperatively using the Quality of Vision questionnaire. RESULTS The study comprised 100 eyes treated with SMILE (preoperative mean spherical equivalent (SE), - 4.52 ± 0.81 dioptres (D)) and 69 eyes with PRK (mean SE, - 4.21 ± 1.25 D). Six months postoperatively, the EOZ reduction was significantly larger in the PRK group (P < 0.001). Decentrations were comparable between the groups. Regarding visual symptoms, monocular diplopia was more common following PRK (P = 0.02), and 98 (98.00%) SMILE-treated and 67 (97.10%) PRK-treated patients were satisfied with the QoV. Both groups demonstrated significant increases in total HOAs, coma, and spherical aberration (SA) at 6 months postoperatively compared to preoperatively (P < 0.001); these values were significantly higher in the PRK (P < 0.05) compared to the SMILE group. SR increased significantly only in the PRK group (P < 0.05). CONCLUSION Although EOZ was more consistent with anticipated treatment and HOAs were fewer in SMILE, high patient-reported satisfaction and good corneal optical quality were achieved in both groups, indicating that both SMILE and alcohol-assisted PRK are excellent options for mild to moderate myopia correction.
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Affiliation(s)
- Ruiyu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China.
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Comparison of visual outcomes between 120-µm and 140-µm cap thicknesses 12 months after small incision lenticule extraction. Lasers Med Sci 2022; 37:2667-2673. [PMID: 35217941 DOI: 10.1007/s10103-022-03534-y] [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: 08/03/2021] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
To compare visual and refractive outcomes as well as changes in high-order aberrations in patients with 120- versus 140-µm cap thicknesses 12 months after small incision lenticule extraction. Ninety-four patients were randomized to receive small incision lenticule extraction with either a 120-µm cap thickness (n = 47) or a 140-µm cap thickness (n = 47) to treat myopia or myopic astigmatism, if not both. In an analysis of right eyes only during the 12-month follow-up period, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and high-order aberrations were evaluated. The distribution of patients by age and sex between the groups did not differ significantly (P = .803 and P = .680, respectively). CDVA, spherical and cylindrical refraction, and changes in total high-order aberration, spherical aberration, coma, and trefoil were similar between the groups at 6 and 12 months, postoperatively. However, UDVA was statistically significantly higher in patients with 140-μm cap thicknesses than with 120-μm cap thicknesses at 6 and 12 months postoperatively (P < .001 and P < .001, respectively). Patients with 140-µm cap thickness showed greater improvement in UDVA than ones with 120-µm cap thickness at 12-month follow-up (P = .005). Both 120- and 140-μm cap thicknesses in small incision lenticule extraction were safe and effective thicknesses for correcting myopia or myopic astigmatism. The patients with 140-μm cap thickness had better improvement in UDVA after 12-month follow-up compared to patients with 120-μm cap thickness.
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Sarkar S, Devi P, Vaddavalli PK, Reddy JC, Bharadwaj SR. Differences in Image Quality after Three Laser Keratorefractive Procedures for Myopia. Optom Vis Sci 2022; 99:137-149. [PMID: 34974458 DOI: 10.1097/opx.0000000000001850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Psychophysical estimates of spatial and depth vision have been shown to be better after bilateral ReLEx small-incision lenticule extraction (SMILE) refractive surgery for myopia, relative to photorefractive keratectomy (PRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). The present study provides the optical basis for these findings using computational image quality analysis. PURPOSE This study aimed to compare longitudinal changes in higher-order wavefront aberrations and image quality before and after bilateral PRK, FS-LASIK, and SMILE refractive procedures for correcting myopia. METHODS Wavefront aberrations and image quality of both the eyes of 106 subjects (n = 40 for FS-LASIK and SMILE and n = 26 for PRK) were determined pre-operatively and at 1-week, 1-month, 3-month, and 6-month post-operative intervals using computational through-focus analysis for a 6-mm pupil diameter. Image quality was quantified in terms of its peak value and its interocular difference, residual defocus that was needed to achieve peak image quality (best focus), and the depth of focus. RESULTS The increase in root mean squared deviations of higher-order aberrations post-operatively was lesser after SMILE (1-month visit median [25th to 75th interquartile range], 0.34 μm (0.28 to 0.39 μm]) than after PRK (0.80 μm [0.74 to 0.87 μm]) and FS-LASIK (0.74 μm [0.59 to 0.83 μm]; P ≤ .001), all relative to pre-operative values (0.20 μm [0.15 to 0.30 μm]). The peak image quality dropped and its interocular difference increased, best focus shifted myopically by 0.5 to 0.75 D, and depth of focus widened significantly after PRK and FS-LASIK surgeries, all relative to pre-operative values (P < .001). All these changes were negligible but statistically significant in a minority of instances after SMILE surgery (P ≥ .01). CONCLUSIONS Although all three refractive surgeries correct myopia, the image quality and its similarity between eyes are better and closer to pre-operative values after SMILE, compared with FS-LASIK and PRK. These results can be explained from the underlying increase in higher-order wavefront aberrations experienced by the eye post-operatively.
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Affiliation(s)
| | | | | | - Jagadesh C Reddy
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Zhao W, Han T, Li M, Sekundo W, Aruma A, Zhou X. Nighttime Symptoms After Monocular SMILE: A Contralateral Eye Study. Ophthalmol Ther 2021; 10:1033-1044. [PMID: 34559401 PMCID: PMC8589907 DOI: 10.1007/s40123-021-00396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To investigate nighttime symptoms in patients with myopic anisometropia after monocular small incision lenticule extraction (SMILE) surgery. Methods Thirty-six patients who had undergone monocular SMILE more than 6 months previously were recruited at the Eye & ENT Hospital of Fudan University. The average age at surgery was 25.4 ± 6.1 years. Preoperative spherical equivalent (SE) was −3.77 ± 1.56 D in SMILE-treated eyes and −0.08 ± 0.66 D in unoperated eyes. Main measurements included uncorrected and corrected distance visual acuity, manifest refraction, halo radius, contrast sensitivity, nighttime symptoms, and patient satisfaction. Results The mean follow-up time was 13.9 ± 3.4 months. The efficacy and safety indexes were 1.18 and 1.28, respectively. The halo radius was not significantly different between SMILE-treated and unoperated eyes under luminance conditions of 1, 5, and 100 cd/m2 (P = 0.055). No significant differences were observed in contrast sensitivity at all spatial frequencies between eyes under both uncorrected and corrected conditions (all P > 0.05). None of the patients reported moderate or severe symptoms at night. Mild symptoms (glare, halo, starburst) were reported and binocularly equal in 13 patients, whereas four patients reported better night vision in SMILE-treated eyes than unoperated eyes, and one of them experienced mild night vision disturbance. The overall satisfaction score was 9.39 ± 0.80. Conclusions The disk halo size and contrast sensitivity in SMILE-treated eyes were similar to those in unoperated eyes, and nighttime symptoms almost completely resolved after SMILE.
