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Yoo TK, Kim D, Kim JS, Kim HS, Ryu IH, Lee IS, Kim JK, Na KH. Comparison of early visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 for myopia: a retrospective matched case-control study. Sci Rep 2024; 14:11989. [PMID: 38796537 PMCID: PMC11127987 DOI: 10.1038/s41598-024-62354-y] [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: 11/27/2023] [Accepted: 05/16/2024] [Indexed: 05/28/2024] Open
Abstract
VISUMAX 800 was introduced to improve the patient experience and clinical outcomes of small incision lenticule extraction (SMILE). This was a retrospective, matched, and case-control study (1:2) controlled for preoperative central corneal thickness and refractive error that compared early refractive and visual outcomes after SMILE using VISUMAX 800 and VISUMAX 500 to treat myopia. We included 50 eyes that underwent the VISUMAX 800 SMILE and 100 eyes that underwent the VISUMAX 500 SMILE. SMILE using VISUMAX 800 was performed using the CentraLign aid for vertex centration. Cyclotorsion was controlled by an OcuLign assistant in the VISUMAX 800 group after corneal marking. Corneal higher-order aberrations (HOAs) were evaluated using a Pentacam 1 month after surgery. No differences were observed in the pre- and post-operative refractive and visual outcomes at 1 day, 1 month, and 6 months after surgery. VISUMAX 800 induced less total HOAs than VISUMAX 500 (P = 0.036). No statistically significant differences were observed in the amounts of induced spherical aberrations or vertical and horizontal comas. No differences were observed in the 1 month and 6 months refractive and visual outcomes between two SMILE procedures, except for VISUMAX 800, which resulted in lower postoperative total HOAs than VISUMAX 500.
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Affiliation(s)
- Tae Keun Yoo
- Department of Ophthalmology, Hangil Eye Hospital, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, South Korea.
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea.
| | - Dongyoung Kim
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - Jung Soo Kim
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - Hee Sun Kim
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Ik Hee Ryu
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
- Research and Development Department, VISUWORKS, Seoul, South Korea
| | - In Sik Lee
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Jin Kuk Kim
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
| | - Kun-Hoo Na
- Department of Refractive Surgery, B&VIIT Eye Center, Seoul, South Korea
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Sachdev MS, Shetty R, Khamar P, Malik R, Schwam BL, Wang Y, Fu H, Voorhees AP, Laron M. Safety and Effectiveness of Smooth Incision Lenticular Keratomileusis (SILK TM) Using the ELITA (TM) Femtosecond Laser System for Correction of Myopic and Astigmatic Refractive Errors. Clin Ophthalmol 2023; 17:3761-3773. [PMID: 38089649 PMCID: PMC10715007 DOI: 10.2147/opth.s432459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/30/2023] [Indexed: 05/18/2024] Open
Abstract
Purpose To evaluate visual outcomes following the Smooth Incision Lenticular Keratomileusis (SILKTM) procedure for correction of myopic refractive errors with and without astigmatism, using the ELITATM Femtosecond Laser System. Patients and Methods A prospective, multicenter, single-arm, open-label clinical study was conducted. Eighty-five myopic subjects (n = 170 eyes), aged 18 years or older, with manifest refractive spherical equivalent (MRSE) up to -12.00 D and astigmatism up to -6.00 D, were treated binocularly using the ELITA femtosecond laser and followed up for 6 months. Intended correction was emmetropia for all eyes. The primary outcome measures included post-operative uncorrected and corrected distance visual acuity (UDVA and CDVA). Secondary outcome measures included surgeon's rating for ease of lenticule extraction, predictability, safety, and stability. Results A total of 170 eyes of 85 patients underwent SILK. Preoperative mean MRSE was -4.14 D ± 1.32 D (range -1.38 D to -8.88 D) and the mean cylinder was -0.77 D ± 0.62 D. Intraoperative surgeon ease of lenticule dissection was rated as grade 0 or 1 in 85.3% of eyes (no/only mild dissection needed). UDVA at 1 day, 1 week, 1 month, and 6 months was 20/20 or better in 65.9%, 85.4%, 91.5%, and 96% of eyes, respectively. No eyes lost any lines of CDVA at 6 months compared to the preoperative. The postoperative MRSE was stable over time, ranging from -0.34 D ± 0.24 D at 1 month to -0.33 D ± 0.23 D at 6 months. MRSE predictability (± 0.50 D) was 93.5% (129/138) at 3 months and 91.1% (113/124) at 6 months. No serious adverse events were noted. Conclusion The SILK procedure with the ELITA Femtosecond Laser System is safe and effective for the treatment of myopic refractive errors with and without astigmatism. Fast visual recovery was demonstrated, with stability achieved by 3 months.
