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Cheng X, Zhao Y, Fu D, Zhou X, Gao Y, Yu Z. Posterior corneal stability after small incision lenticule extraction with different optical zones. Eye (Lond) 2024:10.1038/s41433-024-03224-9. [PMID: 38997503 DOI: 10.1038/s41433-024-03224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/16/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND To assess the changes in the posterior corneal surface following small incision lenticule extraction (SMILE) with different optical zones. METHODS In this retrospective study, 106 eyes of 106 patients who underwent SMILE were recruited 3 years after the procedure. Eyes were divided into two groups according to the size of the surgical optical zone: group A (52 eyes, ≤6.2 mm) and group B (54 eyes, ≥6.5 mm). Posterior central elevation (PCE) and 12 other points at 45°, 135°, 225° and 315° with distances of 1 mm, 2 mm and 3 mm from the centre were recorded from Pentacam. RESULTS No iatrogenic keratectasia was identified, and eyes in the two groups showed comparable visual results. The overall trend in posterior corneal elevation changes was consistent for both groups. PCE decreased significantly from 1.33 ± 2.32 to 0.75 ± 2.41 in group A (P = 0.024) and from 0.87 ± 2.61 to 0.06 ± 2.74 in group B (P = 0.003). All points in the central 2 mm region in both groups were reduced postoperatively. In the 4 mm and 6 mm corneal annulus, almost all points at 225°and 315° showed backward displacement, with the most prominent change occurring at 315° in the 6 mm annulus (P < 0.001), indicating no forward protrusion in the inferior area. CONCLUSIONS No forward protrusion in the posterior corneal surface was observed 3 years after SMILE with different optical zones. Comprehensive preoperative measurements are essential for ensuring corneal stability and avoiding iatrogenic keratectasia.
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Affiliation(s)
- Xueying Cheng
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yu Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ying Gao
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Zhou C, Li Y, Wang Y, Fan Q, Dai L. Comparison of visual quality after SMILE correction of low-to-moderate myopia in different optical zones. Int Ophthalmol 2023; 43:3623-3632. [PMID: 37453939 PMCID: PMC10504213 DOI: 10.1007/s10792-023-02771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To compare the effects of different optical zones for small-incision lenticule extraction (SMILE) on postoperative visual quality in low-to-moderate myopia. METHODS This retrospective case-control study involved patients who underwent SMILE using two optical-zone diameters: 6.5 mm (50 patients, 100 eyes) and 6.8 mm (50 patients, 100 eyes). Uncorrected visual acuity (UCVA), best corrected visual acuity, spherical equivalent (SE), corneal higher-order aberrations (HOAs), and subjective visual-quality questionnaire scores were assessed. RESULTS Postoperatively, UCVA and SE did not differ between the two groups (P > 0.05). In both groups, corneal HOAs, spherical aberration, and coma significantly increased at 1 and 3 months postoperatively (P < 0.05), while trefoil was unchanged after surgery (P > 0.05). Corneal HOAs, spherical aberration, and coma significantly differed between the groups at 1 and 3 months (P < 0.05), while trefoil did not (P > 0.05). Visual-quality scores were higher in the 6.8 mm group than in the 6.5 mm group at 1 month (P = 0.058), but not at 3 months (P > 0.05). In both groups, subjective scores significantly decreased at 1 month (P < 0.05) and gradually returned to the preoperative level at 3 months (P > 0.05). The subjective visual-quality scores were negatively and positively correlated with pupillary and optical-zone diameter, respectively (P < 0.05 for both). Objective visual-quality indicators (HOAs, spherical aberration, and coma) were negatively correlated with optical-zone diameter (P < 0.05) but not pupillary diameter (P > 0.05). CONCLUSION SMILE in different optical zones effectively corrected low-to-moderate myopia. The larger the optical-zone diameter, the better the early postoperative visual quality.
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Affiliation(s)
- Cong Zhou
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150086, China
| | - Ying Li
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150086, China
| | - Yinghan Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150086, China
| | - Qiuyang Fan
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150086, China
| | - Lili Dai
- Department of Ophthalmology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin, 150086, China.