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Affiliation(s)
- Wuxiao Zhao
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Walter Sekundo
- Department of Ophthalmology, Phillips University of Marburg, Marburg, Germany
| | - Aruma Aruma
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Optometry, Eye & ENT Hospital of Fudan University, No.19 Baoqing Road, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
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Comparison of 1-Year Outcomes Between Small Incision Lenticule Extraction With Prophylactic Cross-Linking and Femtosecond Laser-Assisted In Situ Keratomileusis With Prophylactic Cross-Linking. Cornea 2021; 40:12-18. [PMID: 33214416 DOI: 10.1097/ico.0000000000002547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare small incision lenticule extraction with prophylactic cross-linking (SMILE Xtra) and femtosecond laser-assisted in situ keratomileusis with prophylactic cross-linking (FS-LASIK Xtra) in their safety, efficacy, predictability, and stability. METHODS This is a prospective cohort study. Forty-eight eyes subjected to SMILE Xtra and 90 eyes subjected to FS-LASIK Xtra were enrolled. The enrolled eyes exhibited either borderline corneal topography or high myopia with thin cornea. The following parameters were evaluated before surgery and at 1 day; 1 week; and 1, 3, 6, and 12 months after surgery: corrected distance visual acuity, uncorrected distance visual acuity, manifest refractive spherical equivalent (MRSE), keratometry values, and thinnest corneal thickness. RESULTS After 1 month, no eye showed loss of 1 or more lines of corrected distance visual acuity. At 12 months, uncorrected distance visual acuity was 20/20 or better for 98% and 99% eyes in the SMILE Xtra and FS-LASIK Xtra groups, respectively (P = 0.657). For 93.8% eyes in the SMILE Xtra group and 90% eyes in the FS-LASIK Xtra group, the achieved MRSE was within ±0.50 diopter of the intended MRSE (P = 0.669). The correlation coefficients for predictability of MRSE correction by SMILE Xtra and FS-LASIK Xtra were 0.987 and 0.983, respectively. The mean MRSE values, keratometry values, and thinnest corneal thickness measured at the different time points showed no significant intra- or intergroup differences. CONCLUSIONS Our evaluations of 1-year outcomes suggest that the safety, efficacy, predictability, and stability of SMILE Xtra are comparable with those of FS-LASIK Xtra.
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Wan KH, Lin TPH, Lai KHW, Liu S, Lam DSC. Options and results in managing suction loss during small-incision lenticule extraction. J Cataract Refract Surg 2021; 47:933-941. [PMID: 33315737 DOI: 10.1097/j.jcrs.0000000000000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Suction loss is an intraoperative complication in small-incision lenticule extraction (SMILE) that presents a management challenge for the refractive surgeon. The purpose of this review is to evaluate the visual, refractive, and wavefront outcomes after suction loss across the different stages of SMILE with various respective surgical treatments. Surgical management options include immediate re-SMILE by redocking or delayed re-SMILE, with or without adjustment of the laser parameters, conversion to femtosecond laser in situ keratomileusis, transepithelial photorefractive keratectomy, refractive lenticule extraction, or pseudo-SMILE. The restart treatment module on VisuMax provides appropriate retreatment recommendation. Most retreatment options for suction loss, immediate or delayed, resulted in effective, safe, and predictable outcomes, and patients were satisfied with their outcomes. Based on available level II evidence, immediate re-SMILE with or without adjustment to the laser settings achieve favorable visual and refractive outcomes in handling this intraoperative complication across all stages of SMILE.
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Affiliation(s)
- Kelvin H Wan
- From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong (Wan, Lam); Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong (Lin); C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong (Lai, Liu, Lam); International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China (Lam); C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China (Lam)
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Hou X, Du K, Wen D, Hu S, Hu T, Li C, Tang Y, Wu X. Early visual quality outcomes after small-incision lenticule extraction surgery for correcting high myopic astigmatism. BMC Ophthalmol 2021; 21:48. [PMID: 33468105 PMCID: PMC7816348 DOI: 10.1186/s12886-021-01807-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate early optical quality outcomes after small-incision lenticule extraction (SMILE) surgery for correcting high myopic astigmatism. Methods This retrospective study enrolled 55 eyes from 37 patients who had preoperative myopic astigmatism of ≥2.00 diopters (D) who had been treated with SMILE surgery. Preoperatively, the mean cylinder was − 2.41 ± 0.54 D (range, − 2.00 D to − 4.50 D). The preoperative and postoperative visual outcomes, refraction, and higher-order aberration (HOA) at 1 and 3 months were compared. Refractive astigmatism changes were analyzed by the Alpins vector method. Results Three months after SMILE surgery, the average cylinder was − 0.14 ± 0.31 D, and the average astigmatism vector was − 0.09 D × 6.34°. The angle of error (AofE) was limited to within ±10°, and the magnitude of error was limited to within ±1.0 D in all patients. The correction index (CI) was 0.98 ± 0.07, the index of success (IOS) was 0.08 ± 0.13, and the flattening index (FI) was 0.97 ± 0.07. Significant positive correlations were found between IOS and |AofE| (P = 0.000); negative correlations were found between FI and |AofE| (P = 0.000). The postoperative total HOA, spherical aberration, vertical coma aberration, and trefoil 30° were increased significantly compared with preoperative measurements, and the increase in HOA was closely related to preoperative astigmatism (P < 0.05). Conclusions SMILE has preferable outcomes for correcting high myopic astigmatism. Axis rotation during the surgery might influence the undercorrection of astigmatism. The increase of HOA after surgery is related to preoperative astigmatism.
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Affiliation(s)
- Xiangtao Hou
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Kaixuan Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Dan Wen
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Shengfa Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Tu Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Chenling Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Yanhui Tang
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Xiaoying Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China.
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Gyldenkerne A, Aagaard N, Jakobsen M, Toftelund C, Hjortdal J. Changes in accommodative function following small-incision lenticule extraction for high myopia. PLoS One 2020; 15:e0244602. [PMID: 33378342 PMCID: PMC7773189 DOI: 10.1371/journal.pone.0244602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/12/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE). METHODS 35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders push-up-method was used to measure the amplitude of accommodation. The accommodative response was assessed using an open-field autorefractor"Grand Seiko WAM-5500" (Grand Seiko Co. Ltd., Hiroshima, Japan) in combination with a Badal optometer and stimuli of accommodation at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D, respectively. Accommodative facility was measured at 40 cm with ±2,00D flipper lenses. All measurements of accommodation were performed monocularly with the refractive error corrected with soft contact lenses. RESULTS The amplitude of accommodation did not change statistically significantly (mean difference -0.24 D (SD 0.98), 95% CI of mean difference -0.58 D to 0.11 D, paired-sample t(34) = -1.39; P = 0.17). The accommodative responses at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D did not statistically significantly change either (F(6,29) = 1.15; P = .36). Finally, the accommodative facility was also unchanged with a mean difference of 1.11 cycles per minute (SD 5.11, 95% CI of mean difference -0.64 to 2.87, paired-sample t(34) = 1.29; P = 0.21). No clinically significant associations between changes in accommodation and higher-order aberrations were found. CONCLUSIONS SMILE does not alter the amplitude of accommodation, the accommodative response, nor the accommodative facility for highly myopic patients, and the surgically induced corneal higher-order aberrations do not affect the accommodative function.
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Affiliation(s)
- Anders Gyldenkerne
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Nicolaj Aagaard
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Malene Jakobsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Carina Toftelund
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas. Eye (Lond) 2020; 35:2302-2309. [PMID: 33139876 DOI: 10.1038/s41433-020-01256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy. SETTING Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN Retrospective case series. METHODS The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated. RESULTS The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time. CONCLUSION SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.
