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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024; 47:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [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] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Chen L, Khamar P, Wang Y, Fu H, Shetty R. Evaluation of Higher-Order Aberrations After the Smooth Incision Lenticular Keratomileusis (SILK TM) Procedure Using the ELITA TM Femtosecond Platform for Correction of Myopic and Astigmatic Refractive Errors. Clin Ophthalmol 2024; 18:2155-2166. [PMID: 39070107 PMCID: PMC11283805 DOI: 10.2147/opth.s466932] [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: 04/23/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose To evaluate the changes of higher-order wavefront aberrations following the Smooth Incision Lenticular Keratomileusis (SILKTM) procedure for correction of myopic refractive errors with and without astigmatism, using the ELITATM Femtosecond Platform. Methods This prospective study included 24 eyes that underwent SILK procedure using one ELITA femtosecond laser system for the correction of myopic refractive errors with and without astigmatism. Preoperative and postoperative 1-day, 1-week, 1-month, 3-month, and 9-month eye exams were measured with a commercial wavefront aberrometer (iDESIGN ® Refractive Studio, Johnson & Johnson Surgical Vision, Inc). Wavefront aberrations up to the 6th order Zernike coefficients, including coma Z(3, -1) and Z(3, 1), spherical aberration Z(4, 1), and the wavefront error of all higher-order aberrations (HOAs RMS), were evaluated across a 6 mm pupil. Results The mean manifest refractive spherical equivalent changed from the preoperative refractions -3.82 ± 1.26 D (range -6.00 to -2.25 D) to the postoperative refractions -0.20 ± 0.15 D (range -0.50 to 0.00 D) at the 9-month follow-up. Compared to baseline preoperative HOAs, the mean postoperative HOAs were significantly increased at the 1-day follow-up. On average, at the 9-month postoperative assessment the vertical coma Z(3, -1) was -0.054 ±0.186 µm, horizontal coma Z(3, 1) was 0.016 ± 0.124 µm, spherical aberration Z(4, 0) was 0.046 ± 0.163 µm, and HOAs RMS was 0.363 ± 0.115 µm across a 6 mm pupil. There is no significant difference in the mean HOAs starting at 1-week follow-up for the horizontal coma (P = 0.346) and spherical aberration (P = 0.095). Conclusions The visual outcomes demonstrated that the SILK procedure for refractive lenticule extraction using ELITA femtosecond laser system is effective and predictable for the correction of myopic refractive errors with and without astigmatism. The ELITA femtosecond laser system induced minimal HOAs in surgical eyes following the SILK procedures. These results demonstrate fast corneal recovery starting at 1-week follow-up, and spherical aberration was not induced.
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Affiliation(s)
- Li Chen
- Johnson & Johnson Surgical Vision, Inc., Milpitas, CA, USA
| | - Pooja Khamar
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ying Wang
- Johnson & Johnson Surgical Vision, Inc., Irvine, CA, USA
| | - Hong Fu
- Johnson & Johnson Surgical Vision, Inc., Milpitas, CA, USA
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital, Bangalore, India
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Cheng X, Zhao Y, Fu D, Zhou X, Gao Y, Yu Z. Posterior corneal stability after small incision lenticule extraction with different optical zones. Eye (Lond) 2024:10.1038/s41433-024-03224-9. [PMID: 38997503 DOI: 10.1038/s41433-024-03224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/16/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND To assess the changes in the posterior corneal surface following small incision lenticule extraction (SMILE) with different optical zones. METHODS In this retrospective study, 106 eyes of 106 patients who underwent SMILE were recruited 3 years after the procedure. Eyes were divided into two groups according to the size of the surgical optical zone: group A (52 eyes, ≤6.2 mm) and group B (54 eyes, ≥6.5 mm). Posterior central elevation (PCE) and 12 other points at 45°, 135°, 225° and 315° with distances of 1 mm, 2 mm and 3 mm from the centre were recorded from Pentacam. RESULTS No iatrogenic keratectasia was identified, and eyes in the two groups showed comparable visual results. The overall trend in posterior corneal elevation changes was consistent for both groups. PCE decreased significantly from 1.33 ± 2.32 to 0.75 ± 2.41 in group A (P = 0.024) and from 0.87 ± 2.61 to 0.06 ± 2.74 in group B (P = 0.003). All points in the central 2 mm region in both groups were reduced postoperatively. In the 4 mm and 6 mm corneal annulus, almost all points at 225°and 315° showed backward displacement, with the most prominent change occurring at 315° in the 6 mm annulus (P < 0.001), indicating no forward protrusion in the inferior area. CONCLUSIONS No forward protrusion in the posterior corneal surface was observed 3 years after SMILE with different optical zones. Comprehensive preoperative measurements are essential for ensuring corneal stability and avoiding iatrogenic keratectasia.
