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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024; 35:278-283. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Lee CY, Jeng YT, Yang SF, Huang CT, Chao CC, Lian IB, Huang JY, Chang CK. Topographic and Surgical Risk Factors for Early Myopic Regression between Small Incision Lenticule Extraction and Laser In Situ Keratomileusis. Diagnostics (Basel) 2024; 14:1275. [PMID: 38928690 DOI: 10.3390/diagnostics14121275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Our objective was to evaluate the topographic and surgical factors of early myopic regression between laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). A retrospective case-control study was conducted, and 368 and 92 eyes were enrolled in the LASIK and SMILE groups via propensity score matching (PSM). Visual acuity, refractive status, axial length, and topographic/surgical parameters were collected. Multiple linear regression was applied to the yield coefficient and the 95% confidence interval (CI) of the parameters. The cumulative incidence of early myopic regression was higher in the LASIK group (p < 0.001). In the SMILE group, a lower central corneal thickness (CCT) thinnest value and a higher corneal cylinder associated with early myopic regression were observed; meanwhile, in the LASIK group, a lower CCT thinnest value, a higher steep corneal curvature, a larger optic zone, and a lower flap thickness related to early myopic regression were observed (all p < 0.05). In the SMILE group, a higher CCT difference correlated with early myopic regression was observed compared to the LASIK group (p = 0.030), and higher steep corneal curvature and lower cap/flap thickness (both p < 0.05) correlated with early myopic regression were observed in the LASIK group compared to the SMILE group. In conclusion, CCT differences significantly influence early myopic regression in the SMILE group; meanwhile, corneal curvature and flap thickness affect early myopic regression principally in the LASIK group.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412, Taiwan
| | - Yu-Ting Jeng
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chin-Te Huang
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Department of Ophthalmology, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 115, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 515, Taiwan
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Lin MY, Tan HY, Chang CK. Myopic Regression after FS-LASIK and SMILE. Cornea 2024:00003226-990000000-00563. [PMID: 38780430 DOI: 10.1097/ico.0000000000003573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To compare the degree of myopic regression after myopia correction with either femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or small-incision lenticule extraction (SMILE) over 18 months. METHODS Patients undergoing FS-LASIK or SMILE surgery for myopia correction were retrospectively recruited. The propensity scores were used to match patients by age and preoperative manifest spherical equivalent (SEQ) from these 2 groups. Myopic regression was analyzed using the Cox proportional hazard model. RESULTS A total of 416 eyes of 416 patients undergoing FS-LASIK and 416 eyes of 416 patients undergoing SMILE were matched. Using 1-month SEQ as baseline, the SEQ regression values after FS-LASIK were 0D, -0.17 ± 0.69D, -0.24 ± 0.65D, -0.31 ± 0.65D, -0.32 ± 0.63D, and -0.33 ± 0.62D and the SEQ regression values after SMILE were 0D, -0.07 ± 0.75D, -0.18 ± 0.77D, -0.23 ± 0.82 D, -0.21 ± 0.77D, and -0.24 ± 0.68D at 1, 3, 6, 9, 12, and 18 months, respectively. The Cox proportional hazard model showed that preoperative manifest SEQ (P = 0.021) and designed optical zone (P = 0.048) are significant predictors. The selected surgical procedure had no significant effect on predicting myopic regression (P = 0.470). The cumulative survival rates of myopic regression were 54.74% and 42.10% in the FS-LASIK group and 58.66% and 43.83% in the SMILE group, at 12 and 18 months, respectively (log-rank test, P = 0.11). CONCLUSIONS After matching based on age and preoperative manifest SEQ, we found that higher myopia and a smaller optical zone contribute significantly to the development of myopic regression after undergoing FS-LASIK or SMILE surgery at 18 months. The selected surgical procedure, however, does not affect the likelihood of myopic regression.
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Affiliation(s)
- Meng-Yin Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linko, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei, Taiwan; and
- Department of Optometry, Da-Yeh University, Changhua County, Taiwan
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Lee CY, Jeng YT, Chao CC, Lian IB, Huang JY, Yang SF, Chang CK. Refraction and topographic risk factors for early myopic regression after small-incision lenticule extraction surgery. Sci Rep 2024; 14:8732. [PMID: 38627567 PMCID: PMC11021515 DOI: 10.1038/s41598-024-59327-6] [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: 09/19/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
We sought to evaluate the topographic risk factors for early myopic regression after small-incision lenticule extraction (SMILE). A retrospective case‒control study was conducted, and individuals who underwent SMILE surgery were enrolled. Among them, 406 and 14 eyes were categorized into the nonregression and regression groups, respectively. The preoperative and postoperative parameters in the two groups were collected, including spherical refraction (SE), axial length (AXL) and topographic data. A generalized linear model was adopted to analyze the difference in each parameter between the two groups. After 6 months, UCVA decreased in the regression group, and SE increased in the regression group (both P < 0.05). The increase in the CCT at the thinnest point (P = 0.044), flat corneal curvature (P = 0.012) and TCRP (P = 0.001) were significantly greater in the regression group. Regarding the risk factors for myopic regression, preoperative SE, preoperative sphere power, preoperative AXL, preoperative flat corneal curvature, preoperative SA, early postoperative SE, early postoperative sphere power, early postoperative AXL and early postoperative CCT difference were significantly greater in the regression group (all P < 0.05). The SE, sphere power, AXL, preoperative flat corneal curvature, preoperative SA, and postoperative CCT difference correlate with early myopic regression after SMILE.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Yu-Ting Jeng
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan
- Department of Optometry, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist., Taipei, 100008, Taiwan.
- Department of Optometry, Da-Yeh University, Chunghua, Taiwan.
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Xia F, Chen Z, Miao H, Wei R, Li M, Zhao J, Zhou X. Ten-year outcomes following small incision lenticule extraction for up to -10Dioptres myopia. Clin Exp Optom 2024; 107:285-290. [PMID: 37194118 DOI: 10.1080/08164622.2023.2203313] [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: 06/10/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
CLINICAL RELEVANCE More than 6 million small-incision lenticule extraction (SMILE) procedures have been performed worldwide since 2011. Therefore, its long-term safety and efficacy should be investigated. BACKGROUND This study aimed to evaluate 10-year refractive outcomes, corneal stability, axial length, and wavefront aberrations in patients who underwent SMILE to correct myopia. METHODS Thirty two patients (32 eyes) who underwent SMILE-based myopic correction. Corrected distance visual acuity, uncorrected distance visual acuity, corneal stability, axial length, and wavefront aberrations were evaluated preoperatively and at 1 month and 1, 5, and 10 years postoperatively. RESULTS At 10 years postoperatively, the safety and efficacy indices for the patients included in this study were 1.19 ± 0.21 and 1.04 ± 0.27, respectively. For 26 (81%) and 30 eyes (94%), correction to within ±0.50 D and ±1.00 D of the target was achieved, respectively. Over the 10-year follow-up duration, a mean -0.32 ± 0.56 D regression was observed (-0.03 ± 0.06 D/year). Relative to baseline, horizontal and vertical comas significantly increased, as did the incidence of higher-order aberrations (all P < 0.001), whereas axial length and corneal elevation remained stable during follow-up. CONCLUSION These results indicate that the SMILE-based correction for myopia of up to -10 Dioptres is safe, effective, and stable, with relatively constant wavefront aberrations and corneal stability over time after treatment.
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Affiliation(s)
- Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huamao Miao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Differences in ocular high order aberrations before and after small incision lenticule extraction for correction of myopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1274101. [PMID: 38601117 PMCID: PMC11004322 DOI: 10.3389/fmed.2024.1274101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Objective To examine the causes and factors that lead to high order aberration (HOA) during the treatment of myopia using small incision lenticule extraction (SMILE), as well as the differences between SMILE and other corneal refractive surgeries through a systematic review and meta-analysis. Methods A systematic search was conducted from January 2015 to February 2023 in Pubmed, Embase, Web of Science, and Google Scholar databases to gather relevant studies on SMILE and HOA. Studies meeting specific criteria were chosen, and clinical data was retrieved for analysis. Results This meta-analysis resulted in the inclusion of 19 studies involving 1,503 eyes. Pooled results showed significant induction of total HOA (tHOA, d = -0.21, p < 0.001), spherical aberration (SA, d = -0.11, p < 0.001) and coma aberration (CA, d = -0.18, p < 0.001) after SMILE compared to pre-SMILE, while no significant change in trefoil aberration (TA) was observed (d = -0.00, p = 0.91). There was a significantly lower induction of tHOA after SMILE compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK, d = 0.04, p < 0.001), and no significant difference was observed compared to wavefront aberration-guided (WFG) refractive surgery (d = 0.00, p = 0.75). There was also a significant association between different levels of myopia and astigmatism, duration of follow-up, lenticule thickness, and preoperative central corneal thickness (CCT) on the induction of tHOA after SMILE (p < 0.05), while the higher preoperative myopia group (sphere > -5D), lower preoperative astigmatism group (cylinder ≤ -1D), larger lenticule thickness group (lenticule thickness > 100 μm), shorter follow-up group (follow-up 1 month postoperatively) and the thicker CCT group (CCT > 550 μm) brought a significant induction of tHOA compared to the opposite comparison group (p < 0.001). Conclusion While SMILE can induce HOA significantly, it induces less HOA than FS-LASIK. Postoperative HOA following SMILE can be affected by factors such as myopia, astigmatism, lenticule thickness, CCT, and duration of follow-up. Future research should continue to explore techniques to decrease the induction of HOA by using this methodology. Systematic review registration https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | | | | | | | | | | | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Ying J, Zhang J, Wang B, Pan F, Yang S. Comprehensive Assessment of Posterior Corneal Asphericity Change Calculated by Tangential Radius of Curvature After FS-LASIK and SMILE. J Refract Surg 2024; 40:e133-e141. [PMID: 38466766 DOI: 10.3928/1081597x-20240205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE To evaluate changes in posterior corneal asphericity (ΔQ) using the tangential radius of curvature after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) procedures. METHODS One hundred twenty right eyes of myopic patients who underwent either FS-LASIK or SMILE procedures were analyzed using Sirius 3D corneal topography for assessment. The tangential radius was employed to calculate both preoperative and postoperative posterior corneal Q-values across each semimeridian. After both surgical interventions, the ΔQ value variations across the 360° semimeridional regions of the posterior corneal surface were compared. RESULTS A marked postoperative increase in the posterior corneal Q-value was documented. No significant differences were noted between the postoperative Q-values or ΔQ-values of the two surgical approaches. Among patients with moderate myopia, postoperative Q-value exhibited considerably lower increases and ΔQ-value significantly smaller than their counterparts with high myopia. Moreover, the fluctuation in ΔQ across semimeridional regions was less evident in patients with moderate myopia than in those with high myopia. Notably, the degree of ΔQ fluctuation across semimeridional regions was similar between both surgical categories. These data offer insights into variations in the posterior corneal surface after refractive surgeries depending on the degree of myopia, illuminating their clinical relevance. CONCLUSIONS Both FS-LASIK and SMILE introduce notable changes to posterior corneal asphericity among patients with different myopia intensities. Furthermore, the influence on the asphericity across the entire posterior surface is similarly distributed between FS-LASIK and SMILE techniques. [J Refract Surg. 2024;40(3):e133-e141.].