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A comparison of the effects of different cap thicknesses on corneal nerve destruction after small incision lenticule extraction. Int Ophthalmol 2020; 40:1905-1911. [PMID: 32601964 DOI: 10.1007/s10792-020-01362-z] [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: 02/01/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the features of corneal nerve destruction after small incision lenticule extraction (SMILE) with different cap thicknesses (100 and 120 μm). METHODS Nine consecutive patients (18 eyes) received SMILE with a 120-μm cap thickness and nine patients (18 eyes) with a 100-μm cap thickness were recruited. Confocal microscopy was used to evaluate the density and microscopic morphological changes of central corneal subbasal nerves preoperatively and at postoperative week 1. RESULTS The postoperative corneal subbasal nerve densities decreased significantly in both 120 μm and 100 μm groups. No statistical difference was detected in reduction of subbasal nerve density between two groups (P = 0.299). The number of subbasal nerve fibers significantly decreased in both groups. The reductions were not significantly different between two groups (P = 0.293). CONCLUSIONS Using a 120-μm cap thickness during SMILE preserves no more central corneal subbasal nerve fibers compared to a 100-μm cap thickness.
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The best optical zone for small-incision lenticule extraction in high myopic patients. J Cataract Refract Surg 2020; 46:1302-1307. [PMID: 32569029 DOI: 10.1097/j.jcrs.0000000000000282] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Small-incision lenticule extraction (SMILE) is an effective and safe procedure for the correction of myopia due to minimally invasive and noncorneal flap surgery. However, the SMILE procedure has certain requirements for corneal cap thickness, attempted refractive correction, residual stromal bed thickness, and optical zone diameter, which sometimes make surgeons hesitant to choose SMILE or other refractive surgeries. The requirements limit its use in patients with high myopia. The purpose of this review was to find the optimal parameters of SMILE through discussing the best optical zone for high myopic patients, the visual quality of different optical zones, the choice of corneal cap thickness, and their effects on corneal biomechanical parameters, so surgeons can provide reference recommendations for patients with high myopia in choosing a reasonable and safe procedure.
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13
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Han T, Xu Y, Han X, Shang J, Zeng L, Zhou X. Quality of life impact of refractive correction (QIRC) results three years after SMILE and FS-LASIK. Health Qual Life Outcomes 2020; 18:107. [PMID: 32334584 PMCID: PMC7183704 DOI: 10.1186/s12955-020-01362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 04/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background This study aimed to compare long-term postoperative quality of life and satisfaction differences between SMILE and FS-LASIK for myopia correction. Methods This cross-sectional study enrolled patients under the age of 39 years, who chose to undergo SMILE or FS-LASIK surgery to both eyes 3 years previously. Patients completed a common vision test and Quality of Life Impact of Refractive Correction (QIRC) questionnaire, together with the surgical satisfaction, adverse symptoms subjective survey. Patients with preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity of 20/20 or greater were included. Propensity score matching (PSM) was used to match the preoperative and postoperative spherical equivalent, age, and designed optical zones of the left and right eyes between the two groups. Results Forty-nine patients were included in each group after PSM from 188 patients. No significant difference in the total QIRC score was found between the SMILE and FS-LASIK groups (45.89 ± 5.91 vs 45.09 ± 5.65, p = 0.492). There were no differences in surgical satisfaction between the groups (p = 0.178). Compared to the SMILE group, the FS-LASIK group had more glare (2.12 ± 2.25 vs 3.22 ± 2.54, p = 0.026) and severe dryness (1.80 ± 1.98 vs 2.79 ± 2.19, p = 0.021). Conclusion Postoperative quality of life is similar after SMILE or FS-LASIK. Dry eye symptoms and glare were milder in the SMILE group than in the FS-LASIK group.
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Affiliation(s)
- Tian Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China.,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.,Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ye Xu
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China.,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.,Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiao Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China.,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.,Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China.,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.,Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Li Zeng
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China.,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.,Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- The Key Lab of Myopia, Ministry of Health, Shanghai, People's Republic of China. .,Department of Ophthalmology and Vision Science, The Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China. .,Research Center of Ophthalmology and Optometry, Shanghai, China.
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14
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Reinstein DZ, Archer TJ, Vida RS, Carp GI. Suction stability management in small incision lenticule extraction: incidence and outcomes of suction loss in 4000 consecutive procedures. Acta Ophthalmol 2020; 98:e72-e80. [PMID: 31448878 DOI: 10.1111/aos.14215] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To report the incidence and outcomes of suction loss during small incision lenticule extraction (SMILE). METHODS The incidence of suction loss was measured over 4000 consecutive SMILE procedures and categorized by cause, the interface in which suction was lost and management (restart/continue SMILE, re-SMILE thinner cap, convert to laser in-situ keratomileusis [LASIK]). One-year outcomes were compared to the fellow eye where no suction loss occurred. RESULTS There were 20 cases of suction loss (0.50%): during the lenticule interface in seven eyes, lenticule side cut in one eye, cap interface in nine eyes and small incision for three eyes. Small incision lenticule extraction (SMILE) was continued in seven eyes, thinner cap SMILE in four eyes, LASIK in eight eyes, and the small incision was manually completed in one eye. Suction loss was caused by a Bell's reflex in 10 eyes, fixation light tracking in six eyes, patient anxiety in two eyes, a nociceptive reflex in one eye and false suction in one eye. There was no difference in results for suction loss and fellow eyes, respectively: uncorrected distance visual acuity was 20/20 or better in 100% in both groups, spherical equivalent was within ±0.50 D in 85% and 79%, one line loss of corrected distance visual acuity in 5% and 0%, and no eyes lost two lines. CONCLUSION Suction loss can be managed depending on the interface during which suction is lost. Treatment was completed on the same day in all instances. Visual and refractive outcomes were unaffected compared to the fellow eye in this series.
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Affiliation(s)
- Dan Z. Reinstein
- London Vision Clinic London UK
- Department of Ophthalmology Columbia University Medical Center New York NY USA
- Sorbonne Université Paris France
- Biomedical Science Research Institute Ulster University Coleraine UK
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15
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Evaluation of disk halo size after small incision lenticule extraction (SMILE). Graefes Arch Clin Exp Ophthalmol 2019; 257:2789-2793. [PMID: 31664518 DOI: 10.1007/s00417-019-04481-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/21/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To investigate changes in objective disk halo size produced by a glare source after small incision lenticule extraction (SMILE) for myopia correction. METHODS This prospective clinical study included 45 right eyes of 45 patients with a mean age of 25.40 ± 5.06 years and mean spherical equivalent (SE) of - 6.08 ± 1.90 diopters. Disk halo size was measured with a vision monitor before surgery and at postoperative 1 week and 3 months. Other information was collected, including age, SE, lenticule thickness, lenticule diameter, dark pupil, and pupillary response to light parameters (initial diameter; amplitude, latency, duration, and velocity of contraction; latency, duration, and velocity of dilation; and maximum, minimum, and average pupil size). RESULTS Compared to preoperative values, disk halo size increased significantly at postoperative 1 week (P = 0.026) and returned to baseline at postoperative 3 months (P = 0.349). Preoperative disk halo size significantly correlated with SE (r = - 0.346, P = 0.020), minimum pupil size (r = 0.365, P = 0.014), and average pupil size (r = 0.310, P = 0.038). Disk halo size at postoperative 1 week was significantly correlated with age (r = 0.324, P = 0.030) and minimum pupil size (r = 0.297, P = 0.047). Disk halo size at postoperative 3 months was significantly correlated with lenticule diameter (r = - 0.362, P = 0.015), initial diameter (r = 0.311, P = 0.037), maximum pupil size (r = 0.312, P = 0.037), minimum pupil size (r = 0.440, P = 0.002), and average pupil size (r = 0.373, P = 0.012). CONCLUSIONS After SMILE, disk halo size demonstrated a temporary increase and then returned to baseline.