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Affiliation(s)
- Xueying Cheng
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yu Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ying Gao
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Lai X, Liu X, Zeng T, Huang Y, Yang X. Comparison of visual outcomes and optical aberrations after SMILE with intraoperative Kappa angle adjustments between small and large Kappa angles. Sci Rep 2024; 14:14551. [PMID: 38914606 PMCID: PMC11196622 DOI: 10.1038/s41598-024-65366-w] [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: 09/16/2023] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
This study compares postoperative visual outcomes and optical aberrations after Small Incision Lenticule Extraction (SMILE) in patients with both small (S-Kappa: Kappa angle < 0.2 mm) and large Kappa (L-Kappa: Kappa angle ≥ 0.2 mm) angles. The evaluated aberrations include total higher-order aberrations (HOAs), horizontal coma (HC), vertical coma (VC), and spherical aberrations (SA), with procedures incorporating intraoperative Kappa angle adjustments. We retrospectively analyzed patient records undergoing SMILE utilizing linear mixed models (LMM). We assessed adjusted mean uncorrected distance visual acuity (UDVA), Strehl ratio (SR), total HOAs, VC, and SA at pupils of 3 mm and 6 mm for both S-Kappa and L-Kappa. The disparities between S-Kappa and L-Kappa were evaluated by LMM's adjusted mean differences. The differences in optical metrics were also assessed in eyes grouped by myopia levels: low, moderate, and high. A sensitivity analysis was conducted on a threshold of Kappa angle at 0.3 mm. Eight-five patients (169 eyes) were analyzed, and no significant pre-operative difference was found in UDVA (p = .222) or spherical equivalent (p = .433). Post-operative differences were found in SR at 3 mm pupil size (-0.06, p = .022), total HOA 3 mm (0.15, p = .022), HC 3 mm (0.04, p = .042), VC 3 mm and 6 mm (-0.08, p = .041; 0.04, p = .041). The stratified analysis for high myopia revealed significant differences in UDVA (-0.04, p = .037), HC 3 mm (0.07, p = .03), VC 6 mm (-0.21, p = .001), and SA 3 mm and 6 mm (0.07, p = .037; -0.09, p = .037). Sensitivity analysis showed no significant difference using a 0.3 mm Kappa threshold. While some optical aberrations exhibited statistical differences between S-Kappa and L-Kappa, their clinical significance is limited. Thus, a large Kappa angle might not substantially influence post-operative optical aberrations when intraoperative Kappa angle adjustments are implemented.
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Affiliation(s)
- Xiaojuan Lai
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Xi Liu
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China.