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Saad A, Klabe K, Kirca M, Kretz FAT, Auffarth G, Breyer DRH. Refractive outcomes of small lenticule extraction (SMILE) Pro® with a 2 MHz femtosecond laser. Int Ophthalmol 2024; 44:52. [PMID: 38340212 PMCID: PMC10858925 DOI: 10.1007/s10792-024-02915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate the initial visual outcomes of Small Incision Lenticule Extraction (SMILE) Pro® using a 2 MHz femtosecond laser (VisuMax 800, Carl Zeiss Meditec) and to assess the efficacy, safety, predictability, accuracy, and complication rate. METHODS This retrospective analysis included eyes which underwent the SMILE Pro® procedure using VisuMax 800 femtosecond laser to correct myopia. All surgeries were performed by one surgeon (DB). Follow-up was conducted 3 months postoperatively to evaluate visual outcomes after neuroadaptation, corrected visual acuity (CDVA) and intra- and postoperative complications. RESULTS One hundred and fifty-two eyes of 82 patients (mean age 31 ± 6 years) results at 3 months are presented. The mean spherical equivalent (SE) was - 4.44 ± 1.86 D preoperatively while -0.24 ± 0.32 D postoperatively. 99% of eyes achieved SE within ± 1.0 D of attempted correction and 91% were within ± 0.5 D. Efficacy index was 0.93 while the safety index was 1. No complications occurred intra- or postoperatively. No eyes lost more than 1 line of their preoperative CDVA. All highly myopic eyes (- 6.25 to - 10.00 D; n = 18) achieved 20/20 at 3 months postoperatively and were within 0.5 D from the attempted SE and no eyes lost more than 1 line of CDVA. CONCLUSION The SMILE Pro® is a safe, efficient, and predictable procedure for the treatment of myopia and myopic astigmatism, with comparable results of conventional SMILE surgery. High myopic eyes achieve better results than low and moderate myopia. No complications were recorded in our patients.
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Affiliation(s)
- Amr Saad
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany.
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany.
| | - Karsten Klabe
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Mücella Kirca
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Florian A T Kretz
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Precise Vision, Kretz & Colleagues, Rheine, Germany
| | - Gerd Auffarth
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Detlev R H Breyer
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
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Mao X, Chen H, Zhao Y, Ji S, Dai J. Impact of the preoperative cylinder on astigmatism correction in femtosecond lenticule extraction (FLEX): a prospective observational study. Graefes Arch Clin Exp Ophthalmol 2024; 262:631-639. [PMID: 37725147 DOI: 10.1007/s00417-023-06211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To explore the impact of the preoperative manifest cylinder on astigmatism correction via femtosecond lenticule extraction (FLEX), or small incision lenticule extraction (SMILE). METHODS This was a prospective observational study. Eyes were categorized into mild (n = 88), moderate (n = 46), and severe (n = 53) astigmatism groups, based on the preoperative manifest cylinder. Vector analysis was conducted with the back vertex distance set at 12 mm. The primary outcome was the correction index (CI), with secondary outcomes including the safety, efficacy, predictability, and vectoral alterations related to FLEX. RESULTS The average target-induced astigmatism was 0.45 ± 0.20 D, 0.95 ± 0.17 D, and 1.99 ± 0.65 D in the three groups (P < 0.001), and the average CI was 1.12± 0.05, 1.01 ± 0.03, and 0.95 ± 0.02 (P = 0.020), with the severe astigmatism group displaying a notably lower CI. The efficacy, safety, predictability, or stability of FLEX did not demonstrate any significant differences among the three groups. The CIs exhibited a significant difference in eyes with with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism from the mild to severe astigmatism group. In eyes with oblique astigmatism, the average CI exceeded one. CONCLUSION Patients with manifest cylinder exceeding 1.25 D have a heightened risk of under-correction in WTR and ATR astigmatism compared to those with mild astigmatism, and mild over-correction may occur in cases of oblique astigmatism.
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Affiliation(s)
- Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
| | - Han Chen
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
- Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yinzhen Zhao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
| | - Shunmei Ji
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China.
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Lee CY, Shen JH, Chao CC, Lian IB, Huang JY, Yang SF, Chang CK. Topographic and surgical risk factors for high postoperative residual astigmatism after small incision lenticule extraction in patients with different degrees of myopia: a retrospective cohort study. BMC Ophthalmol 2024; 24:45. [PMID: 38287289 PMCID: PMC10826184 DOI: 10.1186/s12886-024-03296-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: 09/19/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND To evaluate the possible topographic and surgical risk factors for high postoperative residual astigmatism in patients who undergo small-incision lenticule extraction (SMILE) surgery and have different myopia degrees. METHODS A retrospective cohort study was conducted, and patients who underwent SMILE surgery were enrolled. A total of 80 and 150 eyes from 40 to 75 individuals, respectively, were selected as the low myopia and high myopia groups. The demographic data, visual acuity, refraction, topographic parameters and surgical settings were recorded. Multiple linear regression with interaction tests were performed to survey the risk factors for high postoperative residual astigmatism in each group. RESULTS Five (6.25%) and 9 (6.00%) eyes presented with high postoperative residual astigmatism in the low myopia and high myopia groups, respectively, but these differences were not significant (P = 0.569). A steep corneal curvature was correlated with a greater risk of high postoperative residual astigmatism in the low myopia group (P = 0.015), while a higher degree of cycloplegic cylinder power, steeper corneal curvature, greater topographic cylinder power, smaller optic zone and longer incision length were associated with a high rate of postoperative residual astigmatism in the high myopia group (all P < 0.05). In addition, the interaction effects of cycloplegic and topographic cylinder power and longer incision length on the incidence of high postoperative residual astigmatism development were more evident in the high myopia group than in the low myopia group (all P < 0.05). CONCLUSIONS A steep corneal curvature correlates with a high risk of high postoperative residual astigmatism after SMILE surgery, and a higher degree of cycloplegic and topographic cylinder and longer incision are associated with high postoperative residual astigmatism in individuals with high myopia.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Jen-Hsiang Shen
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
| | - Chen-Cheng Chao
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan
- Department of Optometry, Nursing, and Management, MacKay Junior College of Medicine, Taipei, Taiwan
| | - Ie-Bin Lian
- Institute of Statistical and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, No. 13-5, Gongyuan Rd., Zhongzheng Dist, 100008, Taipei, Taiwan.
- Department of Optometry, Da-Yeh University, Changhua, Taiwan.
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Yang X, Feng Q, Liu Q, Chen J, Wan P. Long-Term Visual Quality and Pupil Changes after Small-Incision Lenticule Extraction for Eyes without Preoperative Cylinder Refraction. J Ophthalmol 2024; 2024:8835585. [PMID: 38282962 PMCID: PMC10821807 DOI: 10.1155/2024/8835585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To investigate the long-term changes in visual quality and pupil size after small incision lenticule extraction (SMILE) for eyes without preoperative cylinder refraction. Methods Thirty-three myopic eyes (33 patients) without preoperative cylinder refraction were corrected using SMILE. Refractive outcomes, corneal curvature, aberrations, contrast sensitivity (CS), and pupil diameter were evaluated preoperatively, and 30 months postoperatively. Results The 30-month postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA, LogMAR) were -0.10 ± 0.09 and -0.14 ± 0.06, respectively, whereas the preoperative CDVA (LogMAR) was -0.07 ± 0.05. Cylinder refraction of -0.11 ± 0.21 D (ranging from -0.50 to 0.00) was observed at 30 months postoperatively, increasing from the preoperative cylinder refraction of 0.00 ± 0.00 D (P=0.004). Moreover, the centroid coordinates x, y of corneal anterior astigmatic vectors were -0.19 ± 0.22, 0.81 ± 0.33 at 30 months postoperatively, and 0.02 ± 0.28, 0.76 ± 0.51 preoperatively (Px < 0.001 and Py=0.810, respectively). Furthermore, a 15° axis change in the mean anterior corneal astigmatic vector was observed at 30 months postoperatively from the preoperative state, as measured by Pentacam. At 30 months postoperatively, the photopic Log CS reduced significantly with glare at three and six cycles/degrees (P < 0.001 and P=0.015, respectively), a decreased photopic pupil diameter (3.27 ± 0.55 mm vs. 3.10 ± 0.66 mm, P=0.030), and an increased Coma (Z31) and Trefoil (Z3-3) at 4 mm diameter area analysis. However, a significant linear regression relationship was only observed between changes in photopic pupil diameter and changes in photopic Log CS with glare at 12 cycles/degree (P=0.038 and β = 0.282). Conclusion Slight cylinder regression was observed with thicker corneal lenticular extraction after SMILE correction of nonastigmatic eyes 30 months postoperatively. This regression was mainly because of the axis changes in anterior corneal astigmatism power. Therefore, a cylinder nomogram modification of 0.25 to 0.50 D is considerable for correcting nonastigmatic myopic eyes with a predicted spherical lenticular thickness over 100 µm.
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Affiliation(s)
- Xiaonan Yang
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Qiting Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Quan Liu
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jianhui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Pengxia Wan
- Department of Ophthalmology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China
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Lin Q, Shen Z, Zhou X. Intensive topical steroid regimen for enhanced very early recovery after small incision lenticule extraction. Int Ophthalmol 2023; 43:4097-4103. [PMID: 37561251 PMCID: PMC10520117 DOI: 10.1007/s10792-023-02827-7] [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: 11/23/2021] [Accepted: 07/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality. METHODS A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24 h and one week after SMILE. RESULTS The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24 h and one week after SMILE (p > 0.05). CONCLUSION The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.
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Affiliation(s)
- Qinghong Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China
| | - Zhengwei Shen
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China.