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Di Y, Cui G, Li Y, Luo Y. A meta-analysis of visual outcomes and optical quality after small incision lenticule extraction versus implantable collamer lens for myopia. Eur J Ophthalmol 2023; 33:136-144. [PMID: 35469471 DOI: 10.1177/11206721221097249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate possible differences in visual outcome and optical quality when small incision lenticule extraction (SMILE) versus implantable collamer lens (ICL) is used to correct myopia. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched up to August 2021 to identify relevant studies. The PRISMA guidelines were followed. Primary outcomes were postoperative efficacy, safety, and predictability at the end of follow-up. Secondary outcomes were changes in modulation transfer function cutoff frequency (MTF cut-off), objective scatter index (OSI) values, total higher-order aberrations (HOAs), spherical aberrations, and coma aberrations. RESULTS Seven studies with a total of 1296 eyes (SMILE: 731 eyes; TECXL: 565 eyes) were included. The ICL group had a better MTF cut-off (P = 0.007) and less change in the proportion of HOAs (P < 0.001), spherical aberrations (P = 0.009), and coma (P = 0.006) than the SMILE group. For the other outcomes, there were no statistically significant differences. CONCLUSIONS SMILE and ICL implantation are comparable in efficacy, safety, and predictability for correcting myopia. Larger studies with longer follow-up times are warranted to provide a better understanding of the benefits of SMILE and ICL implantation.
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Affiliation(s)
- Yu Di
- Department of Ophthalmology, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ge Cui
- Department of Ophthalmology, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Li
- Department of Ophthalmology, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Luo
- Department of Ophthalmology, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Liu P, Yu D, Zhang B, Zhou S, Zhu H, Qin W, Ye X, Li X, Zhang Y, Bai Y, Wang Y, Shao Z. Influence of optical zone on myopic correction in small incision lenticule extraction: a short-term study. BMC Ophthalmol 2022; 22:409. [PMID: 36271372 PMCID: PMC9585829 DOI: 10.1186/s12886-022-02631-4] [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: 05/20/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the influence of preoperative optical zone on myopic correction in small incision lenticule extraction. METHODS In this retrospective clinical study, 581 eyes from 316 patients underwent SMILE were selected, including 117 eyes in the small optical zone group (range from 6.0 to 6.4 mm) and 464 eyes in the large optical zone group (range from 6.5 to 6.8 mm). The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical, and cylinder were measured preoperatively and 3 months postoperatively. Propensity score match (PSM) analysis was performed with age, gender, eye (right/left), keratometry and preoperative spherical equivalent between two different groups. The influence of optical zones on postoperative refractive outcomes were evaluated using univariate regression analysis. RESULTS In total, 78 pairs of eyes were selected by PSM (match ratio 1:1). There were no differences in the age, gender, eye (right/left), keratometry or preoperative spherical equivalent between the small and large optical zone groups. However, the difference of postoperative spherical equivalent was significantly between groups. Patients with larger optical zones had a trend towards less undercorrection (P = 0.018). Univariate linear regression model analysis found that each millimeter larger optical zone resulted in 8.13% or 0.39D less undercorrection (P < 0.001). The dependency between the optical zones and postoperative spherical equivalent was significant in the higher preoperative myopia group (r = 0.281, P < 0.001), but not significant in the lower myopia group (r = 0.028, P = 0.702). CONCLUSION The diameter of optical zones would affect postoperative refractive outcomes in small incision lenticule extraction. This study indicated that larger optical zones induced less undercorrection, especially in patients with high myopia.
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Affiliation(s)
- Pan Liu
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Dongyu Yu
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Boyu Zhang
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Shiqi Zhou
- Harbin Medical University, No.157 Baojian Road, Nangang District, 150081, Harbin, Heilongjiang Province, China
| | - Haoran Zhu
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Wanyun Qin
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Xinqi Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Xianghui Li
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Yan Zhang
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Ying Bai
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Yuan Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China
| | - Zhengbo Shao
- Department of Ophthalmology, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China. .,Future Medical Laboratory, the Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Nangang District, 150086, Harbin, Heilongjiang Province, China.
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Zhang D, Tian L, Zhang H, Zheng Y, Fu C, Zhai C, Jie Y, Li L. Differences of Corneal Biomechanics Among Thin Normal Cornea, Forme-Fruste Keratoconus, and Cornea After SMILE. Front Bioeng Biotechnol 2022; 10:861924. [PMID: 35646859 PMCID: PMC9136087 DOI: 10.3389/fbioe.2022.861924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To compare the corneal biomechanics of thin normal cornea (TNC) with thinnest corneal thickness (TCT) (≤500 µm), forme-fruste keratoconus (FFKC) and cornea after small incision lenticule extraction (Post-SMILE) had their central corneal thickness (CCT) matched by Corneal Visualization Scheimpflug Technology (Corvis ST).Methods: CCT were matched in 23 eyes with FFKC, 23 eyes by SMILE in 3 months post-operatively, and 23 TNC eyes. The differences in corneal biomechanics by Corvis ST among the three groups were compared.Results: There was no significant difference in CCT among the three groups, and the biomechanically corrected intraocular pressure (bIOP) did not differ significantly among the three groups (all p > 0.05). There were significant differences in most DCR parameters between pre- and post-operatively (all p < 0.05). Compared with TNC, the values of corneal deflection amplitude during the first applanation (A1DA), length at the first applanation (A1L), corneal deflection amplitude during the second applanation (A2DA), and maximum deformation amplitude (DA) decreased in 3 months after SMILE (all p < 0.05), these values increased in the FFKC (all p < 0.05).Conclusion: The majority of the DCR parameters were different among the three groups. The parameters A1DA, A1L, A2DA, and DA may be different between TNC and Post-SMILE, TNC and FFKC, and Post-SMILE and FFKC.