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Yu M, Chen M, Liu W, Dai J. Comparative study of wave-front aberration and corneal Asphericity after SMILE and LASEK for myopia: a short and long term study. BMC Ophthalmol 2019; 19:80. [PMID: 30894159 PMCID: PMC6425702 DOI: 10.1186/s12886-019-1084-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background The study compares the wave-front aberration and corneal asphericity from multiple perspectives after Small Incision Lenticule Extraction and Laser-assisted Subepithelial Keratomileusis for mild to moderate myopia in a short and long time period. Methods This prospective and comparative study included 32 eyes in the SMILE group, with a mean spherical equivalent (SE) of − 4.1 ± 0.9D and 32 eyes in the LASEK group, with a mean SE of − 3.7 ± 1.0D. Visual acuity, refractive error, wave-front aberration, corneal Q value and corneal refractive power were analyzed pre-, 3 months and 3 years post-operatively. Results There was no significant difference in refractive error, wave-front aberration, corneal Q value and corneal refractive power before treatment. Three months postoperative, Q value within 6 mm (SMILE: 0.46 ± 0.27, LASEK: 0.63 ± 0.28, p = 0.02), the relative peripheral corneal power (5-8 mm: p < 0.05), change of higher order aberration (SMILE: 0.10 ± 0.16, LASEK: 0.24 ± 0.20, p = 0.004) and spherical aberration (SA, SMILE: -0.07 ± 0.30, LASEK: -0.41 ± 0.40, p < 0.001) were significantly lower in the SMILE than in LASEK group. The visual acuity, refractive error, coma, peripheral Q value, central corneal power had no significant difference between the two groups. Three years post-operation, the corneal power distribution results and SA were similar to that of 3-month, while the Q value had no significant difference between the two groups. Conclusion In the early stage after SMILE, the HOAs was lower, the corneal refractive power from central to periphery was more uniform than after LASEK; and in the long-term run, SMILE still preceded LASEK in the corneal asphericity and aberration. Electronic supplementary material The online version of this article (10.1186/s12886-019-1084-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manrong Yu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Minjie Chen
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wangyuan Liu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 83 Fenyang Road, Shanghai, 200031, China.,NHC Key Laboratory of Myopia (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jinhui Dai
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No. 83 Fenyang Road, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia (Fudan University) and Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Contralateral Eye Comparison Between 2 Cap Thicknesses in Small Incision Lenticule Extraction: 110 Versus 130 μm. Cornea 2018; 38:617-623. [DOI: 10.1097/ico.0000000000001835] [Citation(s) in RCA: 9] [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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18
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Enhancement of refractive outcomes of small-incision lenticule extraction via tear-film control. Graefes Arch Clin Exp Ophthalmol 2018; 256:2259-2268. [PMID: 30056550 DOI: 10.1007/s00417-018-4074-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To suggest that tear film is a refractive outcome predictor in small-incision lenticule extraction (SMILE) for myopia and describe methods of controlling the tear film and its effects on refractive outcomes. METHODS In this retrospective case-control study, the tear film was kept clear and appropriate in amount during tear-film-controlled SMILE (TFC-SMILE). In contrast, no special care to the tear film was given in direct-docking SMILE (DD-SMILE). Both procedures were performed by the same experienced surgeon, using the same surgical parameters, over defined periods. In select cases, scanning electron microscopy (SEM) of the lenticule and surgical videos of opaque bubble layers (OBLs) were obtained and compared. RESULTS Forty-one eyes had DD-SMILE and 55 eyes had TFC-SMILE. Multivariate analysis showed that TFC-SMILE and the patient's age were significant predictors of refractive outcomes. The refractive predictability of TFC-SMILE was better than that of DD-SMILE, and under-correction of high myopia was evident in the latter patients. The predictive errors of DD-SMILE became more myopic and variable during 1 year than those of TFC-SMILE. The lenticular surface on SEM was more serrated in DD-SMILE. Severe OBLs were evident in four cases of DD-SMILE and the OBL pattern was sporadic at the anterior surface of the lenticule. CONCLUSIONS The presence of a clear and appropriate tear film in SMILE enhanced predictability, minimized variability, and ensured stability of refractive outcomes. An uncontrolled tear film might render cutting imprecise and trigger severe OBL formation. TFC-SMILE had more predictable results than DD-SMILE.
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Moshirfar M, Murri MS, Shah TJ, Linn SH, Ronquillo Y, Birdsong OC, Hoopes PC. Initial Single-Site Surgical Experience with SMILE: A Comparison of Results to FDA SMILE, and the Earliest and Latest Generation of LASIK. Ophthalmol Ther 2018; 7:347-360. [PMID: 29959753 PMCID: PMC6258580 DOI: 10.1007/s40123-018-0137-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The primary objective was to show our initial surgical single-site experience with small incision lenticule extraction (SMILE) after the official enrollment in March 2017 following Food and Drug Administration (FDA) approval for simple myopia in late 2016 in the United States and, subsequently, compare our results to the earliest and most advanced generation of excimer platforms for laser-assisted in situ keratomileusis (LASIK) surgery. Methods This was a retrospective single-site study of 68 eyes from 35 patients who had SMILE surgery. The patients’ preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere, manifest cylinder, intraoperative complications, and preoperative and postoperative visual symptoms were collected. We compared our findings to the results from the FDA SMILE study, and to the three earliest (1999–2000) and three of the most updated (2013–2016) platforms for LASIK. Results The cumulative UDVA was 20/20 and 20/40 or better in 74% and 100% of patients, respectively. The intended target refraction was within ± 0.5 and ± 1.00 D in 80% and 93% of cases, respectively. The prevalence of dry eyes decreased by nearly half from 1-week to the 6-month postoperative interval. Patients noted improvement in glare (17%), halos (17%), fluctuation (25%), and depth perception (8%) at the 6-month interval compared to preoperative levels. Conclusions This study’s findings are consistent with current SMILE reports. Notably, the results are superior to the earliest generation of LASIK, however inferior to the latest excimer platforms. SMILE does meet the efficacy and safety criteria met by FDA; however, there is a definite need for further improvement to reach the superior refractive outcomes produced by the latest generation of LASIK platforms.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA. .,HDR Research Center, Hoopes Vision, Draper, UT, USA.
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tirth J Shah
- University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
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Predictability of the Achieved Lenticule Thickness in Small Incision Lenticule Extraction for Myopia Correction. Eye Contact Lens 2018; 44 Suppl 2:S410-S413. [PMID: 29944495 DOI: 10.1097/icl.0000000000000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the predictability of the achieved lenticule thickness in small incision lenticule extraction (SMILE) for the correction of myopia. METHODS In this prospective study, a total of 80 eyes of 45 patients who underwent the SMILE procedure were included. A Scheimpflug camera was used to measure the preoperative and postoperative corneal topography. Achieved lenticule thicknesses at the pupil center and corneal vertex were calculated by subtracting the postoperative corneal thickness at the pupil center and corneal vertex from preoperative corresponding values. Predictability between the achieved and VisuMax readout at different locations (the pupil center and corneal vertex) and postoperative visits (postoperative day 1 and 6 months) were evaluated using a general linear model. RESULTS Achieved lenticule thickness at the pupil center and corneal vertex showed good correlation at both postoperative day 1 (pupil center: r=0.914, corneal vertex: r=0.903) and 6 months (pupil center: r=0.886, corneal vertex: r=0.866). The achieved lenticule thickness at postoperative day 1 was 8.5-μm thinner at the pupil center and 9.6-μm thinner at the corneal vertex than the VisuMax readout. CONCLUSIONS This study suggests that the predictability between the achieved and VisuMax readout is favorable. The lenticule thickness at the pupil center is closer to the VisuMax readout than corneal vertex.
