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Sedaghat MR, Momeni-Moghaddam H, Yekta AA, Maddah N, Roberts CJ, Savardashtaki M. Early elastic and viscoelastic corneal biomechanical changes after photorefractive keratectomy and small incision lenticule extraction. Int Ophthalmol 2024; 44:302. [PMID: 38954134 DOI: 10.1007/s10792-024-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 06/15/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To compare early changes in the corneal biomechanical parameters after photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE) and their correlations with corneal shape parameters. METHODS One hundred twenty four eyes received myopic PRK and SMILE for similar amounts of myopia. Corneal tomography with Pentacam HR, biomechanical parameters using Corvis ST, and Ocular Response Analyzer (ORA) were evaluated before and 2 weeks after surgery. The change in each parameter was compared between groups, while the difference in central corneal thickness and cornea-compensated intraocular pressure measured before and after surgery were considered as covariates. RESULTS A significant reduction was seen in the corneal stiffness parameter at first applanation, and an increase in deformation amplitude ratio (DAR), and integrated inverse radius (IIR) in both groups after surgery (p < 0.001) Changes in DAR, and IIR were significantly greater in the SMILE than in the PRK group (p < 0.001) Corneal hysteresis (CH) and corneal resistance factor (CRF) decreased in both SMILE and PRK groups after surgery, (p < 0.001) with no statistically significant difference between groups (p > 0.05) Among new Corvis ST parameters, DAR showed a significant correlation with changes in Ambrosio relational thickness in both groups (p < 0.05). CONCLUSIONS Both techniques caused significant changes in corneal biomechanics in the early postoperative period, with greater elastic changes in the SMILE group compared to the PRK group, likely due to lower tension in the SMILE cap and thinner residual stromal bed in SMILE. There were no differences in viscoelastic changes between them, so the lower CH may reflect the volume of tissue removed.
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Affiliation(s)
| | - Hamed Momeni-Moghaddam
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Abbas-Ali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasim Maddah
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Cynthia J Roberts
- Department of Ophthalmology and Visual Sciences; and Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Maryam Savardashtaki
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Zarei-Ghanavati S, Jafarpour S, Hassanzadeh S, Bakhtiari E, Daraee G, Monadi SD, Ziaei M. Changes in Corneal Biomechanical Properties After Small-Incision Lenticule Extraction and Photorefractive Keratectomy, Using a Noncontact Tonometer. Cornea 2022; 41:886-893. [PMID: 34690272 DOI: 10.1097/ico.0000000000002888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate and compare early corneal biomechanical changes after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK). METHODS The study comprised 74 patients eligible for refractive surgery, equally allocated to PRK (37 patients) and SMILE (37 patients). Corneal biomechanical properties were recorded and compared between the 2 groups at preoperatively and 3 months after surgery using a dynamic ultra-high-speed Scheimpflug camera equipped with a noncontact tonometer. RESULTS Both procedures significantly affected corneal biomechanical properties at 3 months after surgery. Patients in the PRK group showed significantly better results for deformation amplitude ratio (DA ratio) ( P = 0.03), maximum inverse radius (InvRadMax) ( P = 0.02), and A2 time ( P = 0.03). The mean changes in DA ratio, HC radius, InvRadMax, and Ambrosio relational thickness were significantly higher in the SMILE group in comparison with those of the PRK group (all, P < 0.05). In both groups, change in CCT was significantly correlated with changes in DA ratio and InvRadMax ( P < 0.05). CONCLUSIONSS Both SMILE and PRK refractive surgeries significantly altered corneal biomechanical properties but the changes were more prominent after SMILE.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Ophthalmology Department, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheyla Jafarpour
- Ophthalmology Department, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Refractive Error Research Center, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Department of ophthalmology, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghazaleh Daraee
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Sahar Darabi Monadi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; and
| | - Mohammed Ziaei