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Affiliation(s)
- Di Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Lei Tian
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Tongren Hospital, Beihang University and Capital Medical University, Beijing, China
| | - Haixia Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
| | - Yan Zheng
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caiyun Fu
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changbin Zhai
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
| | - Ying Jie
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
| | - Lin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
- Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Capital Medical University, Beijing, China
- *Correspondence: Lin Li, ; Changbin Zhai, ; Ying Jie,
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Cao K, Zhang J, Wang J, Yusufu M, Jin S, Chen S, Wang N, Jin ZB, Wan XH. Implantable collamer lens versus small incision lenticule extraction for high myopia correction: A systematic review and meta-analysis. BMC Ophthalmol 2021; 21:450. [PMID: 34961514 PMCID: PMC8711178 DOI: 10.1186/s12886-021-02206-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the efficacy, safety, predictability and visual quality between implantable collamer lens (ICL) implantation and small incision lenticule extraction (SMILE) for high myopia correction in adults. Methods A systematic review and meta-analysis was conducted. A comprehensive literature search was done based on databases including PubMed, Science Direct, Embase, and the Cochrane Central Register of Controlled Trials. The efficacy index, safety index, changes in Snellen lines of corrected distance visual acuity (CDVA), predictability (difference between post-operative and attempted spherical equivalent error, SER), incidence of halos, and change in higher-order aberrations (HOAs) were compared. Mean difference (MD) and 95% confidence interval (CI) was used to estimate continuous outcomes, risk ratio (RR) and 95%CI was used to estimate categorical outcomes. Results Five observational studies involving 555 eyes were included in this review. Studies’ sample sizes (eyes) ranged from 76 to 197. Subjects’ refraction ranged from -6 diopter (D) to -12D. Study duration of most researches were 6 months or 12 months. Compared to SMILE, ICL implantation showed better efficacy index (MD=0.09, 95%CI:0.01 to 0.16) and better safety index (MD=0.08, 95%CI: 0.00 to 0.16). Compared with SMILE, more ICL-treated eyes gained one or more Snellen lines of CDVA (RR=1.54, 95%CI:1.28 to 1.86), more gained two or more lines (RR=2.09, 95%CI:1.40 to 3.13), less lost one or more lines (RR=0.17, 95%CI:0.05 to 0.63). There was no difference in predictability between two treatments, RRs of predictability of within ±0.5D and ±1D were 1.13 (95%CI: 0.94 to 1.36) and 1.00 (95%CI: 0.98 to 1.02). Compared with SMILE, ICL implantation came with a higher risk of halos [RR=1.79, 95%CI: 1.48 to 2.16] and less increase in total HOAs (MD=-0.23, 95%CI: -0.42 to -0.03). Conclusion Compared with SMILE, ICL implantation showed a higher risk of halos, but equal performance on SER control, and better performance on efficacy index, safety index, CDVA improvement and HOAs control. Overall, ICL implantation might be a better choice for high myopia correction in adults.
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Affiliation(s)
- Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Jingshang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Jinda Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Shanshan Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Shuying Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, No17, Hougou ally, Dongcheng district, Beijing, 100005, China.