- Department of Refractive Surgery, Wuhan Bright Eye Hospital, No.179 Zhongshan Road, Wuhan, 430000, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, 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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Luo W, Aruma A, Li M, Wang J, Xie J, Xiao X, Shen Y, Niu L, Wang X, Zhou X. Four-year visual outcomes and optical quality of SMILE and implantable collamer lens V4c (EVO-ICL) implantation for high myopia: a retrospective study. BMC Ophthalmol 2023; 23:341. [PMID: 37525155 PMCID: PMC10392000 DOI: 10.1186/s12886-023-03050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND To compare the 4-year visual outcomes of implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for high myopia and astigmatism. METHODS This retrospective case study included 64 eyes of 40 patients. These patients with preoperative manifest refraction spherical equivalent (SE) between - 6.00 and - 10.00 diopters (D) were screened from the database of SMILE and EVO-ICL implantation procedures in 2015. The ICL group [32 eyes of 19 patients (mean age, 29.6 ± 6.3 years); mean SE, -8.71 ± 1.06 D] and SMILE group [32 eyes of 21 patients (mean age, 27.7 ± 5.6 years); mean SE, -8.35 ± 0.65D] were compared. All patients were then prospectively examined at a four-year follow-up for routine postoperative examinations, higher-order ocular aberrations, retinal image quality and a questionnaire. RESULTS The safety indexes were 1.15 ± 0.14 and 1.22 ± 0.21 (P = 0.36) for the SMILE and ICL groups, respectively. No eyes lost two or more lines of CDVA in either group. The efficacy indexes were 0.97 ± 0.16 and 0.96 ± 0.19 (P = 0.87), respectively. Twenty-three eyes (72%) in ICL and 26 eyes (81%) in SMILE groups were within ± 0.5 D of the attempted SE (P < 0.01). ICL-treated eyes had significantly less spherical aberration and coma (P < 0.01 and < 0.05, respectively) postoperatively. Halos were the prevalent visual disturbance in both groups. CONCLUSION SMILE and EVO-ICL implantation provided safe and effective correction of high myopia. SMILE showed slightly better long-term predictability. Mild postoperative visual disturbances were observed after ICL and SMILE at 4-year follow-up.
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Affiliation(s)
- Wuqiang Luo
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Aruma Aruma
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China
| | - Jing Wang
- Aier Eye Hospital Group, Aier Eye Hospital of Wuhan University, 430063, Wuhan, Hubei Province, China
| | - Jing Xie
- Department of Ophthalmology, Shenzhen Key Laboratory of ENT, Institute of ENT Shenzhen, Longgang ENT hospital, 518172, Shenzhen, China
| | - Xin Xiao
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yang Shen
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China
| | - Lingling Niu
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, NHC Key Laboratory of Myopia, Shanghai Research Center of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 200433, Shanghai, China.
- Department of Ophthalmology and Optometry, Myopia Key Laboratory of the Health Ministry, Eye and ENT Hospital of Fudan University, No.83 Fenyang Road, 200031, Shanghai, People's Republic of China.
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Small Incision Lenticule Extraction (SMILE) Versus Laser Assisted Stromal In Situ Keratomileusis (LASIK) for Astigmatism Corrections: A Systematic Review and Meta-analysis. Am J Ophthalmol 2023; 247:181-199. [PMID: 36410469 DOI: 10.1016/j.ajo.2022.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare small incision lenticule extraction (SMILE) and laser assisted stromal in situ keratomileusis (LASIK) for astigmatism correction. DESIGN Systematic review and meta-analysis METHODS: We reviewed published studies comparing outcomes after LASIK and SMILE for astigmatism correction by querying PubMed, EMBASE, Cochrane, and Web of Science, with a cut-off date of September 3, 2022. We also compared the changes in visual acuity, refraction, and high-order aberrations between the surgeries. Astigmatism correction outcomes in the low-to-moderate group (less than or equal to -2.00 D) and high group (greater than -2.00 D) were evaluated using vector analysis. The Cochrane risk of bias tool in RevMan software was used for randomized studies (RCT), and Risk Of Bias In Nonrandomized Studies - of Interventions (ROBINS-I) was used for the nonrandomized studies (NRSs). RESULTS There were 17 studies (5 randomized studies and 12 cohort studies), including 1,985 eyes. A statistically significant difference was found in the correction index (mean difference [MD] = -0.02, 95% confidence interval [CI] = -0.04 to -0.01, P =0.01), although there was no significant difference in the index of success (MD = 0.01, 95% CI = -0.03 to 0.05, P =0.51), different vector (MD = 0.07, 95% CI = 0.00 to 0.13, P =0.04), and angle of error (MD = 0.56, 95% CI = -0.34 to 1.45, P =0.22) between SMILE and LASIK. However, for low-to-moderate astigmatism correction, SMILE exhibited a smaller correction index (MD = -0.08, 95% CI= -0.13 to -0.02, P =0.008) and a larger difference vector (MD = 0.18, 95% CI = 0.09 to 0.27, P <0.0001) than LASIK. There was no significant difference between the different procedures in visual acuity and refraction (spherical equivalent: MD = -0.04, 95% CI = -0.08 to 0.01, P =0.15) or high-order aberration (MD = -0.01, 95% CI = -0.07 to 0.04, P =0.67), except spherical aberration (MD = -0.12, 95% CI = -0.23 to -0.01, P =0.04). The risk of bias was moderate in most studies because of poor reporting of several bias domains for RCTs, and because of confounding and selective outcome reporting for NRSs. CONCLUSIONS When used to treat severe astigmatism, both SMILE and LASIK provide effective and predictable results and generally have equivalent outcomes. However, evidence reveals a tendency toward undercorrection in the SMILE groups for astigmatism correction. In addition, LASIK has a greater probability of causing postoperative spherical aberration.
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Han T, Zhao L, Shen Y, Chen Z, Yang D, Zhang J, Sekundo W, Shah R, Tian J, Zhou X. Twelve-year global publications on small incision lenticule extraction: A bibliometric analysis. Front Med (Lausanne) 2022; 9:990657. [PMID: 36160168 PMCID: PMC9493269 DOI: 10.3389/fmed.2022.990657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the development process of small incision lenticule extraction (SMILE) surgery in a 12-year period. Methods We conducted a literature search for SMILE research from 2011 to 2022 using the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC). The VOS viewer, and CiteSpace software were used to perform the bibliometric analysis. Publication language, annual growth trend, countries/regions and institutions, journals, keywords, references, and citation bursts were analyzed. Results A total of 731 publications from 2011 to 2022 were retrieved. Annual publication records grew from two to more than 100 during this period. China had the highest number of publications (n = 326). Sixty-five keywords that appeared more than four times were classified into six clusters: femtosecond laser technology, dry eye, biomechanics, visual quality, complications, and hyperopia. Conclusion The number of literatures has been growing rapidly in the past 12 years. Our study provides a deep insight into publications on SMILE for researchers and clinicians with bibliometric analysis for the first time.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Liang Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yang Shen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhi Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jiaoyan Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Walter Sekundo
- The Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany
| | - Rupal Shah
- New Vision Laser Centers, Vadodara, Gujarat, India
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Jinhui Tian,
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Xingtao Zhou,
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Fu M, Li M, Wei R, Zhang C, Huang Y, Niu L, Wang X, Zhang H, Zhou X. Long-term visual quality after small incision lenticule extraction (SMILE) and laser assisted subepithelial keratomileusis (LASEK) for low myopia. BMC Ophthalmol 2022; 22:347. [PMID: 35978275 PMCID: PMC9386982 DOI: 10.1186/s12886-022-02568-8] [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: 06/19/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have reported the visual outcomes of small-incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK) for myopia correction. This study aims to compare the visual quality and corneal wavefront aberrations after SMILE and LASEK for low-myopia correction. Methods In this prospective study, we included 29 eyes of 29 patients who received SMILE and 23 eyes of 23 patients who received LASEK between June 2018 and January 2019. The following measurements were assessed: uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, corneal wavefront aberrations, and subjective visual quality. All patients were followed up for two years. Results All procedures were uneventful. An efficacy index of 1.19 ± 0.17 was established in the SMILE group and 1.23 ± 0.20 in the LASEK group. No eyes lost more than two lines of CDVA. We found that 93% (27/29) of the treated eyes in the SMILE group and 91% (21/23) in the LASEK group had spherical equivalent (SE) within ± 0.25D. The increases in the total corneal spherical aberration and the corneal front spherical aberration were lower in the SMILE group than in the LASEK group (P < 0.01). In contrast, the increases in the total corneal vertical coma and the corneal front vertical coma in the SMILE group were greater than those in the LASEK group (P < 0.01). Conclusion Both SMILE and LASEK have good safety, stability, and patient-reported satisfaction for low myopia. SMILE induced less corneal spherical aberration but greater vertical coma than LASEK.
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Affiliation(s)
- Mengjun Fu
- Department of Ophthalmology, Weifang Eye Hospital, No.139 Xingfu Road, Kuiwen District, Weifang, 261000, Shandong, People's Republic of China.,State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Chuanwei Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yangyi Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Haorun Zhang
- Department of Ophthalmology, Weifang Eye Hospital, No.139 Xingfu Road, Kuiwen District, Weifang, 261000, Shandong, People's Republic of China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Key Laboratory of Myopia, (Fudan University), Chinese Academy of Medical Sciences, Shanghai, 200031, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Zhou J, Gu W, Gao Y, Wang W, Zhang F. Survival analysis of myopic regression after small incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for low to moderate myopia. EYE AND VISION (LONDON, ENGLAND) 2022; 9:28. [PMID: 35909114 PMCID: PMC9341088 DOI: 10.1186/s40662-022-00300-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To report the predictive factors of myopic regression in patients who had undergone small incision lenticular extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileuses (FS-LASIK) after 3-12 months of follow-up. METHODS This retrospective case series study recruited patients with a subjective sphere of - 1.00 to - 6.00 D myopia. SMILE was performed in 1629 eyes of 1629 patients with a subjective refraction spherical equivalent (SEQ) of - 4.57 ± 1.20 D and 1414 eyes of 1414 patients with a subjective SEQ of - 4.53 ± 1.26 D in FS-LASIK. Refractive outcomes were recorded at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Predictors affecting myopic regression and other covariates were estimated with a Cox proportional hazard (Cox PH) model for the two surgical methods. RESULTS At 12 months, no significant difference was evident in the efficacy (P = 0.934), predictability (P = 0.733), or stability (P = 0.66) between FS-LASIK and SMILE. The survival rates were 83.7% in the FS-LASIK group and 88.1% in the SMILE group. Multivariate analysis by the Cox PH model revealed a similar probability of postoperative myopic regression with SMILE or FS-LASIK (P = 0.630). Predictors of myopic regression included preoperative higher-order aberration root mean square with 3 mm pupil diameter (pre-HOA-RMS3) (P = 0.004), anterior chamber depth (ACD) (P = 0.015), pre-subjective sphere (P = 0.016), corneal diameter (P = 0.016), optical zone (OZ) (P = 0.02), and predicted depth of ablation (DA) (P = 0.003). CONCLUSION SMILE and FS-LASIK had a similar risk of myopic regression for low to moderate myopia. Pre-HOA-RMS3, ACD, pre-subjective sphere, corneal diameter, OZ, and predicted DA were predictors of myopic regression.