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Affiliation(s)
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Pooja Khamar
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | - Brian L Schwam
- Johnson and Johnson Surgical Vision, Inc, Milpitas, CA, USA
| | - Ying Wang
- Johnson and Johnson Surgical Vision, Inc, Milpitas, CA, USA
| | - Hong Fu
- Johnson and Johnson Surgical Vision, Inc, Milpitas, CA, USA
| | | | - Michal Laron
- Johnson and Johnson Surgical Vision, Inc, Milpitas, CA, USA
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Soundarya B, Sachdev GS, Ramamurthy S, Kumar SK, Dandapani R. Visual outcomes of early enhancement following small incision lenticule extraction versus laser in situ keratomileusis. Indian J Ophthalmol 2023; 71:1845-1848. [PMID: 37203042 PMCID: PMC10391394 DOI: 10.4103/ijo.ijo_3209_22] [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: 05/20/2023] Open
Abstract
Purpose To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.
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Affiliation(s)
- B Soundarya
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | | | - Shreyas Ramamurthy
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Shreesha K Kumar
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Ramamurthy Dandapani
- Department Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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Li J, Song LL, Song H. Five-year clinical outcomes of rigid iris-fixated phakic intraocular lens in northern Chinese. Int Ophthalmol 2022; 42:2551-2561. [PMID: 35381897 DOI: 10.1007/s10792-022-02303-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/10/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To investigate the 5-year clinic outcomes of rigid iris-fixated pIOL on the visual performance, complications and intraocular light scattering in northern Chinese. METHODS Thirty eyes implanted with iris-fixated phakic IOLs (pIOLs group) and 34 eyes with high myopia (myopia group) were involved in this study. At preoperatively, 6 months, 1, 3, and 5 years postoperatively, the uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD), and intraocular pressure (IOP) were measured in pIOLs group. The objective scatter index (OSI), modulation transfer function cut off (MTF cut off), and Strehl ratio were measured by Optical Quality Analysis System and a pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects' satisfaction in pIOLs and myopia groups. RESULTS At 5 years postoperatively, an UCVA of 20/20 or better was found in 43.33% of eyes in pIOLs group. At 6 months, 1, 3, and 5 years postoperatively, the mean ECD decrease were 1.29% ± 0.45%, 2.59% ± 1.30%, 6.67% ± 2.26%, and 10.80% ± 3.48%. The value of OSI in pIOLs group was significantly higher than that in myopia group (P < 0.001). The PDQ results showed that the subjects in myopia group complained less with intolerance of bright lights than those in pIOLs group. The values of Strehl ratio and MTF cut off in pIOLs group were significantly lower than that in myopia group (P < 0.001). CONCLUSIONS Iris-fixated pIOL induce more intraocular light scattering. A significant decrease in ECD was observed at 5 years postoperatively. An annual evaluation of ECD is necessary for patients undergoing pIOL implantation.
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Affiliation(s)
- Jun Li
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China.
| | - Lin-Lin Song
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Hui Song
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China.
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Kankariya VP, Gogri PY, Dube AB, Mohiuddin SM, Madia T, Vaddavalli PK. CIRCLE Software for Management of Epithelial Ingrowth After SMILE. J Refract Surg 2021; 37:776-780. [PMID: 34756140 DOI: 10.3928/1081597x-20210730-01] [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: 11/20/2022]
Abstract
PURPOSE To report a novel therapeutic use of CIRCLE software (Carl Zeiss Meditec) to manage visually significant epithelial ingrowth following small incision lenticule extraction surgery (SMILE). METHODS Case series. RESULTS In this case series, the authors describe three eyes with progressive and visually significant epithelial ingrowth following an uneventful SMILE procedure. The management of epithelial ingrowth following SMILE is challenging, given the small access incision to the interface and the risk of incomplete removal. All cases were successfully managed by converting the SMILE cap into a flap using the CIRCLE software, which provided the necessary access to the original SMILE interface. Once the flap was lifted, the epithelial in-growth was completely debrided from the underlying stroma and undersurface of the flap, followed by a thorough interface wash. Postoperative recovery was uneventful, with no recurrence noted in any of the eyes. CONCLUSIONS Use of CIRCLE software provides a novel and unique approach to successfully treating vision-threatening epithelial ingrowth after SMILE. [J Refract Surg. 2021;37(11):776-780.].