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Liang C, Zhang Y, He Y, Wang S. Research Progress on Morphological Changes and Surgery-related Parameters of Corneal Cap in Small Incision Lenticule Extraction. Ophthalmic Res 2021; 65:4-13. [PMID: 34670218 DOI: 10.1159/000520241] [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: 06/11/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022]
Abstract
Small incision lenticule extraction (SMILE) is an "all-in-one" surgical method for refractive correction. An advantage of the SMILE over traditional surgery is that it depends on the corneal cap's design. This review discusses the morphological evaluation of the corneal cap, selection of the corneal cap with different thickness and diameters, influence of the corneal cap design on retreatment, and management of corneal cap-related complications. The following points should be recognized to define the correct morphology and design of the operation-related parameters of the corneal cap during SMILE: (1) the thickness and diameter of the corneal cap are predictable and influence postoperative visual quality, (2) the change in anterior surface curvature of the corneal cap should be considered in the design of nomogram value, (3) for patients with moderate myopic correction, early visual quality is better with a 6.9-mm than with a 7.5-mm diameter corneal cap, (4) there is no significant difference in visual quality or biomechanics among corneal caps with different thickness; (5) primary corneal cap thickness plays an important role in the SMILE retreatment, (6) a 7.78-mm diameter corneal cap has a greater risk of suction loss than a 7.60-mm diameter corneal cap, (6) if suction loss occurs when lenticular scanning exceeds 10%, then SMILE can be continued by changing corneal cap thickness, (7) preventive collagen cross-linking with SMILE caps are 90-120 μm thick and 7-7.8 mm in diameter, and (8) properly treating SMILE-related complications ensures better postoperative results. The data presented herein shall deepen the understanding of the importance of the corneal cap during SMILE and provide diversified analysis for personalized operational design of corneal cap parameters.
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Affiliation(s)
- Chen Liang
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China,
| | - Yan Zhang
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
| | - Yuxi He
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
| | - Shurong Wang
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
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Cañones-Zafra R, Katsanos A, Garcia-Gonzalez M, Gros-Otero J, Teus MA. Femtosecond LASIK for the correction of low and high myopic astigmatism. Int Ophthalmol 2021; 42:73-80. [PMID: 34370173 DOI: 10.1007/s10792-021-02001-x] [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: 02/07/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Higher preoperative myopic astigmatism is associated with a higher probability of retreatment due to patient dissatisfaction as a result of residual cylindrical error. Nonetheless, retreatment is safe and the final clinical results are comparable to those of patients with lower preoperative astigmatism who were satisfied with the primary treatment. Our purpose is to compare the efficacy and safety of femtosecond LASIK (FS-LASIK) for the refractive correction of patients with low (< 1.5 Diopters (D) versus high (≥ 1.5 D) myopic astigmatism. METHODS Retrospective observational study of 841 eyes of 825 eligible patients treated with FSLASIK for the correction of simple or compound myopic astigmatism. Outcome measures included residual error, best corrected and uncorrected distance visual acuity (BCVA and UCVA), efficacy and safety 3 months after the primary procedure or the retreatment. RESULTS Of 841 eyes in total, 432 (51.37%) had < 1.5 D (Group 1) and 409 (48.63%) had ≥ 1.5 D (Group 2) preoperative myopic astigmatism. The efficacy index of primary treatment was 0.94 ± 0.18 in Group 1 and 0.89 ± 0.22 in Group 2 (P = 0.001). Of 138 eyes (16.41%) that were retreated due to dis-satisfaction related to residual refractive error, 28 belonged to Group 1 (6.5%) and 110 (26.9%) to Group 2 (P < 0.001). Following retreatment, small but statistically significant differences in the residual mean postoperative cylinder (-0.08 ± 0.24 vs -0.27 ± 0.46 D, P = 0.001) and UCVA (1.11 vs 0.96, P = 0.0001) were detected for Groups 1 and 2, respectively. However, there were no statistically significant differences in the safety and efficacy indices. CONCLUSION Following FS-LASIK, eyes with myopic astigmatism ≥ 1.5 D have approximately four times more chances of undergoing retreatment due to dis-satisfaction caused by residual refractive error compared to eyes with myopic astigmatism < 1.5 D. However, the clinical results after retreatment are highly satisfactory and comparable in both groups.
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Affiliation(s)
- Rafael Cañones-Zafra
- Department of Ophthalmology, Príncipe de Asturias University Hospital, University of Alcalá, Av. Víctimas del Terrorismo N5, Pl 8, 1ºA, 28805, Alcalá de Henares, Madrid, Spain.
- Clínica Novovisión, Madrid, Spain.