- Faculty of Medical and Health Sciences, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Xin Y, Lopes BT, Wang J, Wu J, Zhu M, Jiang M, Miao Y, Lin H, Cao S, Zheng X, Eliasy A, Chen S, Wang Q, Ye Y, Bao F, Elsheikh A. Biomechanical Effects of tPRK, FS-LASIK, and SMILE on the Cornea. Front Bioeng Biotechnol 2022; 10:834270. [PMID: 35433653 PMCID: PMC9009506 DOI: 10.3389/fbioe.2022.834270] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: The objective of this study is to evaluate the in vivo corneal biomechanical response to three laser refractive surgeries. Methods: Two hundred and twenty-seven patients who submitted to transepithelial photorefractive keratectomy (tPRK), femtosecond laser-assisted in-situ keratomileusis (FS-LASIK), or small-incision lenticule extraction (SMILE) were included in this study. All cases were examined with the Corvis ST preoperatively (up to 3 months) and postoperatively at 1, 3, and 6 months, and the differences in the main device parameters were assessed. The three groups were matched in age, gender ratio, corneal thickness, refractive error corrections, optical zone diameter, and intraocular pressure. They were also matched in the preoperative biomechanical metrics provided by the Corvis ST including stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), and deformation amplitude 2 mm away from apex and the apical deformation (DARatio2mm). Results: The results demonstrated a significant decrease post-operation in SP-A1 and significant increases in IIR, DA, and DARatio2mm (p < 0.05), all of which indicated reductions in overall corneal stiffness. Inter-procedure comparisons provided evidence that the smallest overall stiffness reduction was in the tPRK group, followed by the SMILE, and then the FS-LASIK group (p < 0.05). These results remained valid after correction for the change in CCT between pre and 6 months post-operation and for the percentage tissue altered. In all three surgery groups, higher degrees of refractive correction resulted in larger overall stiffness losses based on most of the biomechanical metrics. Conclusion: The corneal biomechanical response to the three surgery procedures varied significantly. With similar corneal thickness loss, the reductions in overall corneal stiffness were the highest in FS-LASIK and the lowest in tPRK.
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Affiliation(s)
- Yue Xin
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bernardo T. Lopes
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Jie Wu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - ManMan Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - MuChen Jiang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - YuanYuan Miao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - HuiNi Lin
- STU-CUHKJoint Shantou International Eye Center, Shantou, China
| | - Si Cao
- Wuhan Puren Hospital, Wuhan, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - ShiHao Chen
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - QinMei Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - YuFeng Ye
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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Evaluation of peripapillary - macular microvascularity and choroidal vascularity index after refractive surgery. Photodiagnosis Photodyn Ther 2022; 37:102714. [PMID: 34995787 DOI: 10.1016/j.pdpdt.2022.102714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/26/2021] [Accepted: 01/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND To evaluate the microvascularity and choroidal vascularity index (CVI) using optical coherence tomography angiography (OCTA) and OCT following femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) procedures. METHODS Patients with myopia (<-6.0D sphere) or myopic astigmatism (<-4.0D astigmatism) were enroled. The percentage of vessel density and foveal avascular zone (FAZ) size, optic disc flux index and perfusion were noted and the CVI was calculated before and after surgery. RESULTS Twenty-nine eyes of 16 patients in the FS-LASIK group and 30 eyes of 16 patients in the SMILE group were enroled. Macular vessel density, FAZ size, and optic disc flux index were significantly higher on postoperative 1st day compared to preoperative day (p = 0.001, p = 0.007, and p < 0.001, respectively). There was no significant difference in terms of macular and peripapillary CVI between postoperative 1st day and preoperative day (p > 0.05). All microvascular parameters were similar on postoperative 7th day and preoperative day (p > 0.05). CONCLUSIONS It was detected that there is a transient alteration in macular and peripapillary microvascularity after FS-LASIK/SMILE, whereas choroidal circularity is not significantly affected by these refractive surgeries.