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Affiliation(s)
- Jihong Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Science Key Lab, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, Beijing, 100730, China
- Beijing Aier Intech Eye Hospital, Beijing, China
| | - Wei Gu
- Beijing Aier Intech Eye Hospital, Beijing, China
| | - Yan Gao
- Beijing Aier Intech Eye Hospital, Beijing, China
| | - Wenjuan Wang
- Beijing Aier Intech Eye Hospital, Beijing, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Science Key Lab, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, Beijing, 100730, China.
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Zhang Y, Sun X, Chen Y. Comparison of Corneal Optical Quality After SMILE, Wavefront-Optimized LASIK and Topography-Guided LASIK for Myopia and Myopic Astigmatism. Front Med (Lausanne) 2022; 9:870330. [PMID: 35449802 PMCID: PMC9016141 DOI: 10.3389/fmed.2022.870330] [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: 02/06/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare visual outcomes and corneal optical quality after small incision lenticule extraction (SMILE), wavefront-optimized (WFO) FS-LASIK, and topography-guided customized ablation treatment (TCAT) FS-LASIK for myopia. Methods This prospective case-series study included 283 eyes of 283 myopic patients who underwent SMILE or FS-LASIK. There were 102, 100, and 81 eyes in the SMILE group, WFO group and TCAT group, respectively. The tomography system (Sirius) was used to measure corneal aberrations and optical quality. Results At postoperative 1 and 6 months, there were no significant differences in uncorrected distance visual acuity and corrected distance visual acuity among the three groups (P > 0.05). Postoperative manifest refractive spherical equivalent was similar among the groups (P > 0.05). There was statistically significant difference in cylinder at 1 month among the three groups, with the highest mean value in TCAT group (P < 0.05). The corneal optical path difference, root mean square of corneal astigmatism and strehl ratio were the most superior in the TCAT group at postoperative 1 and 6 months (P < 0.05). Conclusion SMILE, WFO FS-LASIK, and TCAT FS-LASIK provided similar visual results. The corneal visual quality after TCAT FS-LASIK was the best.
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Affiliation(s)
- Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xiaoxiao Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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20
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Zhou X, Qin B, Han T, Shang J, Chen Z, Zhao J, Yao P, Zhou X. Long-Term Observation of Higher-Order Aberrations and Microdistortions in Bowman’s Layer After Small Incision Lenticule Extraction for the Correcting Myopia With Spherical Equivalent Higher Than −9.0 Diopters. Front Med (Lausanne) 2022; 9:814810. [PMID: 35463029 PMCID: PMC9023804 DOI: 10.3389/fmed.2022.814810] [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: 11/14/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the outcomes in corneal higher-order aberrations (HOAs) and microdistortions in the Bowman’s layer after femtosecond laser small incision lenticule extraction (SMILE) for correcting extremely high myopia. Methods This prospective study included patients with myopia with spherical equivalent ≥ -9.0 Diopters (D). SMILE was performed in forty eyes of 40 patients. Pentacam was used to evaluate HOAs before and at 1 day, 3 months, 6 months, and 2 years after surgery. Fourier-domain optical coherence tomography was used to evaluate microdistortions at 2 years postoperatively. Thirty-two eyes of 32 patients receiving femtosecond laser-assisted in situ keratomileusis (FS-LASIK) were enrolled as the control group. HOAs were measured before, at 1 day and at least 1 year postoperatively. Results After SMILE, the long-term safety and effectiveness index was 1.25 and 0.85, respectively. Microdistortions were observed in 73.5% of the eyes at 2 years, with an average number of 1.20 ± 1.22 microdistortions and an average width of 287.37 ± 259.00 μm. We detected more microdistortions in the horizontal meridian than in the vertical meridian (p = 0.035). The average number and width of microdistortions were both higher in the central region (≤4 mm) than in the peripheral region (4–8 mm) (both p < 0.001). With the exception of horizontal trefoil in the SMILE group and vertical trefoil in the FS-LASIK group, significant changes over time were observed in all other HOAs (all p < 0.05). Meanwhile, we detected significant increases in the total corneal HOA, spherical aberration (SA), and coma at all time-points after both surgeries (all p < 0.01). Compared with FS-LASIK, SMILE induced less SA (p < 0.001) and more horizontal coma (p = 0.036). In the SMILE group, the HOA, SA, and trefoil were more in the small optical zone (≤6.0 mm) than in the large optical zone (>6.0 mm) (all p < 0.05). The increase in SA and most trefoil correlated with the mean number of central microdistortions number (all p < 0.05). Conclusion For myopia over −9.0D, the microdistortions in the Bowman’s layer were still detectable in most eyes long-term after SMILE. Both SMILE and FS-LASIK induced more HOAs, mainly HOA, SA, and coma. The small optical zone and microdistortions may affect postoperative aberrations.
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Affiliation(s)
- Xueyi Zhou
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Bing Qin
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Tian Han
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhuoyi Chen
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye Institute, Eye and ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Fudan University, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- *Correspondence: Xingtao Zhou,
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Chang JY, Lin PY, Hsu CC, Liu CJL. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc 2022; 85:145-151. [PMID: 34861667 DOI: 10.1097/jcma.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
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Affiliation(s)
- Jin-Yu Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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22
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Papa-Vettorazzi MR, Güell-Villanueva JL, Cruz-Rodriguez JB, Moura-Coelho N, Artells-de Jorge N, Elies-Amat D. Long-term efficacy and safety profiles following small incision lenticule extraction in eyes with ≥ 5-year follow-up. Eur J Ophthalmol 2022; 32:3333-3339. [PMID: 35102752 DOI: 10.1177/11206721221077541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate long-term efficacy, safety, predictability and stability (refractive and keratometric) of myopic and myopic astigmatism correction with Small Incision Lenticule Extraction (SMILE). METHODS Single center retrospective review of eyes undergoing SMILE from 2012-2015. Forty-two eyes (23 patients) with ≥ 5-year follow-up. Variables analyzed were preoperative, 3-month, 1-year and last follow-up uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE) and mean keratometry. Descriptive statistics were performed and results reported following the Standard for Reporting Astigmatism Outcomes. RESULTS Mean follow-up of 5.98 ± 0.90 years. Mean preoperative SE was -5.26 ± 1.22D (range -2.50 to -8.12D). Mean preoperative cylinder was -0.66 ± 0.61D (range 0.00 to -2.25D). Efficacy and safety indices were 0.86 and 0.98, respectively. In total, 81% of operated eyes achieved an UDVA of ≥ 0.09 logMar (20/25 Snellen). At the last follow-up, ≥1 line of CDVA was gained in 14% of eyes. Five percent lost 1 line of CDVA, and no eye loss ≥2 lines of CDVA. Sixty-nine percent of eyes were within ± 0.50D and 86% within ± 1.00D of the attempted SE correction. Ninety-one percent of eyes had ≤0.50D of postoperative astigmatism and 71% were within ± 15° from the intended correction axis. At the final follow-up, a statistically significant myopic regression of 0.19 ± 0.50D was observed (p = 0.01). CONCLUSIONS Long-term results demonstrate that SMILE is effective, predictable and safe. SMILE has good stability, low regression compared to LASIK, and no signs of corneal ectasia staging within our standard criteria.
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Affiliation(s)
| | - José Luis Güell-Villanueva
- 427028Department of Cornea and Refractive Surgery, Instituto Microcirugía Ocular (IMO) Barcelona, Spain.,16719Department of Ophthalmology, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | | | - Nuno Moura-Coelho
- 427028Department of Cornea and Refractive Surgery, Instituto Microcirugía Ocular (IMO) Barcelona, Spain.,Department of Ophthalmology, Hospital CUF Cascais, Cascais, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas - Universidade Nova de Lisboa (NMS
- FCM-UNL), Lisbon, Portugal
| | - Nuria Artells-de Jorge
- 427028Department of Cornea and Refractive Surgery, Instituto Microcirugía Ocular (IMO) Barcelona, Spain
| | - Daniel Elies-Amat
- 427028Department of Cornea and Refractive Surgery, Instituto Microcirugía Ocular (IMO) Barcelona, Spain.,Associate professor of European School for advanced Studies in Ophthalmology ESASO, Lugano, Switzerland
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Corneal Asphericity and Higher-Order Aberrations after FS-LASIK and Trans-PRK for Myopia. J Ophthalmol 2021; 2021:3765046. [PMID: 34912576 PMCID: PMC8668292 DOI: 10.1155/2021/3765046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the corneal asphericity and higher-order aberrations (HOAs) of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) with Smart Pulse Technology (SPT) assisted transepithelial photorefractive keratectomy (Trans-PRK) for myopia and myopic astigmatism correction. Methods This prospective study analyzed 88 eyes of 44 patients treated with FS-LASIK and 64 eyes of 32 patients treated with Trans-PRK. All eyes had low to moderate myopia with or without astigmatism (spherical equivalent (SE) <−6.00 diopters). The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), SE, asphericity (Q value) of the anterior corneal surface, index of surface variance (ISV), corneal higher-order aberrations (HOAs), vertical coma (Z3−1), horizontal coma (Z31), and spherical aberration (Z40) over a 6 mm diameter central corneal zone diameter were evaluated preoperatively and 1, 3, and 6 months postoperatively. Results At 6 months, the UDVA and SE were −0.14 ± 0.06 and 0.33 ± 0.33D in FS-LASIK and −0.15 ± 0.06 and 0.35 ± 0.37D in Trans-PRK. There was no difference between the two groups in the postoperative UDVA and SE (P > 0.05). After FS-LASIK and Trans-PRK, the Q values in the 6, 7, 8, and 9 mm zones and ISV of the anterior corneal surface significantly increased (P < 0.001). At 1, 3, and 6 months after surgery, corneal HOA, Z3−1, Z31, and Z40 in both groups were significantly increased compared with those before surgery, with statistically significant differences (P < 0.001). At 1, 3, and 6 months after surgery, the Z3−1 of the Trans-PRK group was significantly lower than that of the FS-LASIK group (P < 0.001). ΔHOA and ΔZ40 were dramatically correlated with the ΔQ value for both FS-LASIK and Trans-PRK procedures. The ΔQ was significantly correlated with the preoperative SE, AD, and AD/CCT after both two procedures (all P < 0.001). Conclusions Both FS-LASIK and Trans-PRK caused the anterior corneal surface to become flatter, and the morphology of the corneal surface was irregular. Corneal HOAs were significantly increased after the two procedures. Trans-PRK using SPT introduced less corneal vertical coma than FS-LASIK. Corneal asphericity changes contributed to the corneal aberrations changes following FS-LASIK and Trans-PRK.