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Montserrat Garcia-Gonzalez
- Department of Ophthalmology, Príncipe de Asturias University Hospital, University of Alcalá, Av. Víctimas del Terrorismo N5, Pl 8, 1ºA, 28805, Alcalá de Henares, Madrid, Spain
- Clínica Novovisión, Madrid, Spain
- Clínica Rementería, Madrid, Spain
| | - Juan Gros-Otero
- Clínica Rementería, Madrid, Spain
- San Pablo CEU University, Madrid, Spain
| | - Miguel A Teus
- Department of Ophthalmology, Príncipe de Asturias University Hospital, University of Alcalá, Av. Víctimas del Terrorismo N5, Pl 8, 1ºA, 28805, Alcalá de Henares, Madrid, Spain
- Clínica Novovisión, Madrid, Spain
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9
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Zhao Y, Qian Y, Chen X, Zhou X, Qin B, Zhou X. Comparison of posterior corneal elevation after SMILE and FS-LASIK in correcting myopia over -9.0 diopters. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:373. [PMID: 33842594 PMCID: PMC8033304 DOI: 10.21037/atm-20-5165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare the changes in posterior corneal elevation after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in correcting myopia over -9 diopters (D). Methods In this prospective comparative study, 82 eyes of 82 patients scheduled for refractive correction were recruited. Eyes were randomly assigned to the SMILE group (45 eyes, -10.43±0.92 D) or FS-LASIK group (37 eyes, -10.97±1.37 D). The posterior corneal surface was measured using a Scheimpflug camera (Pentacam, Oculus, Germany) preoperatively and at 1 day, 1 month, and 6 months after surgery. Posterior corneal elevation in the central point and central 4-mm area, and in various optical zones above the best-fit sphere, was analyzed. A P value of less than 0.05 was considered statistically significant. Results All surgeries were completed successfully. The safety index and efficacy index were 1.20 and 1.00, respectively, in the SMILE group, and was 1.10 and 0.90, respectively, in the FS-LASIK group. No significant difference existed in all analyzed data before and at 6 months after surgery in both the SMILE group and the FS-LASIK group. Changes in posterior corneal elevation after FS-LASIK were greater than after SMILE, with no statistical significance (P≥0.07). In the SMILE group, residual bed thickness was found to be moderately negatively correlated with changes in the elevation in the central area (P≤0.045); whereas it was positively correlated in the peripheral area (P=0.002). Conclusions SMILE and FS-LASIK presented stable posterior corneal surface in correction of myopia over -9.0 D at the follow-up visit of 6 months.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xun Chen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Bing Qin
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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10
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Fu Y, Yin Y, Wu X, Li Y, Xiang A, Lu Y, Fu Q, Hu T, Du K, Wen D. Clinical outcomes after small-incision lenticule extraction versus femtosecond laser-assisted LASIK for high myopia: A meta-analysis. PLoS One 2021; 16:e0242059. [PMID: 33556075 PMCID: PMC7870077 DOI: 10.1371/journal.pone.0242059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To compare postoperative clinical outcomes of high myopia after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS From March 2018 to July 2020, PubMed, MEDLINE, Embase, the Cochrane Library, and several Chinese databases were comprehensively searched. The studies meeting the criteria were selected and included; the data were extracted by 2 independent authors. The clinical outcome parameters were analyzed with RevMan 5.3. RESULTS This meta-analysis included twelve studies involving 766 patients (1400 eyes: 748 receiving SMILE and 652 receiving FS-LASIK). Pooled results revealed no significant differences in the following outcomes: the logarithm of the mean angle of resolution (logMAR) of postoperative uncorrected distance visual acuity (weighted mean difference (WMD) = -0.01, 95% confidence interval (CI): -0.02 to 0.00, I2 = 0%, P = 0.07 at 1 mo; WMD = -0.00, 95% CI: -0.01 to 0.01, I2 = 0%, P = 0.83 at 3 mo; WMD = -0.00, 95% CI: -0.01 to 0.00, I2 = 32%, P = 0.33 in the long term), and the postoperative mean refractive spherical equivalent (WMD = -0.03, 95% CI: -0.09 to 0.03, I2 = 13%, P = 0.30). However, the SMILE group had significantly better postoperative corrected distance visual acuity (CDVA) than the FS-LASIK group (WMD = -0.04, 95% CI, -0.05 to -0.02, I2 = 0%, P<0.00001). In the long term, postoperative total higher-order aberration (WMD = -0.09, 95% CI: -0.10 to -0.07, I2 = 7%, P<0.00001) and postoperative spherical aberration (WMD = -0.15, 95% CI: -0.19 to -0.11, I2 = 29%, P<0.00001) were lower in the SMILE group than in the FS-LASIK group; a significant difference was also found in postoperative coma (WMD = -0.05, 95% CI: -0.06 to -0.03, I2 = 30%, P<0.00001). CONCLUSION For patients with high myopia, both SMILE and FS-LASIK are safe, efficacious and predictable. However, the SMILE group demonstrated advantages over the FS-LASIK group in terms of postoperative CDVA, while SMILE induced less aberration than FS-LASIK. It remains to be seen whether SMILE can provide better visual quality than FS-LASIK; further comparative studies focused on high myopia are necessary.