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Gab-Alla AA. SmartSurfACE transepithelial photorefractive keratectomy with mitomycin C enhancement after small incision lenticule extraction. EYE AND VISION 2021; 8:28. [PMID: 34963489 PMCID: PMC8895781 DOI: 10.1186/s40662-021-00254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
Background To evaluate predictability, stability, efficacy, and safety of transepithelial photorefractive keratectomy (TPRK) using smart pulse technology (SPT) (SmartSurface procedure) of Schwind Amaris with mitomycin C for correction of post small incision lenticule extraction (SMILE) myopic residual refractive errors. Method This study is a prospective, non-comparative case series conducted at a private eye centre in Ismailia, Egypt, on eyes with post-SMILE myopic residual refractive errors because of undercorrection or suction loss (suction loss occurred after the posterior lenticular cut and the creation of side-cuts; redocking was attempted, and the treatment was completed in the same session with the same parameters) with myopia or myopic astigmatism. The patients were followed up post-SMILE for six months before the SmartSurface procedure, and then they were followed up for one year after that. TPRK were performed using Amaris excimer laser at 500 kHz. The main outcomes included refractive predictability, stability, efficacy, safety and any reported complications. Results This study included 68 eyes of 40 patients out of 1920 total eyes (3.5%) with post-SMILE technique myopic residual refractive errors. The average duration between the SMILE surgery and TPRK was 6.7 ± 0.4 months (range 6 to 8 months). The mean refractive spherical equivalent (SE) was within ± 0.50 D of plano correction in 100% of the eyes at 12 months post-TPRK. Astigmatism of < 0.50 D was achieved in 100% of the eyes. The mean of the residual SE error showed statistically significant improvement from preoperative − 1.42 ± 0.52 D to 0.23 ± 0.10 D (P < 0.0001). Uncorrected distance visual acuity (UDVA) (measured by Snellen's chart and averaged in logMAR units) was improved significantly to 0.1 ± 0.07 (P < 0.0001). UDVA was 0.2 logMAR or better in 100% of the eyes, 0.1 logMAR or better in 91.2% of the eyes, and 0.0 logMAR in 20.6% of the eyes. Corrected distance visual acuity (CDVA) remained unchanged in 79.4% of eyes. 14.7% of eyes gained one line of CDVA (Snellen). 5.9% of eyes gained two lines of CDVA (Snellen). Conclusion Transepithelial photorefractive keratectomy using smart pulse technology with mitomycin C enhancement after SMILE is a safe, predictable, stable, and effective technique.
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Zhang D, Qin X, Zhang H, Li L. Time-varying regularity of changes in biomechanical properties of the corneas after removal of anterior corneal tissue. Biomed Eng Online 2021; 20:113. [PMID: 34801040 PMCID: PMC8606087 DOI: 10.1186/s12938-021-00948-7] [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: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background The corneal biomechanical properties with the prolongation of time after corneal refractive surgery are important for providing a mechanical basis for the occurrence of clinical phenomena such as iatrogenic keratectasia and refractive regression. The aim of this study was to explore the changes of corneal elastic modulus, and stress relaxation properties from the 6-month follow-up observations of rabbits after a removal of anterior corneal tissue in simulation to corneal refractive surgery. Methods The anterior corneal tissue, 6 mm in diameter and 30–50% of the original corneal thickness, the left eye of the rabbit was removed, and the right eye was kept as the control. The rabbits were normally raised and nursed for 6 months, during which corneal morphology data, and both of corneal hysteresis (CH) and corneal resistance factor (CRF) were gathered. Uniaxial tensile tests of corneal strips were performed at months 1, 3, and 6 from 7 animals, and corneal collagen fibrils were observed at months 1, 3, and 6 from 1 rabbit, respectively. Results Compared with the control group, there were statistical differences in the curvature radius at week 2 and month 3, and both CH and CRF at months 1, 2, and 6 in experiment group; there were statistical differences in elastic modulus at 1, 3, and month 6, and stress relaxation degree at month 3 in experiment group. The differences in corneal elastic modulus, stress relaxation degree and the total number of collagen fibrils between experiment and control groups varied gradually with time, and showed significant changes at the 3rd month after the treatment. Conclusions Corneas after a removal of anterior corneal tissue undergo dynamic changes in corneal morphology and biomechanical properties. The first 3 months after treatment could be a critical period. The variation of corneal biomechanical properties is worth considering in predicting corneal deformation after a removal of anterior corneal tissue.