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24
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Tian M, Jian W, Miao H, Li M, Xia F, Zhou X. Five-Year Follow-Up of Visual Outcomes and Optical Quality After Small Incision Lenticule Extraction for Moderate and High Myopia. Ophthalmol Ther 2021; 11:355-363. [PMID: 34905159 PMCID: PMC8770774 DOI: 10.1007/s40123-021-00436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction This study investigated the long-term visual and optical quality changes after small incision lenticule extraction (SMILE) for the correction of moderate to high myopia. Methods Forty-one eyes of 41 patients with a mean spherical equivalent (SE) of − 6.74 ± 1.45 D undergoing SMILE were enrolled. Preoperative and 1-month, 3-month, 1-year and 5-year postoperative follow-up examinations were performed including visual acuity, manifest refraction, corneal aberrations and contrast sensitivity. An optical quality analysis system was used to measure objective scatter index (OSI), Strehl ratio (SR) and modulation transfer function cutoff frequency (MTFcutoff). Results The safety and efficacy indices were 1.09 ± 0.12 and 1.03 ± 0.17, respectively, at the 5-year follow-up. No significant changes in SE from 1 month to 5 years postoperatively were found. The OSI significantly increased at 1 and 3 months postoperatively (p < 0.01 and p < 0.01) and declined at 1 and 5 years (p = 0.81 and p = 0.87). MTFcutoff and SR showed similar trends. Coma, spherical aberration and total higher-order aberration significantly increased after SMILE (p < 0.01) and remained stable from 1 month to 5 years after surgery (p > 0.05). Contrast sensitivity in the photopic and mesopic condition showed no significant changes during 5-year follow-up (p > 0.05). Conclusion The SMILE procedure is satisfactory in terms of optical quality for correcting moderate and high myopia in the long-term period. Trial Registration ChiCTR-ONRC-13003114.
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Affiliation(s)
- Mi Tian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China
| | - Weijun Jian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China
| | - Huamao Miao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China
| | - Meng Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China
| | - Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 19# Baoqing Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, People's Republic of China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, People's Republic of China.
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Liu ET, Sella R, Goernert P, Kim K, Chen H, Lin RT. Refractive results with SMILE using lower energy settings in the United States. PLoS One 2021; 16:e0258835. [PMID: 34679121 PMCID: PMC8535172 DOI: 10.1371/journal.pone.0258835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the visual and refractive results of small incision lenticule extraction (SMILE) with low energy settings in the United States (US) and to evaluate outcomes for low astigmatism treatment. Setting Private clinical practice. Design Retrospective cohort study. Methods This study retrospectively reviewed 462 consecutive eyes that underwent SMILE with lower energy settings. Inclusion criteria included all patients between the ages of 19–39 with myopic astigmatism up to -11.25 diopters (D) spherical equivalent (sphere up to -10.00 D, astigmatism up to -3.00 D), and corrected distance visual acuity of at least 20/25. Eyes with low astigmatism (0.25 D-0.50 D) were also included. Outcome analysis was performed according to the Standard Graphs for Reporting Refractive Surgery at postoperative month (POM) 1, and POM 3–6 when data were available. Results The mean preoperative spherical equivalent treated was -4.96 ± 2.07; at POM 1, 92% of eyes achieved uncorrected visual acuity (UCVA) of 20/20 or better and maintained visual stability throughout the remainder of the study. At last visit, 431 eyes (93%) achieved UCVA of 20/20 or better, and 461 eyes (99.8%) were 20/25 or better. Ninety-seven (21%) eyes gained at least 1 Snellen line of corrected distance visual acuity and no eyes lost 2 or more lines. Almost all eyes (n = 453, 98%) were within 0.5D of target; 85% of eyes with low astigmatism had ≤0.25 D at last visit compared to 80% of eyes with moderate astigmatism. Conclusions SMILE with U.S.-approved low energy settings is safe, predictable, and efficacious and provides patients with a fast visual recovery.
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Affiliation(s)
- Erica T. Liu
- IQ Laser Vision, City of Industry, California, United States of America
- * E-mail:
| | - Ruti Sella
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Kevin Kim
- IQ Laser Vision, City of Industry, California, United States of America
| | - Henry Chen
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, California, United States of America
| | - Robert T. Lin
- IQ Laser Vision, City of Industry, California, United States of America
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Damgaard IB, Sejersen H, Ivarsen A, Hjortdal J. 7-Year Results of SMILE for High Myopia: Visual and Refractive Outcomes and Aberrations. J Refract Surg 2021; 37:654-661. [PMID: 34661473 DOI: 10.3928/1081597x-20210712-02] [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 7-year visual, refractive, and optical outcomes following small incision lenticule extraction (SMILE) for high myopia and myopic astigmatism. METHODS Sixty-nine eyes (69 patients) undergoing SMILE between March 2011 and January 2012 at Aarhus University Hospital were included. Preoperative, 3-month, 3-year, and 7-year evaluation included: manifest refraction and uncorrected (UDVA) and corrected (CDVA) distance visual acuities, total corneal refractive power (TCRP), average keratometry (Km), aberrations, and central corneal thickness (CCT). RESULTS Preoperative spherical equivalent averaged -7.53 ± 1.18 diopters (D). Twenty-seven eyes were targeted emmetropia. In the emmetropic eyes, the postoperative logMAR UDVA remained stable (P = .11). When including all eyes, UDVA became worse from 3 to 7 years (3 months: 0.050 ± 0.16 logMAR; 3 years: 0.044 ± 0.21 logMAR; 7 years: 0.131 ± 0.29 logMAR; P < .027), whereas CDVA remained stable (3 months: -0.07 ± 0.09 logMAR; 3 years: -0.09 ± 0.08 logMAR; 7 years: -0.09 ± 0.08 logMAR, P > .99). At 7 years, 59.4% and 81.2% were within ±0.50 and ±1.00 D of target refraction, respectively. Average refractive regression was significant from 3 months to 7 years (-0.34 ± 0.69 D) and from 3 to 7 years (-0.25 ± 0.41 D, P < .05). After exclusion of three outliers with high myopic correction (< 9.63 D) and considerable regression (<-1.50 D), the average regression over 7 years was -0.25 ± 0.49 D (P = .004) with no significant change from 3 to 7 years (P = .069). Average CCT, TCRP, and anterior Km significantly increased (P < .001), whereas the posterior Km and total corneal aberrations remained stable (P > .092). CONCLUSIONS The long-term visual outcome remained stable after SMILE, but with an average regression of -0.34 D over 7 years. A minor group with high myopic correction exhibited considerable refractive regression years after SMILE. [J Refract Surg. 2021;37(10):654-661.].
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Long term efficacy and safety profiles following posterior chamber phakic intraocular lens implantation in eyes with ≥ 10-year follow-up. J Cataract Refract Surg 2021; 48:813-818. [PMID: 34670948 DOI: 10.1097/j.jcrs.0000000000000848] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Evaluate long-term efficacy, safety, predictability and stability of a posterior chamber phakic intraocular lens (Visian ICL) in eyes with ≥10-year follow-up. SETTING Instituto de Microcirugía Ocular, Barcelona, Spain. DESIGN Retrospective study. METHODS Eyes undergoing ICL implantation from 2008-2011 with ≥10-year follow-up were included. Variables analyzed were: preoperative, 1-month, 1-year, 5-years and last follow-up uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE), endothelial cell count (ECC) and intraocular pressure (IOP). Descriptive statistics were performed and results reported following the Standard for Reporting Refractive Surgery Outcomes. RESULTS 45 eyes (26 patients) were analyzed, mean follow-up 11.35 ± 1.30 years. Mean preoperative SE was -10.06 ± 3.40D and mean preoperative cylinder -1.55 ± 1.45D. At last follow-up, efficacy and safety indices were 0.79 and 1.12, respectively. In total, 32 (71%) eyes achieved an UDVA of ≥20/40. 22 (49%) eyes gained ≥1 line of CDVA, and 2 (4%) eyes lost ≥2 lines of CDVA. At final follow-up, 19 (42%) and 29 (64%) eyes were within ±0.50D and ±1.00D of attempted SE correction, respectively. 31 (69%) eyes had ≤1.00D of postoperative astigmatism and 29 (74%) eyes were within ±15° from the intended correction axis. At the last visit, a statistically significant myopic progression of -0.75 ± 1.20D was observed (p=0.01). ECC loss at last follow-up was 9.85 ± 11.35%. IOP remained stable. There were no intraoperative complications. 3 eyes (7%) developed cataract after 10 years. CONCLUSIONS Long-term results demonstrate that ICL is effective, predictable, stable and safe.
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Yam GHF, Bandeira F, Liu YC, Devarajan K, Yusoff NZBM, Htoon HM, Mehta JS. Effect of corneal stromal lenticule customization on neurite distribution and excitatory property. J Adv Res 2021; 38:275-284. [PMID: 35572401 PMCID: PMC9091752 DOI: 10.1016/j.jare.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Refractive SMILE-derived stromal lenticules are useful in various tissue-engineering approach for therapeutics, of which they are required to be customized before implantation. Excimer laser-mediated reshaping, riboflavin-UVA-induced collagen crosslinking and chemical decellularization significantly removed lenticule neurites, but the residual neurites retained excitatory response. Reinnervation occurred in the decellularized lenticules, indicating a potential of nerve regeneration. Stromal lenticules, as a unique collagen-rich biomaterial with high transparency, refractivity and mechanically robust, together with the ability of neurite regeneration, could hold a potential for various ophthalmic applications.
Introduction Refractive stromal lenticules from Small Incision Lenticule Extraction (SMILE), though usually discarded, hold a potential for various ophthalmic applications, including refractive correction, stromal volume expansion, and biomechanical strengthening of the cornea. Objectives To investigate the effect of lenticule customization on lenticule neurite length profile and the excitatory response (calcium signaling) and the potential of reinnervation. Methods Human and porcine stromal lenticules were treated by (1) excimer laser reshaping, (2) ultraviolet A-riboflavin crosslinking (CXL), and (3) decellularization by sodium dodecyl sulfate (SDS), respectively. The overall neurite scaffold immuno-positive to TuJ1 (neuron-specific class III β-tubulin) expression and population of active neurite fragments with calcium response revealed by L-glutamate-induced Fluo-4-acetoxymethyl ester reaction were captured by wide-field laser-scanning confocal microscopy, followed by z-stack image construction. The NeuronJ plugin was used to measure neurite lengths for TuJ1 (NL-TuJ1) and calcium signal (NL-Ca). Reinnervation of lenticules was examined by the ex vivo grafting of chick dorsal root ganglia (DRG) to the decellularized human lenticules. Differences between groups and controls were analyzed with ANOVA and Mann-Whitney U test. Results The customization methods significantly eliminated neurites inside the lenticules. NL-TuJ1 was significantly reduced by 84% after excimer laser reshaping, 54% after CXL, and 96% after decellularization. The neurite remnants from reshaping and CXL exhibited calcium signaling, indicative of residual excitatory response. Re-innervation occurred in the decellularized lenticules upon stimulation of the grafted chick embryo DRG with nerve growth factor (NGF 2.5S). Conclusion All of the lenticule customization procedures reduced lenticule neurites, but the residual neurites still showed excitatory potential. Even though these neurite remnants seemed minimal, they could be advantageous to reinnervation with axon growth and guidance after lenticule reimplantation for refractive and volume restoration of the cornea.