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Affiliation(s)
- Yanyan Fu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yewei Yin
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Xiaoying Wu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yuanjun Li
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Aiqun Xiang
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Ying Lu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Qiuman Fu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Tu Hu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Kaixuan Du
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Dan Wen
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- * E-mail:
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11
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Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for high myopia. J Cataract Refract Surg 2021; 46:419-427. [PMID: 32142040 DOI: 10.1097/j.jcrs.0000000000000075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism. SETTING The Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective case series. METHODS Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (-6.00 to -8.75 diopters [D]) and extremely high myopia (≥-9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism. RESULTS This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01). CONCLUSIONS SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
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12
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Xia F, Qin B, Shang J, Chen Z, Zhou X, Zhao J, Wang X, Zhou X. Four-Year Outcomes of Small Incision Lenticule Extraction for Extreme High Myopia and Myopic Astigmatism. Front Med (Lausanne) 2020; 7:575779. [PMID: 33313044 PMCID: PMC7703695 DOI: 10.3389/fmed.2020.575779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the long-term safety, efficacy, predictability, and stability of small incision lenticule extraction (SMILE) for the treatment of high myopia and myopic astigmatism >−10.0 D. Methods: This was a prospective study that incorporated 35 consecutive patients (35 eyes) undergoing SMILE from September 2015 to March 2016. These patients had a mean preoperative spherical equivalent refraction of −10.06 ± 0.64 D. Patients were followed over a 4-year period and assessed for outcomes including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and corneal topography. Results: At 4 years post-SMILE, respective efficacy and safety indices were 1.01 ± 0.19 and 1.07 ± 0.15. In total, 97% of operated eyes achieved an UDVA of 20/25 or better. ≥1 line was gained for 9 eyes (26%), with 25 eyes (71%) remaining stable. Twenty-four (69%) and 33 (94%) eyes, respectively, were within ±0.50 D and ±1.0 D of target refraction. From 3 months to 4 years postoperatively, a mean refractive regression of −0.22 D (−0.06 D per year) was detected, whereas no significant changes in mean corneal back curvature or posterior central elevation were detected (P = 0.617 and 0.754, respectively). We detected significant increases in higher-order aberrations (HOAs) of the anterior and total cornea (all P < 0.001), with spherical aberrations and vertical coma being particularly common, whereas posterior corneal HOA remained fairly stable (all P < 0.05). Conclusion: SMILE is a safe, effective, predictable, and stable means of correcting high myopia and myopic astigmatism over a 4-year postoperative period.
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Affiliation(s)
- Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Bing Qin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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13
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Asif MI, Bafna RK, Mehta JS, Reddy J, Titiyal JS, Maharana PK, Sharma N. Complications of small incision lenticule extraction. Indian J Ophthalmol 2020; 68:2711-2722. [PMID: 33229647 PMCID: PMC7856979 DOI: 10.4103/ijo.ijo_3258_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
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Affiliation(s)
- Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jodhbir Singh Mehta
- Singapore Eye Research Institute; Singapore National Eye Centre, 168751; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Jagadesh Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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14
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Arba Mosquera S, Verma S. A review of clinical outcomes following SMILE for the treatment of astigmatism. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1810017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
| | - Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
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15
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Bandeira F, Yam GHF, Liu YC, Devarajan K, Mehta JS. Three-Dimensional Neurite Characterization of Small Incision Lenticule Extraction Derived Lenticules. Invest Ophthalmol Vis Sci 2020; 60:4408-4415. [PMID: 31639827 DOI: 10.1167/iovs.19-27566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We study the density and excitatory response of neurites, and Schwann cells (SCs) in fresh and cryopreserved stromal lenticules derived from small incision lenticule extraction (SMILE). Methods Human stromal lenticules (n = 23) were immunostained for β III-tubulin and imaged using spinning disk confocal laser microscopy, followed by three-dimensional reconstruction, to reveal neurite distribution. The lenticule neurite density (LND) was assessed using a validated neurite tracing and length measurement method with NeuronJ. LND was compared among groups of different lenticule thickness (71-165 μm) obtained from -3 to >-6 diopters (D) corrections. SCs were identified by marker expression and the laser effect on SC-neurite interaction was examined under transmission electron microscopy (TEM). Fresh porcine SMILE-lenticules (n = 18) were used for LND comparison among storage conditions and functional excitatory calcium response assay. Results Using a validated neurite length measurement method, we found an inverse correlation of LND with lenticule thickness. Higher LND was found in thinner lenticules obtained from lower power of correction (r = -0.8925, P < 0.0001), whereas total lenticule neurite lengths did not alter significantly with regards to lenticule thickness. SCs were identified by GAP43 and p75NTR expression and were closely associated with lenticule neurites under TEM. In porcine lenticules, LND and excitatory calcium response were reduced after cold and cryogenic storage, when compared to fresh lenticules. Conclusions The stromal neurites showed variations in density related to SMILE lenticule thickness and cryopreservation. With the presence of SC support and excitatory response, these neurite residues could retain minimal functionality that might serve as a potential advantage in the event of lenticule implantation.