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21
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Fu D, Zeng L, Zhao J, Miao HM, Yu ZQ, Zhou XT. Safety and satisfaction of myopic small-incision lenticule extraction combined with monovision. BMC Ophthalmol 2018; 18:131. [PMID: 29855287 PMCID: PMC5984466 DOI: 10.1186/s12886-018-0794-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background To investigate the safety and optical quality of small-incision lenticule extraction (SMILE) combined with monovision, and patient satisfaction with the procedure. Methods The present study assessed a non-random case series involving 60 eyes of 30 patients (mean age 45.53 ± 3.20 years [range 41 to 52 years]) treated bilaterally using the VisuMax 500 system (Carl Zeiss Meditec, Jena, Germany) between January and July 2016. The target refraction was plano for the distance eye, and between − 0.5 and − 1.75 diopters (D) for the near eye. Visual acuity, refraction errors, ocular aberrations, and satisfaction questionnaire scores were calculated 1 year after surgery. Results All surgeries were uneventful, with a mean safety index of 1.03 and 1.04 in dominant and nondominant eyes, respectively. Binocular uncorrected distance visual acuity of all patients was ≥20/32, while binocular uncorrected near visual acuity was ≥20/40 1 year postoperatively. Higher-order aberration (0.45 ± 0.14, 0.51 ± 0.15 μm), spherical (0.18 ± 0.15, 0.21 ± 0.14 μm) and coma aberration (0.31 ± 0.16, 0.27 ± 0.17 μm) were identical between dominant and nondominant eyes after surgery. The overall satisfaction rate was 86.7% (26/30), with large contributions from age (OR = 1.76 95% CI: 1.03–2.53; P = 0.036). Binocular uncorrected distance visual acuity was related to preoperative spherical diopter (r = − 0.500; P = 0.005). Conclusions Monovision appears to be a safe and effective option for myopia patients with presbyopia who are considering the SMILE procedure. Patients with younger age were more satisfied with the procedure.
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Affiliation(s)
- Dan Fu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Li Zeng
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Hua-Mao Miao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Zhi-Qiang Yu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 FenYang Road, Shanghai, 200031, People's Republic of China
| | - Xing-Tao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), No. 83 FenYang Road, Shanghai, 200031, People's Republic of China.
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Fu D, Wang L, Zhou XT, Yu ZQ. Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering. Int J Ophthalmol 2018; 11:456-461. [PMID: 29600180 DOI: 10.18240/ijo.2018.03.16] [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] [Received: 05/26/2017] [Accepted: 10/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate cap morphology after small-incision lenticule extraction (SMILE) and its effects on intraocular scattering. METHODS Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at 1d, 1wk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System (OQAS) values, and objective scattering index (OSI), were evaluated using OQAS™. RESULTS Cap thickness decreased from 1d to 1wk (P<0.001), but remained higher than intended thickness of 120 µm after 3mo (P<0.001). Cap thickness in central area was thinner than that of in the paracentral and peripheral areas (P<0.0001). Total number of microdistortions decreased from 1d to 3mo (P<0.0001). Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at 1d and 1mo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at 1d and 1moafter surgery. CONCLUSION The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.
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Affiliation(s)
- Dan Fu
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Lin Wang
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Xing-Tao Zhou
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Myopia Key Laboratory of the Health Ministry, Shanghai 200031, China
| | - Zhi-Qiang Yu
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Myopia Key Laboratory of the Health Ministry, Shanghai 200031, China
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Kobashi H, Kamiya K, Igarashi A, Takahashi M, Shimizu K. Two-years results of small-incision lenticule extraction and wavefront-guided laser in situ keratomileusis for Myopia. Acta Ophthalmol 2018. [PMID: 28631305 DOI: 10.1111/aos.13470] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the 2-years visual and refractive outcomes between small-incision lenticule extraction (SMILE) and wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopia and myopic astigmatism. METHODS Our retrospective case-control study examined 30 eyes of 30 patients with the manifest refraction spherical equivalent (MRSE) of -3.71 ± 1.83 dioptres (D) who underwent SMILE and 30 eyes of 30 patients with MRSE of -3.81 ± 1.40 D who underwent wavefront-guided LASIK. We assessed the 2-years clinical outcomes. RESULTS Logarithm of the minimal angle of resolution (LogMAR)-corrected distance visual acuity (CDVA) was -0.23 ± 0.07 in the SMILE group and -0.24 ± 0.07 in the wavefront-guided LASIK group 2 years postoperatively (p = 0.82). Logarithm of the minimal angle of resolution-uncorrected distance visual acuity (UDVA) was -0.18 ± 0.09 and -0.15 ± 0.11 (p = 0.30, respectively). In the SMILE and wavefront-guided LASIK groups 2 years postoperatively, 100% and 73% of eyes, respectively, were within 0.5 D of the prompted MRSE correction (p = 0.005). Changes in the MRSE of -0.10 ± 0.30 D and -0.23 ± 0.51 D occurred from 3 months to 2 years (p = 0.40, respectively). We found a significant correlation between myopic regression and the changes in the keratometric readings from 3 months to 2 years after wavefront-guided LASIK (r = -0.48, p = 0.002), but not after SMILE (r = -0.004, p = 0.90). CONCLUSION Small-incision lenticule extraction offers better refractive outcomes than wavefront-guided LASIK during a 2-years follow-up for the correction of myopia and myopic astigmatism.
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Affiliation(s)
- Hidenaga Kobashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Kazutaka Kamiya
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Akihito Igarashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Masahide Takahashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Kimiya Shimizu
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
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Small Incision Lenticule Extraction for Correction of Myopia and Myopic Astigmatism: First 24-Hour Outcomes. J Ophthalmol 2017; 2017:5824534. [PMID: 28680704 PMCID: PMC5478873 DOI: 10.1155/2017/5824534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/17/2017] [Accepted: 05/08/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose To observe the first 24-hour (h) outcomes of the small incision lenticule extraction procedure (SMILE) for myopia and myopic astigmatism. Methods Fifty-three eyes (27 patients) scheduled for SMILE were followed immediately (0 h), 2, 4, 6, and 24 h after SMILE. Uncorrected visual acuity (UCVA), conjunctival congestion, pain level, and corneal edema, thickness, and densitometry were recorded. Results At 2 h after SMILE, 15.1% of eyes had ≤0.1 LogMAR UCVA; this increased to 62.3%, 98.1%, and 100% at 4, 6, and 24 h, respectively. Some eyes (33.96%) had mild corneal edema immediately after surgery. No 6 h postoperative edema was observed. In the first 24 h after SMILE, corneal thickness gradually decreased. Postoperative corneal densitometry values were significantly higher than preoperative values but gradually decreased during the first postoperative 24 h. Conclusions In the first postoperative 24 h, UCVA and corneal status (edema and densitometry) improved quickly.