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Comparison of 1-Year Outcomes Between Small Incision Lenticule Extraction With Prophylactic Cross-Linking and Femtosecond Laser-Assisted In Situ Keratomileusis With Prophylactic Cross-Linking. Cornea 2021; 40:12-18. [PMID: 33214416 DOI: 10.1097/ico.0000000000002547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare small incision lenticule extraction with prophylactic cross-linking (SMILE Xtra) and femtosecond laser-assisted in situ keratomileusis with prophylactic cross-linking (FS-LASIK Xtra) in their safety, efficacy, predictability, and stability. METHODS This is a prospective cohort study. Forty-eight eyes subjected to SMILE Xtra and 90 eyes subjected to FS-LASIK Xtra were enrolled. The enrolled eyes exhibited either borderline corneal topography or high myopia with thin cornea. The following parameters were evaluated before surgery and at 1 day; 1 week; and 1, 3, 6, and 12 months after surgery: corrected distance visual acuity, uncorrected distance visual acuity, manifest refractive spherical equivalent (MRSE), keratometry values, and thinnest corneal thickness. RESULTS After 1 month, no eye showed loss of 1 or more lines of corrected distance visual acuity. At 12 months, uncorrected distance visual acuity was 20/20 or better for 98% and 99% eyes in the SMILE Xtra and FS-LASIK Xtra groups, respectively (P = 0.657). For 93.8% eyes in the SMILE Xtra group and 90% eyes in the FS-LASIK Xtra group, the achieved MRSE was within ±0.50 diopter of the intended MRSE (P = 0.669). The correlation coefficients for predictability of MRSE correction by SMILE Xtra and FS-LASIK Xtra were 0.987 and 0.983, respectively. The mean MRSE values, keratometry values, and thinnest corneal thickness measured at the different time points showed no significant intra- or intergroup differences. CONCLUSIONS Our evaluations of 1-year outcomes suggest that the safety, efficacy, predictability, and stability of SMILE Xtra are comparable with those of FS-LASIK Xtra.
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Ying J, Zhang J, Cai J, Pan F. Comparative Change in Anterior Corneal Asphericity After FS-LASIK and SMILE. J Refract Surg 2021; 37:158-165. [PMID: 34038303 DOI: 10.3928/1081597x-20210105-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate changes in anterior corneal asphericity (ΔQ) by calculating tangential radius (rt) after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE). METHODS Sirius corneal topography (Costruzione Strumenti Oftalmici) was used to evaluate 120 right eyes from patients with moderate and high myopia who had previously undergone FS-LASIK and SMILE. The preoperative and postoperative tangential radii obtained in reference to various semi-meridional regions and radii zones were compared. Variation in ΔQ values in semi-meridional regions across 360 degrees of the anterior surface after FS-LASIK and SMILE were compared. RESULTS The tangential radii in the 1.2- and 1.8-mm radii zones were lower in patients who underwent SMILE compared to those who underwent FS-LASIK. The tangential radii in the 2.4- and 3-mm zones were higher in patients who underwent SMILE compared to those who underwent FS-LASIK. In both the moderate and high myopia groups, postoperative Q-values and ΔQ-values were lower in patients who had undergone SMILE than in patients who had undergone FS-LASIK. Postoperative Q-values and ΔQ-values were lower in the moderate myopia group than in the high myopia group for FS-LASIK and SMILE. The magnitude of variation in ΔQ as a function of semi-meridional region was lower in patients who had undergone SMILE than in patients who had undergone FS-LASIK. CONCLUSIONS FS-LASIK and SMILE alter anterior corneal tangential radius and anterior corneal asphericity in patients with moderate or high myopia. SMILE is more effective than FS-LASIK in preserving normal anterior corneal asphericity. [J Refract Surg. 2021;37(3):158-165.].
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Aruma A, Li M, Choi J, Miao H, Wei R, Yang D, Yao P, Sun L, Wang X, Zhou X. Visual outcomes after small incision lenticule extraction and implantable collamer lens V4c for moderate myopia: 1-year results. Graefes Arch Clin Exp Ophthalmol 2021; 259:2431-2440. [PMID: 33661364 DOI: 10.1007/s00417-020-04982-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare 1-year visual outcomes after implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for moderate myopia. METHODS In this retrospective study, 67 eyes of 39 patients with a preoperative manifest refraction spherical equivalent between - 3.00 and - 6.00 diopters (D) were selected from a database of SMILE and ICL implantation procedures performed from April 2018 to December 2018. Thirty-two eyes of 20 patients underwent EVO-ICL implantation, and 35 eyes of 19 patients underwent SMILE. At the routine 1-year follow-up appointment, all selected patients were examined for higher-order ocular aberrations, retinal image quality, and a quality of vision (QoV) questionnaire. This data was then analyzed. RESULTS No complications were observed. Uncorrected and corrected visual acuities at 1 year after surgery were - 0.13 ± 0.07 and - 0.15 ± 0.06 logMAR in the SMILE group, and - 0.10 ± 0.07 and - 0.16 ± 0.05 logMAR in the ICL group. Twenty-nine eyes (90.6%) which underwent ICL implantation and 34 eyes (97.1%) which underwent SMILE were within ± 0.5 D of the attempted spherical equivalent (P = 0.49). Changes in coma after ICL were significantly less than after SMILE (P = 0.002). The leading complaints after ICL and SMILE were halos (84.4%) and blurred vision (65.7%), respectively. CONCLUSIONS Both SMILE and ICL implantation provided good safety, efficacy, and predictability in correcting moderate myopia. The subjective visual complaints consisted mainly of halos after ICL and starbursts and blurred vision after SMILE.
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Affiliation(s)
- Aruma Aruma
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Joanne Choi
- Kresge Eye Institute/Department of Ophthalmology, Wayne State University, Detroit, MI, USA
| | - Huamao Miao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ruoyan Wei
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Danjuan Yang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), No. 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for high myopia. J Cataract Refract Surg 2021; 46:419-427. [PMID: 32142040 DOI: 10.1097/j.jcrs.0000000000000075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism. SETTING The Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective case series. METHODS Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (-6.00 to -8.75 diopters [D]) and extremely high myopia (≥-9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism. RESULTS This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01). CONCLUSIONS SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
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Hamilton DR, Chen AC, Khorrami R, Nutkiewicz M, Nejad M. Comparison of early visual outcomes after low-energy SMILE, high-energy SMILE, and LASIK for myopia and myopic astigmatism in the United States. J Cataract Refract Surg 2021; 47:18-26. [PMID: 32769749 DOI: 10.1097/j.jcrs.0000000000000368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare uncorrected distance visual acuities (UDVAs) and induced higher-order aberrations (HOAs) in the early postoperative period between low-energy (LE) small-incision lenticule extraction (SMILE), high-energy (HE) SMILE, and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) procedures. SETTING University based refractive surgery center. STUDY DESIGN Retrospective cohort study. METHODS Records of patients who underwent SMILE or FS-LASIK were retrospectively reviewed. SMILE patients were separated into 2 groups: HE settings (125 nJ, 3.0 μm spot spacing) and LE settings (125-130 nJ, 4.5 μm spot spacing). UDVA was measured at postoperative day (POD) 1. Corneal HOAs and UDVA were measured at postoperative month (POM) 1. Induced spherical aberration, vertical coma, horizontal coma, total coma, and total HOAs were calculated. RESULTS The study included 147 eyes of 106 patients, 49 in each group. For SMILE patients, the difference in mean UDVA at POD1 was highly statistically significant in favor of the LE group (-0.003 vs 0.141, P < .0001). No significant difference in mean UDVA at POD1 was noted between the LE group and FS-LASIK group (-0.003 vs -0.011, P = .498). Induced change in spherical aberration was less in LE SMILE than that in FS-LASIK (0.136 vs 0.186 μm, P = .02) at POM1. No significant differences in POM1 mean UDVA (-0.033 vs -0.036) or induced change in all other HOAs were noted between LE SMILE and FS-LASIK. CONCLUSIONS LE settings were associated with significantly improved POD1 UDVA. POD1 and POM1 UDVA were comparable with those of FS-LASIK. Spherical aberration induction was less with LE SMILE than that with FS-LASIK, whereas all other induced HOAs were comparable with FS-LASIK.
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Affiliation(s)
- D Rex Hamilton
- From the Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles (Chen, Khorrami, Nejad), Los Angeles, and Hamilton Eye Institute (Hamilton, Nutkiewicz), Los Angeles, California, USA
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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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Pérez-Gracia J, Ávila FJ, Ares J, Vallés JA, Remón L. Misalignment and tilt effect on aspheric intraocular lens designs after a corneal refractive surgery. PLoS One 2020; 15:e0243740. [PMID: 33315894 PMCID: PMC7735572 DOI: 10.1371/journal.pone.0243740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To numerically evaluate and compare the tolerance to misalignment and tilt of aspheric intraocular lenses (IOLs) designed for three eyes: with standard cornea and with simulated corneas after myopic and hyperopic laser ablation surgery. METHODS Three aspheric IOLs of +20.00 diopter (D) with different spherical aberration (SA) ([Formula: see text]) values have been designed using a theoretical model eye. Drastic changes on the theoretical eye anterior corneal asphericity have been performed to simulate myopic and hyperopic refractive surgeries. The effect of IOL misalignment and tilt on the image quality has been evaluated using a commercial optical software design for the three eye models. Image quality was assessed from the modulation transfer function (MTF), root mean square (RMS) values of defocus, astigmatism, coma and spherical aberration ([Formula: see text]), and retinal images obtained from a visual simulator using an aleatory optotype of 0.00 LogMar visual acuity (VA). RESULTS IOL misalignment and tilt reduced MTF values in general, and increased wavefront aberrations errors. Aberration-free IOLs maintained best the MTF values when misalignments were applied, together with good on-axis optical quality. IOLs with negative SA ([Formula: see text]) correction decreased the MTF value under 0.43 for misalignments values higher than 0.50 mm with the three corneas. The effect of misalignment on RMS astigmatism and coma was correlated with the IOL SA ([Formula: see text]) and with the three corneas. CONCLUSIONS This theoretical study shows that the largest degradation in image quality arises for the IOL with the highest amount of spherical aberration ([Formula: see text]). Moreover, it has been found that the aspherical design has a more influential role in misalignment tolerance than in tilt tolerance.