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Affiliation(s)
- Di Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Xiao Qin
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Haixia Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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Samir A, Lotfy A, Heikal MA, Abdelrahman Elsayed AM. Small Incision Lenticule Extraction for Correction of Pediatric Unilateral Anisometropic Myopia. J Refract Surg 2021; 37:510-515. [PMID: 34388076 DOI: 10.3928/1081597x-20210506-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of femtosecond laser small incision lenticule extraction (SMILE) on treating unilateral myopic anisometropia in children with spectacles or contact lens intolerance. METHODS This was a retrospective study that included children with unilateral myopic anisometropic amblyopia who underwent a SMILE procedure at Alpha Vision Center, Zagazig, Egypt, from January 2014 to December 2016. RESULTS One hundred twenty-four eyes of 124 patients were included in this study. The postoperative corrected distance visual acuity (CDVA) at the 3-month and 1-, 2-, 3-, and 4-year follow-up visits improved significantly (P < .05) compared to the preoperative CDVA, indicating the safety of the procedure. At the 3-month postoperative visit, 23% of cases showed improvement of one or more lines of CDVA, whereas only 2% of cases showed a decline of only one line. Moreover, the postoperative uncorrected distance visual acuity compared favorably to the preoperative CDVA, denoting the efficacy of the refractive correction. The spherical equivalent was within ±0.50 diopters of the intended correction in 75% of the cases and within ±1.00 diopters in 89% of the cases. The intraoperative complications were scarce and relatively innocuous. CONCLUSIONS SMILE is a safe and effective alternative method for correcting myopic anisometropic amblyopia in children with spectacles or contact lens intolerance with good refractive results. A larger study with longer follow-up periods is necessary to determine the long-term effects of SMILE. [J Refract Surg. 2021;37(8):510-515.].
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Yang LJ, Liu X, Mi SJ, Sun L, Chen MX. Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism. Int J Ophthalmol 2021; 14:423-429. [PMID: 33747820 PMCID: PMC7930544 DOI: 10.18240/ijo.2021.03.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the quality outcomes of vision at early phase after topography-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK-CV) and small incision lenticule extraction (SMILE) in treatment of myopia and myopic astigmatism. METHODS Retrospective comparative analysis of 49 patients that underwent FS-LASIK (n=23) or SMILE (n=26) procedure for myopia and myopic astigmatism between April and September in 2019. Pre- and postoperative uncorrected visual acuity (UCVA), spherical equivalent refraction (SEQ), cylindrical refraction, contrast sensitivity function (CSF), and corneal higher-order aberrations (HOAs) were evaluated. Independent t-test was used for inter-group comparison, while repeated measures ANOVA was used to analyze changes at different time points. RESULTS In both groups, 100% of the eyes obtained a UCVA of 20/20 or better at 1wk, 1, and 3mo postoperatively. At 1d and 3mo postoperatively, UCVA was better in FS-LASIK-CV group than in SMILE group. At 1wk postoperatively, SEQ was lower in SMILE group than in FS-LASIK-CV group (P=0.006). At 3mo postoperatively, the SEQ reached target refraction in both groups. The residual astigmatism was reduced in both groups without intergroup difference (P>0.05). At 3mo postoperatively, the spherical aberration and coma under 6 mm pupil size were higher than preoperative levels in both groups (P<0.05). However, the increase in the corneal HOAs in the FS-LASIK-CV group was less than the SMILE group (P<0.05). At 3mo postoperatively, the logCS were better than preoperative levels under scotopic conditions without glare and scotopic conditions with glare in both groups (P<0.05). At 1 and 3mo postoperatively, under scotopic conditions without glare and scotopic conditions with glare, FS-LASIK-CV group showed more improvement in logCS at two spatial frequencies (12.0 c/d and 18.0 c/d; P<0.05). CONCLUSION Both FS-LASIK-CV and SMILE demonstrate to be safe, effective, and predictable in treatment of myopia and myopic astigmatism. Early postoperative improvement in UCVA and CSF at high spatial frequency under scotopic conditions were better after FS-LASIK-CV than SMILE.