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Flap Thickness and the Risk of Complications in Mechanical Microkeratome and Femtosecond Laser In Situ Keratomileusis: A Literature Review and Statistical Analysis. Diagnostics (Basel) 2021; 11:diagnostics11091588. [PMID: 34573930 PMCID: PMC8468565 DOI: 10.3390/diagnostics11091588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recent Cochrane review found no difference in visual acuity outcomes between femtosecond-assisted laser in situ keratomileusis (LASIK) and LASIK using mechanical microkeratomes (MMKs). This study compares the flap thickness and risk of complications related to flap creation using femtosecond lasers and MMKs. METHODS PubMed and the Web of Science are used to search the medical literature. An extensive search is performed to identify the flap thickness and complications of LASIK as reported up to 15 July 2021. The following keywords are used in various combinations: Corneal flap, femtosecond laser, laser in situ keratomileusis, laser-assisted in situ keratomileusis, LASIK, mechanical microkeratome. RESULTS After removing duplicates and irrelevant studies, 122 articles were included for review. Pooled differences for intended vs. postoperative flap thickness using MMKs and femtosecond laser were -4.07 μm (95% CI: -19.55, 3.24 μm) in studies on the MMK and 5.43 μm (95% CI: 2.30, 7.84 μm; p < 0.001), respectively. After removing the studies evaluating outcomes of the old generation Hansatome MMKs (which had a significantly greater variation of flap thickness), the pooled difference for newer MMKs was 4.97 μm (95% CI: 0.35, 9.58 μm; p < 0.001), but the results still favored the femtosecond laser. Uncommon and mild complications unique for the femtosecond LASIK are epithelial gas breakthrough, opaque bubble layer, transient light sensitivity syndrome, and rainbow glare. A single study reported a very low, but stastically different risk of postoperative flap slippage (0.033% for MMK LASIK, and 0.003% for femtosecond LASIK, respectively). CONCLUSION In both manual microkeratome and femtosecond LASIK, intra- and postoperative complications were uncommon. The evidence of the superiority of one technique in terms of complications over another cannot be indisputably stated.
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Jun I, Kang DSY, Roberts CJ, Lee H, Jean SK, Kim EK, Seo KY, Kim TI. Comparison of Clinical and Biomechanical Outcomes of Small Incision Lenticule Extraction With 120- and 140-µm Cap Thickness. Transl Vis Sci Technol 2021; 10:15. [PMID: 34259803 PMCID: PMC8288062 DOI: 10.1167/tvst.10.8.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to compare the clinical outcomes and corneal biomechanical changes between 120-µm and 140-µm cap thickness after small incision lenticule extraction (SMILE). Methods This prospective study included 150 eyes (150 patients: 91 eyes in the 120-µm group, and 59 eyes in the 140-µm group) who underwent SMILE. Enhanced correction nomograms were applied for patients according to cap thickness. Clinical outcomes, including visual acuity, refraction, and corneal wavefront aberrations, were compared between the two groups. Corneal biomechanics were evaluated using the Corvis ST (Oculus, Wetzlar, Germany). Results The mean uncorrected-distance visual acuity, safety and efficacy indices, and refractive predictability were comparable in the 120-µm and 140-µm groups after SMILE. The postoperative total corneal root mean square higher-order aberrations (HOAs) and spherical aberrations was 0.48 ± 0.31 and 0.26 ± 0.10 in the 120-µm group, and 0.53 ± 0.16 and 0.34 ± 0.13 in the 140-µm group, which showed significant differences between the two groups (P = 0.027, and <0.001, respectively). Although corneal stiffness decreased after SMILE in both groups, the changes in the deformation amplitude ratio were significantly higher in the 140-µm group than in the 120-µm group (P = 0.022). Conclusions SMILE with 120-µm and 140-µm cap thickness provided excellent predictable outcomes according to our enhanced correction nomogram. The amount of tissue removal required to achieve the same amount of refractive correction was greater in the thicker cap group. The induction of corneal HOAs and weakening of corneal biomechanics were less pronounced in the thin-cap group, which may be associated with the thinner cap, lesser lenticule thickness, or thicker residual stromal bed. Translational Relevance Although SMILE with different cap thickness was effective, thicker lenticule thickness in the thick-cap group may be associated with induction of HOAs, and corneal stiffness changes.
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Affiliation(s)
- Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Cynthia J Roberts
- Department of Ophthalmology & Visual Sciences and Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Hun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Saevit Eye Hospital, Goyang-Si, Gyeonggi-Do, Republic of Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.