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Affiliation(s)
- Francisco Bandeira
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Federal University of São Paulo, Sao Paulo, Brazil.,São Gonçalo Eye Hospital, Rio de Janeiro, Brazil
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Experimental Microscopy Platform, Singapore Eye Research Institute, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Singapore National Eye Centre, Singapore
| | - Kavya Devarajan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Eye-Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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16
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Wang Y, Ma J. Future Developments in SMILE: Higher Degree of Myopia and Hyperopia. Asia Pac J Ophthalmol (Phila) 2019; 8:412-416. [PMID: 31490200 PMCID: PMC6784781 DOI: 10.1097/01.apo.0000580128.27272.bb] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022] Open
Abstract
Small incision lenticule extraction (SMILE) is a novel 1-step refractive procedure with femtosecond laser for the correction of myopia and myopic astigmatism. Although it has shown good clinical results in efficacy, safety, predictability, and stability, there are still some concerns. In this study, we review the published clinical outcomes of high myopia correction and exploration in hyperopia correction. Results have suggested that SMILE has acceptable outcomes in correction for high myopia <10.0 diopters (D), and it is a feasible and effective procedure for the treatment of hyperopia. However, it is unsuitable for the treatment of extremely high myopia because there is undercorrection and regression as existed in laser-assisted in situ keratomileusis (LASIK), and compound hyperopic astigmatism currently could not be corrected either. More technical and clinical improvements are required to make SMILE competitive.
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Affiliation(s)
- Yan Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
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17
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Lee H, Kang DSY, Reinstein DZ, Roberts CJ, Ambrósio R, Archer TJ, Jean SK, Kim EK, Seo KY, Jun I, Kim TI. Adjustment of Spherical Equivalent Correction According to Cap Thickness for Myopic Small Incision Lenticule Extraction. J Refract Surg 2019; 35:153-160. [PMID: 30855092 DOI: 10.3928/1081597x-20190205-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/05/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the amount of spherical equivalent correction for three different cap thicknesses (120, 130, and 140 µm) during myopic small incision lenticule extraction (SMILE) and determine the association between the amount of spherical equivalent correction and several variables in each cap thickness group. METHODS In this retrospective, comparative, observational case series study, the authors compared refractive errors, keratometric values, laser setting (sphere correction, cylinder correction, spherical equivalent correction, optical zone, and cap diameter), and spherical aberration measured preoperatively and at 3 months postoperatively between three different cap thickness groups: 120 µm (n = 554), 130 µm (n = 377), and 140 µm (n = 90). Multiple linear regression analyses were used to determine the associations between the amount of spherical equivalent correction and several variables, including age, preoperative spherical equivalent, optical zone diameter, central corneal thickness, preoperative mean keratometric values, and preoperative corneal asphericity. RESULTS According to cap thickness, attempted correction is adjusted to achieve the same refractive outcomes for different cap thicknesses. There were significant differences in the amount of sphere correction and spherical equivalent correction, as well as lenticule thickness, among subgroups. Changes in keratometric values, corneal asphericity, and spherical aberration were also significantly different among subgroups (all P < .001). Changes in keratometric values, corneal asphericity, and spherical aberration significantly increased as cap thickness increased. Preoperative spherical equivalent mainly influenced the amount of spherical equivalent correction in each group. CONCLUSIONS Dioptric adjustment of spherical equivalent correction according to cap thickness is essential to obtain similar refractive outcomes in myopic SMILE procedures. [J Refract Surg. 2019;35(3):153-160.].