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Affiliation(s)
- Lin-Juan Yang
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Xuan Liu
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Sheng-Jian Mi
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Le Sun
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Meng-Xin Chen
- Department of Ophthalmology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Lanza M, De Rosa L, Sbordone S, Boccia R, Gironi Carnevale UA, Simonelli F. Analysis of Corneal Distortion after Myopic PRK. J Clin Med 2020; 10:jcm10010082. [PMID: 33379378 PMCID: PMC7794860 DOI: 10.3390/jcm10010082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 01/22/2023] Open
Abstract
The purpose of the study is to evaluate the corneal biomechanical properties (CBP) and their behaviors after myopic refractive surgery both with Ocular Response Analyzer (ORA) and Corvis ST (CST). This retrospective study included 145 eyes of 145 patients with a mean age of 33.13 ± 9.24 years, who underwent myopic photorefractive keratectomy (PRK) for a refractive defect, measured as spherical equivalent, of mean −4.69 ± 2.04 D and have been evaluated before surgery and at 1, 3 and 6 months follow-up. Corneal hysteresis (CH) and corneal resistance factor (CRF) values significantly decreased after 1 month and remained statistically stable during further follow-ups. CST parameters had a different evolution: only second applanation time (AT2) differences showed a significant variation after 1 month that did not statistically change over time. Highest concavity deformation amplitude (HCDA), highest concavity peak distance (HCPD), first applanation time (AT1) and velocity (AV1) showed continuous significant differences both after 3 and after 6 months. This study suggests that after central surface ablation surgery, such as myopic PRK, corneal shape is remodeling, and its deformation parameters are going to change even at 6 months follow-up. This indicates that it should be important to evaluate refractive surgery patients during a longer follow-up because this could allow earlier diagnosis and better management of late-onset complications.
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Chen Y, Liao H, Sun Y, Shen X. Short-term changes in the anterior segment and retina after small incision lenticule extraction. BMC Ophthalmol 2020; 20:397. [PMID: 33028265 PMCID: PMC7539406 DOI: 10.1186/s12886-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE). Methods Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density. Results Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p < 0.05), while LT was thickened after surgery (p < 0.05). MT at the fovea decreased 1 day and 1 week after surgery (p < 0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. ΔACD and ΔLT showed no significant correlation 1 day after surgery. ΔACD was negatively correlated with ΔLT and sphere 1 week after surgery (r = − 0.847, p < 0.000; r = − 0.398, p = 0.002). ΔLT was positively correlated with the sphere 1 week after surgery (r = 0.256, p = 0.048). Conclusion The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
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Affiliation(s)
- Yanwei Chen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huaping Liao
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Changes in corneal biomechanics during small-incision lenticule extraction (SMILE) and femtosecond-assisted laser in situ keratomileusis (FS-LASIK). Lasers Med Sci 2019; 35:599-609. [DOI: 10.1007/s10103-019-02854-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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Guo H, Hosseini-Moghaddam SM, Hodge W. Corneal biomechanical properties after SMILE versus FLEX, LASIK, LASEK, or PRK: a systematic review and meta-analysis. BMC Ophthalmol 2019; 19:167. [PMID: 31370817 PMCID: PMC6676534 DOI: 10.1186/s12886-019-1165-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the postoperative corneal biomechanical properties between small incision lenticule extraction (SMILE) and other corneal refractive surgeries. METHODS A systematic review and meta-analysis were conducted. Articles from January 2005, to April 2019, were identified searching PubMed, EMBASE, Web of Science, and International Clinical Trials Registry Platform. Studies that compared SMILE with other corneal refractive surgeries on adult myopia patients and evaluated corneal biomechanics were included. Multiple effect sizes in each study were combined. Random-effects model was conducted in the meta-analysis. RESULTS Twenty-two studies were included: 5 randomized controlled trials (RCTs), 9 prospective and 6 retrospective cohort studies, and 2 cross-sectional studies. Using the combined effect of corneal hysteresis (CH) and corneal resistance factor (CRF), which were obtained from ocular response analyzer (ORA), the pooled Hedges' g of SMILE versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) was 0.41 (95% CI, 0.00 to 0.81; p = 0.049; I2 = 78%), versus LASIK was 1.31 (95% CI, 0.54 to 2.08; p < 0.001; I2 = 77%), versus femtosecond lenticule extraction (FLEX) was - 0.01 (95% CI, - 0.31 to 0.30; p = 0.972; I2 = 20%), and versus the group of photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (LASEK) was - 0.26 (95% CI, - 0.67 to 0.16; p = 0.230; I2 = 54%). The summary score of Corvis ST (CST) after SMILE was comparable to FS-LASIK/LASIK with the pooled Hedges' g = - 0.05 (95% CI, - 0.24 to 0.14; p = 0.612, I2 = 55%). CONCLUSIONS In terms of preserving corneal biomechanical strength after surgeries, SMILE was superior to either FS-LASIK or LASIK, while comparable to FLEX or PRK/LASEK group based on the results from ORA. More studies are needed to apply CST on evaluating corneal biomechanics after refractive surgeries.