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Affiliation(s)
- Jesús Pérez-Gracia
- Departamento de Física Aplicada, Universidad de Zaragoza, Zaragoza, Spain
| | - Francisco J. Ávila
- Departamento de Física Aplicada, Universidad de Zaragoza, Zaragoza, Spain
| | - Jorge Ares
- Departamento de Física Aplicada, Universidad de Zaragoza, Zaragoza, Spain
| | - Juan A. Vallés
- Departamento de Física Aplicada, Universidad de Zaragoza, Zaragoza, Spain
| | - Laura Remón
- Departamento de Física Aplicada, Universidad de Zaragoza, Zaragoza, Spain
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Wei R, Li M, Zhang H, Aruma A, Miao H, Wang X, Zhou J, Zhou X. Comparison of objective and subjective visual quality early after implantable collamer lens V4c (ICL V4c) and small incision lenticule extraction (SMILE) for high myopia correction. Acta Ophthalmol 2020; 98:e943-e950. [PMID: 32419383 DOI: 10.1111/aos.14459] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/14/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate differences in the objective and subjective visual quality of patients with high myopia following implantable collamer lens V4c (ICL V4c) versus small incision lenticule extraction (SMILE) early postoperatively. METHODS This prospective analysis included 94 eyes of 57 patients (8 males) in the ICL V4c group (mean spherical equivalent (SE), -8.07 ± 1.03 dioptres (D)) and 103 eyes of 57 patients (13 males) in the SMILE group (mean SE, -7.85 ± 0.78 D). Refractive parameters and wavefront aberrations were recorded preoperatively and 6 months postoperatively. Subjective visual quality was scored with the Quality of Vision questionnaire, and operation satisfaction was evaluated 6 months postoperatively. RESULTS At 6 months postoperatively, the efficacy index was 1.17 ± 0.16 in the ICL and 1.09 ± 0.20 in the SMILE group; the safety index was 1.21 ± 0.18 in the ICL and 1.12 ± 0.16 in the SMILE group. A significant increase in total higher-order aberrations (HOAs) in both the ICL and SMILE groups was observed, but to a lesser degree in ICL (p < 0.05). In the ICL group, trefoil significantly increased (p < 0.05), whereas in the SMILE group, coma, trefoil and spherical aberration significantly increased (p < 0.05). Glare, haloes and blurred vision had the highest incidences after both types of surgery, and postoperative haloes were significantly more common following ICL; 96.1% of ICL-treated and 94.9% of SMILE-treated patients were satisfied with their visual outcomes. CONCLUSION ICL V4c caused lower HOAs induction than SMILE. Despite the postoperative visual disturbances, both ICL and SMILE provided good efficacy, safety, predictability and high satisfaction in correcting high myopia.
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Affiliation(s)
- Ruoyan Wei
- Department of Clinical Medicine Fudan University Shanghai China
| | - Meiyan Li
- Department of Ophthalmology and Optometry Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Huihui Zhang
- Department of Ophthalmology and Optometry Chengdu Aier Eye Hospital Chengdu China
| | - Aruma Aruma
- Department of Ophthalmology and Optometry Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Huamao Miao
- Department of Ophthalmology and Optometry Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Xiaoying Wang
- Department of Ophthalmology and Optometry Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Jin Zhou
- Department of Ophthalmology and Optometry Chengdu Aier Eye Hospital Chengdu China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
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Age-Related Change of Axial Length, Spherical Equivalent, and Prevalence of Myopia and High Myopia in School-Age Children in Shanghai: 2014–2018. J Ophthalmol 2020. [DOI: 10.1155/2020/4235893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the age-related change of axial length (AL), spherical equivalent (SE), and prevalence of myopia and high myopia in children at 7–18-year-olds in Shanghai in 2014 and 2018, respectively. Methods. This was an observational study in Shanghai. The same 3 schools were selected in 2014 and 2018, respectively. AL, SE, prevalence of myopia and high myopia, height, and weight were measured. A questionnaire regarding the lifestyles was completed. Results. Mean age was smaller in 2018 than in 2014 (
), and mean AL was shorter in 2018 than in 2014 (
), whereas mean SE was greater in 2018 than in 2014 (
). The prevalence of myopia and high myopia was lower in 2018 than in 2014 (
and
, respectively). Mean AL increased with age from 7-year-olds to 18-year-olds in 2014 and 2018 (both
), respectively. Mean SE decreased with age in 2014 and 2018 (both
), respectively. The prevalence of myopia and high myopia increased with age in 2014 and 2018 (all
), respectively. Less mean time outdoors and more mean time of study of all children were observed in 2018 than in 2014 (
and
, respectively). Conclusion. This study shows normative growth values for AL and SE in Shanghai children at the age of 7–18-year-olds, as well as the age-specific prevalence of myopia and high myopia.
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Li M, Yang D, Zhao Y, Yang W, Shang J, Zhou X, Yao P, Yang D, Lin X, Zhou X. Impact of ablation ratio on 5-year postoperative posterior corneal stability after refractive surgery: SMILE and FS-LASIK. EYE AND VISION 2020; 7:53. [PMID: 33292814 PMCID: PMC7654178 DOI: 10.1186/s40662-020-00218-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the impact of the ablation ratio on 5-year postoperative posterior corneal stability in myopic eyes after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. METHODS A prospective, nonrandomized, cohort study: 80 eyes of 43 patients underwent SMILE surgery and 63 eyes of 32 patients underwent FS-LASIK surgery at the EYE & ENT Hospital, Fudan University. Ablation ratio was defined as lenticule thickness (SMILE cases) or ablation depth (FS-LASIK cases) divided by central corneal thickness (CCT). Posterior corneal elevation changes were recorded as posterior central elevation (PCE), posterior corneal surface at thinnest point (PTE) and posterior corneal mean elevation (PME). Patients were followed up at 6-month and 5-year interval to investigate the impact of the ablation ratio on posterior corneal elevation after SMILE and FS-LASIK surgery. RESULTS PCE dropped at the 6-month follow-up for both SMILE (decreased by -1.11 ± 2.93 μm, P < 0.05) and FS-LASIK groups (decreased by -0.46 ± 3.72 μm, P < 0.05). PTE also dropped in SMILE (reduced by -2.04 ± 3.02 μm, P < 0.05) and FS-LASIK group (reduced by -1.28 ± 4.21 μm, P < 0.05) at the 6-month follow-up. Stable PCE (elevation change: SMILE -0.28 ± 4.03 μm; FS-LASIK 0.79 ± 4.13 μm, P > 0.05) and PTE (elevation change: SMILE -0.08 ± 4.28 μm; FS-LASIK 1.42 ± 3.85 μm, P > 0.05) for both groups were recorded at the 5-year follow-up compared to the 6-month visit. Ablation ratio was strongly correlated with 5-year postoperative PCE (β = 2.68 ± 1.05, P < 0.01) and PTE (β = 2.35 ± 1.17, P < 0.05). Cut-off value for 5-year postoperative raised PCE and PTE was 27.3 and 27.1%, respectively. CONCLUSIONS Ablation ratio was strongly correlated with postoperative posterior corneal elevation in a 5-year follow-up in both SMILE and FS-LASIK groups. PCE and PTE underwent slight backward displacement 6-month postoperatively and remain stable at the 5-year follow-up. Threshold of the ablation ratio for resisting forward displacement of posterior corneal surface was 27.3 and 27.1% for SMILE and FS-LASIK groups, respectively.
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Affiliation(s)
- Meiyan Li
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Danjuan Yang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yu Zhao
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology and Optometry, Children's Hospital of Fudan University, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xue Lin
- Department of Ophthalmology, Dalian Municipal Women and Children's Medical Center, Dalian, China.
| | - Xingtao Zhou
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China. .,Department of Ophthalmology and Optometry, Children's Hospital of Fudan University, Shanghai, China.
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Huang TZ, Shen L, Yu XN, Jin HY. Risk factors and incidence of suction loss during small incision lenticule extraction (SMILE) in 8493 eyes. BMC Ophthalmol 2020; 20:412. [PMID: 33066752 PMCID: PMC7566065 DOI: 10.1186/s12886-020-01680-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report the incidence and risk factors of suction loss during small incision lenticule extraction (SMILE). METHODS This retrospective comparative case control study included 8493 eyes of 4261 patients. Patients underwent SMILE surgery between January 2014 and September 2019 were included. Videos of suction loss were reviewed, and the direct causes of suction loss were noted. An independent samples t-test was used for comparisons between the suction loss group and the control group. A binary logistic regression model was used to determine the possible significant risk factors that might increase the likelihood of suction loss during SMILE surgery. RESULTS Suction loss occurred in 31 (0.37%) eyes of 30 patients; 23 (74.2%) cases occurred in the right eye (the first operative eye) and 8 (25.8%) cases occurred in the left eye. Among the 30 patients, 23 (76.7%) were male and 7 (23.3%) were female. The incidence in the six consecutive years were 0, 2.13, 0.34, 0.24, 0.22, and 0.25%. Head and eye movements during surgery caused suction loss in 16 (51.6%) and 15 (48.4%) eyes, respectively. Comparison between the suction loss group and the control group showed that the first operative eye and male sex are at a significantly high risk for suction loss (p < 0.05). CONCLUSIONS The risk factors of suction loss were first operative eye and male sex. Head and eye movements due to patient anxiety are the most common direct causes of suction loss. Surgeon's experience may help to reduce the incidence of suction loss. Preoperative education and better communication during surgery needs to be emphasized. TRIAL REGISTRATION Retrospectively registered. ChiCTR-ORC-17011040 . Registered 1 April 2017. Name of registry: The observation of clinical results after corneal refractive surgery. Data of enrolment of the first participant to the trial: 1 January 2014.
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Affiliation(s)
- Tian-Ze Huang
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ling Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, China
| | - Xiao-Ning Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, China
| | - Hong-Ying Jin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, China.