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Abstract
PURPOSE To evaluate clinical outcomes after small incision lenticule extraction (SMILE) with different cap thicknesses in thick corneas. METHODS Forty patients with central corneal thickness of more than 560 μm were recruited in this prospective, randomized, masked, paired-eye study. Patients were randomized to receive SMILE with a 120-μm cap thickness in 1 eye and 140-μm cap thickness in the other. Uncorrected and corrected distance visual acuity (CDVA), contrast sensitivity (CS), higher-order aberrations (HOAs), and morphologic modifications of corneal architecture were measured during the 3-month follow-up period. RESULTS Postoperative refractive outcomes, visual outcomes, CS, and the changes in HOAs were similar between both groups. The persistence of brightly reflective particles in the corneal interface layer was 1388.6 ± 219.5/mm in eyes with 120-μm cap thickness and 54.7 ± 8.6/mm in eyes with 140-μm cap thickness (P < 0.001). The hyperreflectivity line at the interface layer almost disappeared in all eyes with 140-μm cap thickness, and it still persisted in 43% of the fellow eyes at 3 months postoperatively. The anterior surfaces of lenticules in the 140-μm cap thickness group exhibited more smoothness than in the 120-μm cap thickness group. CONCLUSIONS There was a lower level corneal wound-healing response after SMILE with a 140-μm cap thickness than with a 120-μm cap thickness, although the thickness of cap creation did not affect visual outcomes by 3 months postoperatively.
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Wu W, Wang Y, Zhang H, Zhang J, Li H, Dou R. One-year visual outcome of small incision lenticule extraction (SMILE) surgery in high myopic eyes: retrospective cohort study. BMJ Open 2016; 6:e010993. [PMID: 27655258 PMCID: PMC5051337 DOI: 10.1136/bmjopen-2015-010993] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether the long-term visual outcome of small incision lenticule extraction (SMILE) surgery is consistent with the short-term results in high myopic eyes. DESIGN Retrospective cohort study; data collected from 8 August 2011 to 31 August 2015. SETTING Single refractive surgery centre. PARTICIPANTS A total of 156 eyes were studied: 65 eyes of 39 subjects (22 female/17 male) in the high myopic group (manifest refraction spherical equivalent (MRSE) ≥-6.0 D), and 91 eyes of 54 subjects (29 female/25 male) in the control group (MRSE <-6.0 D). The inclusion criteria were subjects who had follow-ups after 1 day, 1 week, 1 month, 3, 6 months and 1 year with the manifest refraction, uncorrected and corrected distance visual acuity (UDVA/CDVA). There were no statistically significant differences between the two groups in the subjects' gender, age, or cylindrical dioptre, preoperatively (p=0.835, p=0.055, p=0.341, respectively). PRIMARY AND SECONDARY OUTCOME MEASURES UDVA, refractive stability, safety index (postoperative CDVA/preoperative CDVA), and predictability (the percentage of eyes within ±0.50 D). RESULTS In both groups, the 1-year UDVA and safety index were significantly better than results at 1 day (high myopic group: p=0.035, p<0.001; control group: p<0.016, p<0.001); the 1-year predictability showed no significant difference with the short-term results (p=1.00 in both groups). In the high myopic eyes, the 1-year MRSE was significantly worse than the short-term result (p=0.048). To correct it, the added magnitude (D) for the high myopic eyes may equal 0.13×Attempted SE (D)-0.66 D. However, the postoperative MRSE showed no differences from 1 day to 1 year (p=0.612) in the control group. CONCLUSIONS The 1-year visual outcomes were better than the short-term results after the SMILE surgery on the visual acuity and safety. However, the high myopic eyes suffered a significant regression at 1 year, which may be corrected by adding additional magnitude to the SE for high myopic eyes.
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Affiliation(s)
- Wenjing Wu
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yan Wang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Hui Zhang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jiamei Zhang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Hua Li
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Rui Dou
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
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Han T, Zheng K, Chen Y, Gao Y, He L, Zhou X. Four-year observation of predictability and stability of small incision lenticule extraction. BMC Ophthalmol 2016; 16:149. [PMID: 27577086 PMCID: PMC5006606 DOI: 10.1186/s12886-016-0331-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate long-term refractive outcomes, wavefront aberrations and quality of life after small incision lenticule extraction (SMILE) for moderate to high myopia. METHODS A total of 26 patients (47 eyes) with preoperative mean spherical equivalent (SE) of -6.30 ± 1.47 diopters (D) who underwent SMILE were recruited. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, wavefront aberrations, and quality of life. RESULTS At 4 years postoperatively, UDVA was better than or equal to 20/20 in 92 % of eyes. The efficacy index was 1.07 ± 0.16. 89 % of eyes were within ± 0.5 D of the intended refractive target. No eye lost any Snellen lines. The safety index was 1.16 ± 0.14. No significant changes of SE occurred among postoperative follow-ups at months 1, 3, 6 and years 1, 2, 4 (P > 0.05, Scheffe test). Higher-order aberrations, coma, spherical aberration and higher-order astigmatism increased postoperatively, and no significant changes of aberrations were detected among the 1-month, 6-month or 4-year follow-ups postoperatively (37 eyes). Compared to the spectacles group, the surgery group showed a significantly higher total score on quality of life (45.71 ± 2.61 vs 39.96 ± 3.56, P < 0.001). CONCLUSIONS SMILE provides a predictable and stable correction of moderate to high myopia as documented by long-term follow-up.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Ke Zheng
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Yingjun Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Yang Gao
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Li He
- Department of Ophthalmology, UruTmqi Eye and ENT Hospital, No.387 Zhongshan Road, Urumqi, Xinjiang, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.
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Short-Term Outcomes of Small-Incision Lenticule Extraction (SMILE) for Low, Medium, and High Myopia. Eur J Ophthalmol 2016; 27:153-159. [DOI: 10.5301/ejo.5000849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 12/28/2022]
Abstract
Purpose To determine the safety, efficacy, and predictability of small-incision lenticule extraction at 6-month follow-up, depending on the level of the myopic refractive error. The surgeries were performed by a surgeon new to this technique. Methods Seventy-one subjects with a mean age of 31.86 ± 5.57 years were included in this retrospective observational study. Subjects were divided into 3 groups depending on the preoperative spherical equivalent (SE): low group from -1.00 D to -3.00 D, medium from -3.25 D to -5.00 D, and high from -5.25 D to -7.00 D. Manifest refraction, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) were measured before surgery and at 6 months after the treatment. Results In total, 1.4% of the eyes lost 1 line of CDVA after the procedure, whereas 95.8% remained unchanged and 2.8% gained 1 line. A significant undercorrection (p = 0.031) was found in the high myopia group (median -0.50 D), whereas the low and medium groups remained near to emmetropia. In terms of efficacy, no statistically significant intergroup differences for postoperative UDVA (p = 0.282) were found. The vector analysis also showed undercorrection of the preoperative cylinder, even though the standard deviations decreased from 0.9 D in the x axis and 0.7 D in the y axis to 0.24 D and 0.27 D, respectively. Conclusions Small-incision lenticule extraction might be a safe, effective, and predictable procedure even for inexperienced surgeons. No differences in efficacy were found among myopia levels even though undercorrections were found for SE and cylinder in high myopia.