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Affiliation(s)
- Hui Guo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - William Hodge
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Department of Ophthalmology, Ivey Eye Institute, St. Joseph's Health Care London, 268 Grosvenor St., London, ON, Canada.
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Changes in Retinal Vasculature and Thickness after Small Incision Lenticule Extraction with Optical Coherence Tomography Angiography. J Ophthalmol 2019; 2019:3693140. [PMID: 31236290 PMCID: PMC6545814 DOI: 10.1155/2019/3693140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To evaluate the changes in retinal vessel density and thickness after small incision lenticule extraction (SMILE) with optical coherence tomography angiography (OCTA) in myopic patients. Methods In this prospective study, SMILE surgeries were done in 46 eyes of 24 patients with spherical equivalent (SE) more than −6.0 diopters (D). Retinal vessel density and thickness at the macula and optic nerve were recorded with OCTA before and 1 day, 2 weeks, and 1 month after surgery. Intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), and refraction were taken at the same time. Results The superficial retinal vessel density and deep foveal retinal vessel density 1 day after surgery were less than those before surgery; however, the changes at any timepoints were not statistically significant (p=0.2736 and p=0.1590, respectively). Both the superficial vessel density and deep vessel density at the parafoveal and perifoveal regions decreased significantly 1 day postoperatively (all p < 0.05) and then returned to the preoperative level at 2 weeks and stabilized thereafter. There were no significant changes in any of the 4 vessel densities in the area of peripapillary before and 1 day, 2 weeks, and 1 month after surgery (p=0.3345). No statistically significant differences between preoperative and postoperative retinal thickness were detected for the area of macula and optic nerve (all p > 0.5). Conclusions The vessel density at the parafoveal and perifoveal regions decreased at 1 day after SMILE with no effect on the visual acuity and relieved within 2 weeks. Decreased ocular blood flow in response to the spike in IOP may account for such changes.
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Rævdal P, Grauslund J, Vestergaard AH. Comparison of corneal biomechanical changes after refractive surgery by noncontact tonometry: small-incision lenticule extraction versus flap-based refractive surgery - a systematic review. Acta Ophthalmol 2019; 97:127-136. [PMID: 30203530 DOI: 10.1111/aos.13906] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/04/2018] [Indexed: 01/23/2023]
Abstract
Corneal refractive surgery disrupts corneal integrity and reduces biomechanical stability in consequence of the beneficial refractive alteration. The minimal invasive cap-based refractive procedure, small-incision lenticule extraction (SMILE), has been proposed to affect corneal integrity less than flap-based procedures, due to the fibre-sparing incision of the strong anterior corneal lamellae. Flap-based procedures include laser-assisted in situ keratomileusis (LASIK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and femtosecond lenticule extraction (FLEx). The purpose of this systematic review was to evaluate corneal biomechanical changes by noncontact air pulse tonometry after treatment of myopia/myopic astigmatism with SMILE compared to flap-based refractive surgery. A total of 220 publications were identified through a systematic search in PubMed and Embase. Two levels of screening identified nine studies (three randomised controlled trials (RCT) and six nonrandomised clinical trials) eligible for the review. All the nonrandomised clinical trials were graded to have an overall serious risk of bias. Measurements with the Corvis ST were not included in any of the eligible studies. The RCTs found no statistical significant differences between SMILE or flap-based procedures concerning corneal hysteresis (CH) or corneal resistance factor (CRF), as measured with the Ocular Response Analyzer. However, a greater reduction in CRF and CH was found in the flap-based group in five and two of the nonrandomised studies, respectively. The findings in this review illustrate that the presumed biomechanical advantages of a cap-based small incision could not be demonstrated in existing studies and by commercially available technology. However, studies with lower levels of evidence suggest less affection of corneal viscoelastic properties after SMILE when evaluating corneal stability by noncontact tonometry.