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Zhang Q, Wang J, Li M, Ding X, Tao L. Assessment of surgical outcomes of femtosecond laser-assisted in situ keratomileusis in patients with low compliance to postoperative follow-up: a retrospective observational study in a tertiary hospital in China. BMJ Open 2019; 8:e021702. [PMID: 30798286 PMCID: PMC6278781 DOI: 10.1136/bmjopen-2018-021702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Poor follow-up after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) is common in general clinical practice. We aimed to assess the surgical outcomes of patients with poor compliance to FS-LASIK follow-up but who returned to the clinic with additional prompting at a 1-year visit. We also compared their surgical outcomes with those of patients who returned unprompted. DESIGN Retrospective and observational study. SETTING An urban tertiary hospital in China. PARTICIPANTS We reviewed the medical records of myopic patients who underwent binocular FS-LASIK. These patients were all recommended, but not compulsively required, to return for termly postoperative examinations including measurement of uncorrected distance visual acuity (UDVA), refraction and assessment of complications. According to records of follow-up visits, 1009 eligible patients were categorised as follows: (1) 124 who returned unprompted at the 1-year visit (group 1) and (2) 885 lost to follow-up at the 1-year visit. We randomly selected and called back 105 (group 2) out of the 885 patients for an extra postoperative examination. RESULTS At the 1-year visit, the visual outcomes of the two groups of patients were comparable. No differences in postoperative UDVA were found between the two groups (-0.02±0.06 logarithm of the minimum angle of resolution (logMAR) and -0.02±0.05 logMAR for groups 1 and 2, respectively, p=0.175). Patients in group 2 showed greater hyperopic dioptres than patients in group 1 (0.37±0.59 D vs -0.29±0.69, p<0.0001). No vision-threatening complications were observed in either group of patients. CONCLUSIONS The visual and refractive outcomes of patients who were lost to follow-up after FS-LASIK surgery were good and comparable to those who returned unprompted. The results indicated that rigorous postoperative follow-up may be unnecessary in general clinical practice, except for patients who are at a high risk for postoperative complications.
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Affiliation(s)
- Qing Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mohan Li
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Elkamshoushy A, Gonnah R, Madi S, Beltz J. Single-piece femtosecond-assisted mushroom keratoplasty in children. J AAPOS 2019; 23:28.e1-28.e5. [PMID: 30500436 DOI: 10.1016/j.jaapos.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To report outcomes of femtosecond-assisted single-piece mushroom keratoplasty for the treatment of full-thickness corneal disease in pediatric patients with healthy endothelium. METHODS Femtosecond-assisted mushroom keratoplasty was performed in 8 eyes of 8 patients (age range, 8-17 years) with central full-thickness corneal opacity. The single-piece mushroom-shaped graft consisted of a large anterior portion (9 mm in diameter; 250 μm in thickness) and a small posterior portion (6-6.5 mm). Donor and recipient corneas were prepared using the WaveLight FS200 laser (Alcon Laboratories, Fort Worth, TX). The donor cornea was oversized by 0.2 mm. Outcome measures were best spectacle-corrected visual acuity, spectacle refraction, topographic astigmatism, endothelial cell density, graft rejection, and graft failure at 1, 3, 6, and 12 months. RESULTS Mean best spectacle-corrected visual acuity at 1, 3, 6, and 12 months was 0.28, 0.16, 0.13, and 0.10 logMAR; all patients achieved logMAR of at least 0.4 at 1, 3, 6, and 12 months. The mean refractive cylinder was 2.6 D, and mean endothelial cell loss was 13.3% at 12 months postoperatively. Two eyes had immunologic rejection episodes that were reversed with topical steroids. All corneas remained clear at final follow-up. CONCLUSIONS Femtosecond-assisted mushroom keratoplasty is a viable surgical option for eyes of older pediatric patients with full-thickness corneal stromal disease and healthy endothelium. Mushroom keratoplasty combines the refractive advantage of a large keratoplasty with the immunologic advantage of a small keratoplasty. Single-piece femtosecond-assisted mushroom keratoplasty may have a mechanical advantage over regular penetrating keratoplasty.
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Affiliation(s)
- Amr Elkamshoushy
- Ophthalmology Department, Alexandria University, Alexandria, Egypt
| | - Reem Gonnah
- Ophthalmology Department, Alexandria University, Alexandria, Egypt
| | - Silvana Madi
- Ophthalmology Department, Alexandria University, Alexandria, Egypt.