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Yu M, Chen M, Wang B, Zou L, Zhu X, Dai J. Comparison of Visual Quality After SMILE and LASEK for Mild to Moderate Myopia. J Refract Surg 2016; 31:795-800. [PMID: 26653723 DOI: 10.3928/1081597x-20151111-02] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/26/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the objective and subjective quality of vision after femtosecond laser-assisted small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK) for mild to moderate myopia. METHODS This prospective, comparative study included 65 eyes of 33 patients in the SMILE group, with a mean spherical equivalent (SE) of -4.16 ± 0.82 diopters, and 50 eyes of 25 patients in the LASEK group, with a mean SE of -3.81 ± 0.97 diopters. Visual acuity, corneal topography, contrast sensitivity, and wavefront aberrations were recorded preoperatively and compared with postoperative measurements. A quality of vision questionnaire was scored and analyzed 3 months postoperatively. RESULTS Three months postoperatively, the SMILE group had fewer (P < .05) higher-order aberrations (HOAs) (0.390 ± 0.175 µm), including spherical aberration (SA) (0.262 ± 0.242 µm), than the LASEK group (HOAs = 0.479 ± 0.148 µm, SA = 0.576 ± 0.287 µm, trefoil = 0.465 ± 0.248 µm). There was no significant difference in the amount of coma and trefoil between the two groups after surgery. Analysis of the scores of glare and halos in the quality of vision questionnaire revealed that SMILE (night glare = 1.25 ± 1.22, halos = 0.97 ± 1.12) provided a better quality of vision (P < .05) than LASEK (night glare = 2.32 ± 1.99, halos = 1.96 ± 1.77). The two groups demonstrated no significant difference in contrast sensitivity 3 months postoperatively. No vision-threatening complications were noted at any stage in either group. CONCLUSIONS Both SMILE and LASEK are safe and effective surgical procedures in the correction of myopia. SMILE has a lower induction rate of HOAs and a higher degree of patient satisfaction than LASEK at 3 months postoperatively.
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Miao H, Tian M, Xu Y, Chen Y, Zhou X. Visual Outcomes and Optical Quality After Femtosecond Laser Small Incision Lenticule Extraction: An 18-Month Prospective Study. J Refract Surg 2016; 31:726-31. [PMID: 26544559 DOI: 10.3928/1081597x-20151021-01] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/13/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the long-term visual outcomes and optical quality after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction. METHODS Fifty-four patients (37 women, 17 men) who underwent SMILE were enrolled in this prospective clinical study. Patient ages ranged from 18 to 40 years, with a mean spherical equivalent of -6.50 ± 1.64 diopters. Data including refractive parameters, retinal image quality, intraocular scattering, and aberrations were collected at 6 and 18 months after surgery. Patient satisfaction was also evaluated. RESULTS At 18 months after surgery, both the mean safety index and the efficacy index were 1.23 ± 0.23 (range: 0.80 to 1.50); there was no significant difference with indices measured at 6 months (P > .05). No patient lost two or more lines of corrected distance visual acuity. Total higher-order aberrations (HOAs) and coma significantly increased after SMILE (P < .05), whereas total spherical aberrations and trefoil changed only slightly. The mean modulation transfer function cutoff frequency was 36.66 ± 8.54 cycles per degree (cpd) before surgery and 37.81 ± 6.89 cpd at 18 months postoperatively; the mean objective scatter index was 0.62 ± 0.33 before surgery and 0.71 ± 0.38 at 18 months postoperatively. No significant difference was found between the three time points (P > .05). Mean patient satisfaction was 9.31 ± 0.64 (with a maximum score of 10). CONCLUSIONS SMILE showed good safety, efficacy, and stability in correcting moderate to high myopia, and patients were highly satisfied. HOAs increased after SMILE, mainly due to the increase of coma, whereas retinal image quality and intraocular scattering barely changed.
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Ma J, Cao NJ, Xia LK. Efficacy, safety, predictability, aberrations and corneal biomechnical parameters after SMILE and FLEx: Meta-analysis. Int J Ophthalmol 2016; 9:757-62. [PMID: 27275436 DOI: 10.18240/ijo.2016.05.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/30/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To identify possible differences of efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters after small-incision lenticule extraction (SMILE) and femtosecond lenticule extraction (FLEx). METHODS A systematic literature retrieval was conducted in Medline, Embase and the Cochrane Library, up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio (OR) or weighted mean differences (WMD). Of 95% confidence intervals (CI) were used to analyze data. RESULTS A total of seven studies were included. Firstly, there were no differences in uncorrected distance visual acuity (UDVA) 20/20 or better (OR, 1.37; 95% CI, 0.69 to 2.69; P=0.37) and logMAR UDVA (WMD, -0.02; 95% CI, -0.05 to 0.01; P=0.17) after SMILE versus FLEx. We found no differences in corrected distance visual acuity (CDVA) unchanged (OR, 0.98; 95% CI, 0.46 to 2.11; P=0.97) and logMAR CDVA (WMD, -0.00; 95% CI, -0.01 to 0.01; P=0.90) either. Secondly, we found no differences in refraction within ±1.00 D (OR, 0.98; 95% CI, 0.13 to 7.28; P=0.99) and ±0.50 D (OR, 1.62; 95% CI, 0.62 to 4.28; P=0.33) of target postoperatively. Thirdly, for higher-order aberrations, we found no differences in the total higher-order aberrations (WMD, -0.04; 95% CI, -0.09 to 0.01; P=0.14), coma (WMD, -0.04; 95% CI, -0.09 to 0.01; P=0.11), spherical (WMD, 0.01; 95% CI, -0.02 to 0.03; P=0.60) and trefoil (WMD, -0.00; 95% CI, -0.04 to 0.03; P=0.76). Furthermore, for corneal biomechanical parameters, we also found no differences (WMD, 0.08; 95% CI, -0.17 to 0.33; P=0.54) after SMILE versus FLEx. CONCLUSION There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.
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Affiliation(s)
- Jing Ma
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Nan-Jue Cao
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Li-Kun Xia
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Shetty R, Shroff R, Kaweri L, Jayadev C, Kummelil MK, Sinha Roy A. Intra-Operative Cap Repositioning in Small Incision Lenticule Extraction (SMILE) for Enhanced Visual Recovery. Curr Eye Res 2016; 41:1532-1538. [PMID: 27044473 DOI: 10.3109/02713683.2016.1168848] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the role of intra-operative cap repositioning in acute visual recovery after small incision lenticule extraction (SMILE). MATERIALS AND METHODS Ninety-four eyes of 47 patients underwent the SMILE procedure for correction of myopic refractive error. Manifest refraction and visual quality parameters (optical quality analysis system) were evaluated before surgery. The Bowman's membrane was imaged using a handheld spectral domain optical coherence tomography device. All patients underwent an uneventful SMILE surgery by a single experienced surgeon. Intra-operative cap repositioning was done in the "right" eye of all patients (repositioned group) and the "left" eye of each patient served as controls (non-repositioned group). Visual acuity and optical quality were assessed 1 day and 1 week after surgery. RESULTS Bowman's membrane microdistortions were found in 21.3% of eyes in the repositioned group and 59.57% of the eyes in the non-repositioned group (p = 0.003) on the first day after surgery. Comparison of optical quality parameters was carried out between eyes where repositioning was done and control eyes (with and without microdistortions). On the first day after surgery, the modulation transfer function (MTF) and Strehl's ratio (SR) were significantly better in the repositioned group when compared with the controls (p = 0.002 and p = 0.003, respectively). Refractive error and lenticule thickness in eyes with microdistortions were similar (p > 0.05) between the two groups indicating other contributors to acute optical quality postoperatively. CONCLUSIONS Although the refractive error before surgery determines the extent of microdistortions, intra-operative cap repositioning can reduce them, thereby expediting acute visual recovery after SMILE.