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18
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Li M, Li M, Chen Y, Miao H, Yang D, Ni K, Zhou X. Five-year results of small incision lenticule extraction (SMILE) and femtosecond laser LASIK (FS-LASIK) for myopia. Acta Ophthalmol 2019; 97:e373-e380. [PMID: 30632671 DOI: 10.1111/aos.14017] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/26/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare visual outcomes and aberration outcomes in small incision lenticule extraction (SMILE) versus femtosecond laser LASIK (FS-LASIK). METHODS This prospective, comparative, nonrandomized clinical study included 68 eyes of 37 patients receiving SMILE and 55 eyes of 30 patients receiving FS-LASIK between December 2011 and January 2013 at the Fudan University Eye and ENT Hospital (Shanghai, People's Republic of China). Patients were followed up at 3, 6 months and 5 years after surgery. Main outcome measurements included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, central corneal thickness (CCT), total corneal refractive power (TCRP) and wavefront aberrations. RESULTS About 98% (49/50) of treated eyes in the SMILE group and 95% (39/41) in the FS-LASIK group had a postoperative logMAR UDVA of 0 or better. Spherical equivalent (SE) after 5 years was -0.01 ± 0.35 D in the SMILE group and -0.23 ± 0.41 D in the FS-LASIK group. A regression of -0.02 ± 0.39 D in the SMILE group and -0.12 ± 0.32 D in the FS-LASIK group was observed between 6 months and 5 years postoperative time-points. TCRP increased by 0.39 ± 0.38 D in the SMILE group and 0.45 ± 0.49 D in the FS-LASIK group between 6-month and 5-year time-points. However, no statistically significant difference was found between the SMILE and FS-LASIK groups in terms of ∆SE, ∆CCT and ∆TCRP between 6 months and 5 years postoperative time-points. CONCLUSION Myopic regression was observed in terms of TCRP but not in subjective refraction. No statistically significant difference in stability was found between SMILE and FS-LASIK.
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Affiliation(s)
- Meiyan Li
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
| | - Meng Li
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
| | - Yingjun Chen
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
| | - Huamao Miao
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
| | - Dong Yang
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
| | - Katherine Ni
- Department of Medicine The Mount Sinai Hospital New York New York USA
| | - Xingtao Zhou
- Key Lab of Myopia, Ministry of Health Department of Ophthalmology EYE & ENT Hospital of Fudan University Shanghai China
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Yang X, Liu F, Liu M, Liu Q, Weng S, Lin H. 15-Month Visual Outcomes and Corneal Power Changes of SMILE in Treating High Myopia With Maximum Myopic Meridian Exceeding 10.00 D. J Refract Surg 2019; 35:31-39. [PMID: 30633785 DOI: 10.3928/1081597x-20181126-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term visual and refractive outcomes, optical quality, and stability of the cornea and axial length after small incision lenticule extraction (SMILE) for the correction of high myopia with a maximum myopic meridian exceeding 10.00 diopters (D). METHODS Via a prospective cohort study, 53 eyes (53 patients) with a maximum myopic meridian exceeding 10.00 D were corrected with a VisuMax femtosecond laser (version 3.0; Carl Zeiss Meditec AG, Jena, Germany) at the Zhongshan Ophthalmic Center of Sun Yat-sen University. Refractive outcomes, aberrations, axial length, and corneal curvature were evaluated preoperatively and at 1, 3, and 15 months postoperatively. RESULTS At 15 months postoperatively, the efficacy and safety indexes were 0.91 ± 0.25 and 1.15 ± 0.18, respectively. A total of 72% of eyes were within ±0.50 D and 89% were within ±1.00 D of the attempted spherical equivalent, respectively. From 1 to 15 months postoperatively, the significant regression was -0.24 ± 0.28 D (P < .001) on manifest refraction and -0.43 ± 0.54 D (P < .001) on anterior corneal curvature. In addition, a significant increase of 0.20 µm (P = .016) was observed in the spherical aberration. No significant change was observed in posterior corneal curvature (P > .999), including mean keratometry or astigmatism, or in the ocular axis length from 1 to 15 months postoperatively (26.82 ± 0.93 and 26.82 ± 0.95 mm, respectively, P > .99). CONCLUSIONS SMILE had long-term safety, efficacy, and predictability when treating high myopia with a maximum myopic meridian exceeding 10.00 D. Both a manifest refraction regression of -0.24 D and a significant spherical aberration increase of 0.20 µm were observed between 1 and 15 months postoperatively, due to the increased anterior corneal curvature. [J Refract Surg. 2019;35(1):31-39.].
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Visual and Refractive Outcomes of Small-Incision Lenticule Extraction in High Myopia: 5-Year Results. J Ophthalmol 2018; 2018:5893126. [PMID: 30420916 PMCID: PMC6215553 DOI: 10.1155/2018/5893126] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. Materials and Methods Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. Results Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was −7.47 ± 1.10 D (range −6.00 to −10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was −0.43 ± 0.47 (0.50 to −1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. Conclusion SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up.
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Jeon SH, Park CH, Kim HS. Effect of the Corneal Incision Direction Using an Image-guided System on Residual Astigmatism. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.6.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Hee Jeon
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hyun Park
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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