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Jun I, Kang DSY, Reinstein DZ, Arba-Mosquera S, Archer TJ, Seo KY, Kim TI. Clinical Outcomes of SMILE With a Triple Centration Technique and Corneal Wavefront-Guided Transepithelial PRK in High Astigmatism. J Refract Surg 2018. [PMID: 29522224 DOI: 10.3928/1081597x-20180104-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To comparatively investigate the clinical outcomes, vector parameters, and corneal aberrations of small incision lenticule extraction (SMILE) with a triple centration technique and corneal wavefront-guided transepithelial photorefractive keratectomy (PRK) for the correction of high astigmatism. METHODS This retrospective, comparative case series study included 89 eyes (89 patients) that received treatment for myopia with high astigmatism (≥ 2.50 diopters) using SMILE with a triple centration technique (SMILE group; 45 eyes) and corneal wavefront-guided transepithelial PRK (transepithelial PRK group; 44 eyes). Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1, 3, and 6 months after surgery. The safety, efficacy, vector parameters, and corneal aberrations at 6 months after surgery were compared between the two groups. RESULTS At 6 months after surgery, the transepithelial PRK and SMILE groups exhibited comparable mean uncorrected distance visual acuities (-0.06 ± 0.07 and -0.05 ± 0.07 logMAR, respectively), safety, efficacy, and predictability of refractive and visual outcomes. There was a slight but statistically significant difference in the correction index between the transepithelial PRK and SMILE groups (0.96 ± 0.11 and 0.91 ± 0.10, respectively). Whereas the transepithelial PRK group exhibited increased corneal spherical aberration and significantly reduced corneal coma and trefoil, no changes in aberrometric values were noted in the SMILE group. CONCLUSIONS Both SMILE with a triple centration technique and corneal wavefront-guided transepithelial PRK are effective and provide predictable outcomes for the correction of high myopic astigmatism, although slight undercorrection was observed in the SMILE group. The triple centration technique was helpful in astigmatism correction by SMILE. [J Refract Surg. 2018;34(3):156-163.].
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Sedky AN, Wahba SS, Roshdy MM, Ayaad NR. Cap-preserving SMILE Enhancement Surgery. BMC Ophthalmol 2018; 18:49. [PMID: 29454328 PMCID: PMC5816371 DOI: 10.1186/s12886-018-0712-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different enhancement procedures have been suggested for reduction of residual refractive errors after SMILE. The aim of this study is to evaluate an improved cap-preserving technique for enhancement after SMILE (Re-SMILE). METHODS A retrospective case series was conducted at Eye subspecialty center, Cairo, Egypt on 9 eyes with myopia or myopic astigmatism (spherical equivalent - 8.0 and - 12.0D). undergoing SMILE procedure and needed second interference. This was either because the more myopic meridian was more than - 10.0 D and therefore planned to have two-steps procedure (six eyes) or because of under correction needing enhancement (three eyes). Assessment after the primary SMILE procedure was conducted at 1 day, 1 week, 1 month and 3 months postoperatively. Assessment after Re-SMILE was conducted at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year postoperatively. The assessments included full ophthalmic examination, objective and subjective refraction, and rotating Scheimpflug camera imaging. RESULTS Preoperatively, the mean refractive spherical equivalent (MRSE) values were: - 9.36 ± 0. 89. After primary SMILE it was - 2.18 ± 0.71. After Re-SMILE it was - 0.13 ± 0.68. MRSE was significantly improved after both procedures (P < 0.01). The safety index of primary SMILE cases was 1.65 ± 0.62 and for Re-SMILE 1.13 ± 0.34 and the efficacy index was 1.14 ± 0.24 after primary SMILE and 1.11 ± 0.26 after Re-SMILE. CONCLUSION Centered cap-preserving Re-SMILE is an effective procedure in reducing residual refractive errors after primary SMILE in high myopes.
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Affiliation(s)
- Ahmed N Sedky
- Eye Subspecialty Center, Cairo, Egypt, 18 Elkhalifa Elmamoun Street, Heliopolis, Cairo, Egypt.
| | - Sherine S Wahba
- Ain Shams University, Al Watany Eye Hospital and Watany Research and Development Center (WRDC), Cairo, Egypt
| | - Maged M Roshdy
- Ain Shams University, Al Watany Eye Hospital and Watany Research and Development Center (WRDC), Cairo, Egypt
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Kim WK, Ryu IH, Lee IS, Kim HS, Kim JS, Kim JK. Comparison of Postoperative Results of One Day Laser-assisted in-situKeratomileusis, Laser-assisted Sub-epithelial Keratectomy Surgery, and Conventional Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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