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Affiliation(s)
- Rohit Shetty
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.,b Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Rushad Shroff
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Luci Kaweri
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Chaitra Jayadev
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Mathew Kurian Kummelil
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Abhijit Sinha Roy
- c Imaging, Biomechanics and Mathematical Modeling Solutions , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
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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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Quality control outcomes analysis of small-incision lenticule extraction for myopia by a novice surgeon at the first refractive surgery unit in Nepal during the first 2 years of operation. J Cataract Refract Surg 2016; 42:267-74. [DOI: 10.1016/j.jcrs.2015.09.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022]
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Clinical Outcomes After SMILE and Femtosecond Laser-Assisted LASIK for Myopia and Myopic Astigmatism. Cornea 2016; 35:210-6. [DOI: 10.1097/ico.0000000000000707] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kamiya K, Shimizu K, Igarashi A, Kobashi H. Visual and refractive outcomes of small incision lenticule extraction for the correction of myopia: 1-year follow-up. BMJ Open 2015; 5:e008268. [PMID: 26610755 PMCID: PMC4663429 DOI: 10.1136/bmjopen-2015-008268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the 1 year clinical outcomes of small incision lenticule extraction (SMILE) for the correction of myopia and myopic astigmatism using a 500 kHz femtosecond laser system. METHODS This prospective study evaluated 52 eyes of 39 consecutive patients (31.8±6.9 years, mean age±SD) with spherical equivalents of -4.11±1.73 D (range, -1.25 to -8.25 D) who underwent SMILE for myopia and myopic astigmatism. Preoperatively, 1 week, and 1, 3, 6 and 12 months postoperatively, we assessed the safety, efficacy, predictability, stability, corneal endothelial cell loss and the adverse events of the surgery. RESULTS The logarithm of the minimal angle of resolution (logMAR) uncorrected distance visual acuity and LogMAR corrected distance visual acuity were -0.16±0.11 and -0.22±0.07, respectively, 1 year postoperatively. At 1 year, all eyes were within±0.5 D of the targeted correction. Manifest refraction changes of -0.05±0.32 D occurred from 1 week to 1 year postoperatively (p=0.20, Wilcoxon signed-rank test). The endothelial cell density was not significantly changed from 2804±267 cells/mm(2) preoperatively to 2743±308 cells/mm(2) 1 year postoperatively (p=0.12). No vision-threatening complications occurred during the observation period. CONCLUSIONS SMILE performed well in the correction of myopia and myopic astigmatism, and no significant change in endothelial cell density or any other serious complications occurred throughout the 1-year follow-up period, suggesting its viability as a surgical option for the treatment of such eyes.
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Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kimiya Shimizu
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Hidenaga Kobashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
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Pedersen IB, Ivarsen A, Hjortdal J. Three-Year Results of Small Incision Lenticule Extraction for High Myopia: Refractive Outcomes and Aberrations. J Refract Surg 2015; 31:719-24. [DOI: 10.3928/1081597x-20150923-11] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/20/2015] [Indexed: 11/20/2022]
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Kim JR, Kim BK, Mun SJ, Chung YT, Kim HS. One-year outcomes of small-incision lenticule extraction (SMILE): mild to moderate myopia vs. high myopia. BMC Ophthalmol 2015; 15:59. [PMID: 26059895 PMCID: PMC4462177 DOI: 10.1186/s12886-015-0051-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/05/2015] [Indexed: 11/11/2022] Open
Abstract
Background The purpose of this study was to compare the refractive outcomes of small incision lenticule extraction (SMILE) in high-myopic patients with those of mild- to moderate-myopic patients. Methods This study included 183 eyes of 92 myopic patients treated with SMILE using a VisuMax 500-kHz femtosecond laser. Treated eyes were divided into two groups, according to the preoperative spherical equivalent (SE): mild to moderate myopia (A group, <−6.0 D) and high myopia (B group, ≥ − 6.0 D). Follow-up visits were at 1 day, 1 week, and 1, 3, 6, and 12 months. The outcome measures included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index, and predictability. Results Preoperative SE was −5.05 ± 0.71 D in the A group and −7.67 ± 1.01 D in the B group. No differences were observed between −0.13 ± 0.38 D in the A group and −0.24 ± 0.35 D in the B group 12 months postoperatively (p = 0.18). At 12 months postoperatively, 93.1 % and 76.8 % had an UDVA of 20/20 or better in the A and B groups, respectively. In the A group, 87.9 % and 96.6 % were within ±0.5 D and ±1.0 D, respectively, of the intended correction; in the B group, 88.0 % and 97.6 % were within ±0.5 D and ±1.0 D, respectively. The efficacy index was 1.04 ± 0.19 in the A group and 0.99 ± 0.19 in the B group. The safety index was 1.27 ± 0.17 for the A group and 1.24 ± 0.17 for the B group. The efficacy and safety index were not significantly different between the two groups 12 months postoperatively (p = 0.141 and p = 0.307, respectively). Conclusions This study showed that SMILE is effective and safe for correcting high myopia, as well as mild to moderate myopia.
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Affiliation(s)
- Jae Ryun Kim
- St. Mary's Hospital, Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | | | | | | | - Hyun Seung Kim
- St. Mary's Hospital, Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Kamiya K, Shimizu K, Igarashi A, Kobashi H. Effect of femtosecond laser setting on visual performance after small-incision lenticule extraction for myopia. Br J Ophthalmol 2015; 99:1381-7. [PMID: 25855501 DOI: 10.1136/bjophthalmol-2015-306717] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/22/2015] [Indexed: 11/04/2022]
Abstract
AIM To compare the effect of the two femtosecond laser settings on visual performance after small-incision lenticule extraction (SMILE) for myopia and myopic astigmatism. METHODS Forty-four eyes of 22 consecutive patients who underwent SMILE with an energy level of 140 nJ (spot distance 3.0 µm) in one eye, and with an energy level of 170 nJ (spot distance 4.5 µm) in the other eye, the eyes being randomly assigned. Preoperatively, 1 week, and 1 and 3 months postoperatively, the values of the modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI) and Optical Quality Analysis System (OQAS) values (OVs) for these eyes were quantitatively assessed using an Optical Quality Analysis System (Visiometrics). RESULTS No significant differences were detected between the two groups in the visual and refractive outcomes, or in the MTF cutoff frequency, the Strehl ratio, the OSI, the OV 100%, the OV 20% or the OV 9% at any time point before or after surgery. CONCLUSIONS SMILE with energy settings of 140 and 170 nJ was effective for the correction of myopia and myopic astigmatism. It is indicated that the differences in laser setting (140 nJ, spot distance 3.0 µm vs 170 nJ, spot distance 4.5 µm) did not significantly affect the optical quality including the intraocular scattering of eyes undergoing SMILE. CLINICAL TRIAL NUMBER The protocol was registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN000016241).
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Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Kimiya Shimizu
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Akihito Igarashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
| | - Hidenaga Kobashi
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan
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