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Niu L, Miao H, Tian M, Fu D, Wang X, Zhou X. One-year visual outcomes and optical quality of femtosecond laser small incision lenticule extraction and Visian Implantable Collamer Lens (ICL V4c) implantation for high myopia. Acta Ophthalmol 2020; 98:e662-e667. [PMID: 32003129 DOI: 10.1111/aos.14344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare one-year visual outcomes and optical quality after femtosecond laser small incision lenticule extraction (SMILE) and Visian Implantable Collamer Lens with a central hole (ICL V4c) implantation for high myopia. METHODS This prospective non-randomized study included 37 eyes of 20 patients who underwent SMILE (G-S) and 39 eyes of 20 patients who underwent ICL V4c implantation (G-V). Spherical equivalent (SE), uncorrected distance visual acuity, corrected distance visual acuity, retinal image quality and intraocular scattering were evaluated at one year after surgery. Each model was adjusted for age, gender, eye and preoperative SE during treatment. RESULTS At the one-year follow-up, G-S and G-V showed similar safety index (1.13 ± 0.13 and 1.11 ± 0.15, respectively) and efficacy index (1.05 ± 0.14 and 1.06 ± 0.15, respectively). All 21 eyes with Toric ICL (TICL) had a postoperative astigmatism of ≤0.5 dioptres (D), while the astigmatism was ≤0.5 D in all G-S eyes. Thirty-six G-S eyes (97%) and 35 G-V eyes (90%) were within ± 0.5 D of the target SE. The changes in the modulation transfer function cut-off frequency (MTFcut-off ) and the objective scatter index from before operation to one year following the operation were not significantly different between the groups (p = 0.523 and 0.826, respectively). CONCLUSION Both SMILE and ICL V4c implantation provide good safety, efficacy, predictability, and stability in correcting high myopia. Optical quality including intraocular scattering was great and relatively stable in both groups during the one-year observation period.
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Affiliation(s)
- Lingling Niu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Huamao Miao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Mi Tian
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Xiaoying Wang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia Fudan University Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
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Chong JK, Hamilton DR. SMILE for Myopic Astigmatism: Early Experience in the USA and International Advances. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00250-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Yam GHF, Riau AK, Funderburgh ML, Mehta JS, Jhanji V. Keratocyte biology. Exp Eye Res 2020; 196:108062. [PMID: 32442558 DOI: 10.1016/j.exer.2020.108062] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
The study of corneal stromal keratocytes is motivated by its strong association with corneal health and visual function. They play a dominant role in the maintenance of corneal homeostasis and transparency through the production of collagens, proteoglycans and corneal crystallins. Trauma-induced apoptosis of keratocytes and replacement by fibroblasts and myofibroblasts disrupt the stromal matrix organization, resulting in corneal haze formation and vision loss. It is, therefore, important to understand the biology and behaviours of keratocytes and the associated stromal cell types (like fibroblasts, myofibroblasts, stromal stem cells) in wound healing, corneal pathologies (including keratoconus, keratitis, endothelial disorders) as well as different ophthalmic situations (such as collagen crosslinking/photodynamic treatment, keratoplasty and refractive surgery, and topical medications). The recent development of ex vivo propagation of keratocytes and stromal stem cells, and their translational applications, either via stromal injection or incorporated in bioscaffold, have been shown to restore the corneal transparency and regenerate native stromal tissue in animal models of corneal haze and other disorders.
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Affiliation(s)
- Gary H F Yam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Andri K Riau
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | | | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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Liu L, Cheng W, Wu D, Chen L, Yu S, Zuo T, Zhang L, Yang K, Li H, Zhang H, Wei P, Ng ALK, Cheng GPM, Woo VCP, Yin J, Chiu K, Wang Y. The Differential Expression of Cytokines and Growth Factors After SMILE Compared With FS-LASIK in Rabbits. Invest Ophthalmol Vis Sci 2020; 61:55. [PMID: 32460319 PMCID: PMC7405797 DOI: 10.1167/iovs.61.5.55] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the differential expression of cytokines and growth factors in the cornea and aqueous humor after small incision lenticule extraction (SMILE) compared with femtosecond LASIK (FS-LASIK) using rabbit model. Methods Sixteen eyes of 16 rabbits in each group underwent SMILE or FS-LASIK with refractive correction of −6.00 DS/−1.00 DC. Eight additional rabbits served as controls. Pre- and 24 hours, 1 week, 1 month, and 3 months postoperatively, slit-lamp and anterior segment optical coherence tomography were performed, followed by cornea and aqueous humor collection. Apoptosis and proliferation were evaluated with TUNEL assay and Ki-67 immunostaining, respectively. The mRNA and protein expression of cytokines and growth factors was determined by RT-qPCR and Western blotting, respectively. Cytokine levels in the aqueous humor were detected with ELISA. Results Compared with FS-LASIK, SMILE induced less apoptosis and proliferation in the cornea within 1 week postoperatively. Levels of IL-1β, TNF-α, and EGFR in the cornea were significantly increased after FS-LASIK compared with SMILE within 24 hours. Levels of IL-8 in the aqueous humor remained elevated until 1 week after FS-LASIK but not SMILE. TGF-β1 level was elevated up to 1 month after both procedures, while BFGF level was kept high within 1 month after SMILE but not FS-LASIK. Conclusions SMILE could induce significantly less acute inflammation than FS-LASIK in the cornea and aqueous humor. The differential expression of TGF-β1 and BFGF between two procedures until 1 month might contribute to the post-SMILE delayed recovery and underline the importance of continued treatment postoperatively.
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Small Incision Lenticule Extraction (SMILE) for Moderate and High Myopia: Seven-Year Outcomes of Refraction, Corneal Tomography, and Wavefront Aberrations. J Ophthalmol 2020; 2020:3825864. [PMID: 32377418 PMCID: PMC7195656 DOI: 10.1155/2020/3825864] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the long-term outcomes of refraction, corneal tomography, and wavefront aberrations after small incision lenticule extraction (SMILE) for moderate and high myopia. Methods Prospective, nonconsecutive case series. A total of 26 patients (26 eyes) who underwent SMILE from May 2010 to March 2013 at the Fudan University Eye and ENT Hospital (Shanghai, China) were enrolled. The periods of follow-up were 1 month, 1 year, 5 years, and 7 years after surgery. The routine eye examinations included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Results All surgeries were executed without any complications. At the final visit, an UDVA of 20/20 or better was achieved in 26 eyes (100%) and 11 eyes (42%) exhibited no change in CDVA. 9 eyes (35%) gained one line, 6 eyes (23%) gained two lines, and no eyes lost CDVA. 24 eyes (92%) and 26 eyes (100%) were within ±0.5 D and ±1.00 D of the target refraction, respectively. A mean refractive regression of −0.17 D was observed between 1 month and 7 years postoperatively. Mean corneal front curvature (MCFC) was significantly decreased between pre- and post-SMILE surgery (P < 0.0001). Higher-order aberrations (HOAs) and vertical coma were significantly increased after SMILE compared to those measured before surgery (all P < 0.001). There were no significant differences in trefoil and spherical aberration between pre- and post-SMILE surgery (all P > 0.05). Conclusion SMILE is an effective, safe, and stable procedure for moderate and high myopia, with relatively constant corneal stability and wavefront aberrations. This trial is registered with ChiCTR-ONRC-13003114.
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The Modulation of Laser Refractive Surgery on Sensory Eye Dominance of Anisometropia. J Ophthalmol 2020; 2020:3873740. [PMID: 32351721 PMCID: PMC7152944 DOI: 10.1155/2020/3873740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To evaluate the effect of laser refractive surgery on sensory eye dominance of anisometropia. Methods A total of 156 subjects with nonanisometropic myopia and 70 subjects with anisometropic myopia were enrolled in the first part of the study. The dichoptic motion coherence threshold technique was applied to collect the normal dataset and distribution of sensory eye dominance. The second part of the study included 40 subjects with nonanisometropic myopia and 40 subjects with anisometropic myopia who received the femtosecond laser-assisted in situ keratomileusis (Fs-LASIK). A comprehensive ophthalmologic evaluation was performed with particular attention to sensory eye dominance preoperatively and one-week and one-month postoperatively. The ocular dominance index (ODI) was applied to evaluate the subject's overall degree of sensory ocular dominance. Visual acuity, sighting eye dominance, and stereo acuity were also accessed. Results In experiment one, the mean ODI in the nonanisometropic group and the anisometropic group was 1.48 ± 0.63 and 1.95 ± 1.07, respectively. The ODI values of the anisometropic group were significantly higher than those of the nonanisometropic group (Mann–Whitney U test, P < 0.001). The demographics information and the distribution of ODI values in both groups are summarized in tables and figures. In experiment two, all LASIK procedures were uneventful and no postoperative complications were observed during the postoperative follow-up. Preoperatively, the ODI values of the anisometropic LASIK group were significantly higher than those of the nonanisometropic LASIK group, which was consistent with the results of part 1. However, one week after operation, the mean ODI values of the anisometropic LASIK group had significantly decreased from 1.89 ± 1.09 to 1.39 ± 0.44. And, the mean ODI values slightly increased to 1.65 ± 0.61 one-month postoperatively. In the nonanisometropic LASIK group, there were no statistically significant differences of ODI changes among preoperative, post-one-week and post-one-month visits. The demographics information and the changes of ODI of both LASIK groups are summarized in tables and figures. Conclusion Stronger sensory eye dominance is seen in the subjects with anisometropic myopia compared to subjects with nonanisometropic myopia. The strong sensory dominance of anisometropia becomes more balanced at one week of postoperation but returns to the preoperative level after one month. Laser refractive surgery had a short-term modulation of sensory eye dominance.
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46
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Five-year outcomes of small-incision lenticule extraction vs femtosecond laser–assisted laser in situ keratomileusis: a contralateral eye study. J Cataract Refract Surg 2020; 46:403-409. [DOI: 10.1097/j.jcrs.0000000000000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Shetty N, Dadachanji Z, Narasimhan R, Kundu G, Khamar P, Ahuja P, Kumar V, Kumar V, Shetty R, Nuijts RMMA, Sinha Roy A. Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK. J Refract Surg 2019; 35:624-631. [PMID: 31610003 DOI: 10.3928/1081597x-20190916-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].
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Liu Q, Yang X, Lin L, Liu M, Lin H, Liu F, Xie Y, Lam DS. Review on Centration, Astigmatic Axis Alignment, Pupil Size and Optical Zone in SMILE. Asia Pac J Ophthalmol (Phila) 2019; 8:385-390. [PMID: 31567265 PMCID: PMC6784779 DOI: 10.1097/01.apo.0000580144.22353.46] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
The advent of "flapless" small-incision lenticule extraction (SMILE), employing all-in-one technology, has resulted in a revolutionary breakthrough in refractive surgeries. SMILE has been gaining popularity due to fewer potential complications, such as postoperative dry eyes and greater biomechanical stability, etc. However, attention must be given to 1) the centration on the corneal vertex, 2) the proper alignment of the astigmatic axis, and 3) the relationship between pupil size and treatment diameter, to achieve good SMILE results. There is no pupil-tracking system to ascertain the accuracy of centration during the SMILE surgery. To improve the centration accuracy, our center uses two corneal topographers (Pentacam and Sirius) to measure and determine corneal vertex. Proper predicted optical zone diameter is not clearly defined yet in SMILE. Some scholars insist that mesopic pupil size should be taken into consideration when setting the predicted optical zone. Meanwhile, the issue of "functional optical zone" still has many unresolved issues and warrants further studies.
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Affiliation(s)
- Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaonan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Manli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haiqin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dennis S.C. Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Futian, Shenzhen, China
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