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Affiliation(s)
- Pernille Rævdal
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
| | - Anders Højslet Vestergaard
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Research Unit of Ophthalmology University of Southern Denmark Odense Denmark
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Comparison of the posterior corneal elevation and biomechanics after SMILE and LASEK for myopia: a short- and long-term observation. Graefes Arch Clin Exp Ophthalmol 2019; 257:601-606. [DOI: 10.1007/s00417-018-04227-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022] Open
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Titiyal JS, Kaur M, Shaikh F, Gagrani M, Brar AS, Rathi A. Small incision lenticule extraction (SMILE) techniques: patient selection and perspectives. Clin Ophthalmol 2018; 12:1685-1699. [PMID: 30233132 PMCID: PMC6134409 DOI: 10.2147/opth.s157172] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Refractive lenticule extraction is becoming the procedure of choice for the management of myopia and myopic astigmatism owing to its precision, biomechanical stability, and better ocular surface. It has similar safety, efficacy, and predictability as femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and is associated with better patient satisfaction. The conventional technique of small incision lenticule extraction (SMILE) involves docking, femtosecond laser application, lenticule dissection from the surrounding stroma, and extraction. It has a steep learning curve compared to conventional flap-based corneal ablative procedures, and the surgical technique may be challenging especially for a novice surgeon. As SMILE is gaining worldwide acceptance among refractive surgeons, different modifications of the surgical technique have been described to ease the process of lenticule extraction and minimize complications. Good patient selection is essential to ensure optimal patient satisfaction, and novice surgeons should avoid cases with low myopia (thin refractive lenticules), difficult orbital anatomy, high astigmatism, or uncooperative, anxious patients to minimize complications. A comprehensive MEDLINE search was performed using “small incision lenticule extraction,” “SMILE,” and “refractive lenticule extraction” as keywords, and we herein review the patient selection for SMILE and various surgical techniques of SMILE with their pros and cons. With increasing surgeon experience, a standard technique is expected to evolve that may be performed in all types of cases with optimal outcomes and minimal adverse effects.
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Affiliation(s)
- Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Farin Shaikh
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Meghal Gagrani
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Anand Singh Brar
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Anubha Rathi
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
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Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm. Indian J Ophthalmol 2018; 66:10-19. [PMID: 29283117 PMCID: PMC5778540 DOI: 10.4103/ijo.ijo_761_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.
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Affiliation(s)
- Sri Ganesh
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Raghavender Reddy Arra
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Siedlecki J, Luft N, Kook D, Wertheimer C, Mayer WJ, Bechmann M, Wiltfang R, Priglinger SG, Sekundo W, Dirisamer M. Enhancement After Myopic Small Incision Lenticule Extraction (SMILE) Using Surface Ablation. J Refract Surg 2017; 33:513-518. [DOI: 10.3928/1081597x-20170602-01] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
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Ji YW, Kim M, Kang DSY, Reinstein DZ, Archer TJ, Choi JY, Kim EK, Lee HK, Seo KY, Kim TI. Lower Laser Energy Levels Lead to Better Visual Recovery After Small-Incision Lenticule Extraction: Prospective Randomized Clinical Trial. Am J Ophthalmol 2017; 179:159-170. [PMID: 28499707 DOI: 10.1016/j.ajo.2017.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE). DESIGN Prospective randomized clinical trial. METHODS A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively. RESULTS Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001). CONCLUSIONS SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.
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