| | - Tao Zeng
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Yi Huang
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Xin Yang
- The University of Alabama, Tuscaloosa, AL, 35487, USA
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Huang Y, Zhan B, Han T, Zhou X. Effective optical zone following small incision lenticule extraction: a review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1657-1665. [PMID: 37851133 DOI: 10.1007/s00417-023-06263-2] [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: 04/14/2023] [Revised: 08/18/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
Small incision lenticule extraction (SMILE) is a "flapless" keratorefractive surgery with excellent safety, efficacy, stability, and predictability for myopia correction. A recent global multicenter study also reported good refractive outcomes for hyperopic SMILE. SMILE has shown advantages including improved biomechanical strength, fewer dry eye symptoms, less corneal denervation, and fewer surgery-induced higher-order aberrations over laser in situ keratomileusis (LASIK). However, night vision complaints, including glare, halos, and starbursts, could still occur after SMILE. These symptoms have been proven to be closely related to the effective optical zone (EOZ), which is defined as the achieved area of corneal ablation. A larger postoperative EOZ may indicate better visual quality, making EOZ an important safety parameter for keratorefractive surgeries. As SMILE has gained wider application globally, the EOZ following SMILE has also been increasingly studied in the field of refractive surgery. This review provides an update on topics related to the EOZ after SMILE, including its measurement and influencing factors, aiming to benefit the personalization of the surgical algorithm and ultimately improve the visual quality after the SMILE procedure.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Biyun Zhan
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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Lischke R, Wiltfang R, Bechmann M, Kreutzer TC, Priglinger SG, Dirisamer M, Luft N. Intraocular lens power calculation using total keratometry and ray tracing in eyes with previous small incision lenticule extraction - A case series. Am J Ophthalmol Case Rep 2024; 34:102037. [PMID: 38487335 PMCID: PMC10937105 DOI: 10.1016/j.ajoc.2024.102037] [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: 10/08/2023] [Revised: 01/24/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Purpose To assess the IOL power calculation accuracy in post-SMILE eyes using ray tracing and a range of total keratometry based IOL calculation formulae. Observations Ray tracing showed excellent predictability in IOL power calculation after SMILE and its accuracy was clinically comparable with the Barrett TK Universal II and Haigis TK formula. Conclusions and importance Incorporating posterior corneal curvature measurements into IOL power calculation after SMILE seems prudent. The ray tracing method as well as selected TK-based formulae yielded excellent accuracy and should be favored in post-SMILE eyes.
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Affiliation(s)
- Roman Lischke
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Austria
| | - Rainer Wiltfang
- SMILE Eyes Clinic, Munich, Germany
- SMILE Eyes Clinic, Trier, Germany
| | - Martin Bechmann
- SMILE Eyes Clinic, Munich, Germany
- SMILE Eyes Clinic, Trier, Germany
| | | | - Siegfried G. Priglinger
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
- SMILE Eyes Clinic, Austria
| | - M. Dirisamer
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
- SMILE Eyes Clinic, Austria
| | - Nikolaus Luft
- University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
- SMILE Eyes Clinic, Austria
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Kim BK, Chung YT. Clinical outcomes of epithelial basement membrane dystrophy after keratorefractive lenticule extraction. J Cataract Refract Surg 2024; 50:558-564. [PMID: 38270250 PMCID: PMC11146164 DOI: 10.1097/j.jcrs.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/07/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To determine the clinical outcomes of keratorefractive lenticule extraction (KLEx) in eyes with epithelial basement membrane dystrophy (EBMD) that developed after surgery. SETTING Onnuri Smile Eye Clinic, Seoul, South Korea. DESIGN Retrospective single-center study. METHODS This study reviewed the medical records of 26 eyes of 16 patients who exhibited signs of EBMD after KLEx. Postoperatively, corneal findings and visual outcomes were evaluated. Statistical analyses were also performed on eyes without corneal complications after KLEx. RESULTS Signs of EBMD were first observed within 1 week postoperatively in 22 eyes (84.6%): 6 eyes (23.1%) showed epithelial defects, 10 eyes (38.5%) showed subepithelial corneal opacity, 5 eyes (19.2%) showed diffuse lamellar keratitis, and 1 eye (3.9%) showed epithelial ingrowth. Symptoms such as pain, while corneal lesions were present, occurred in 21 eyes (80.8%). At 3 months postoperatively, 21 eyes (80.8%) showed no specific findings on slitlamp microscopy after medical treatment, 2 eyes (7.7%) showed subepithelial corneal opacity, 2 eyes (7.7%) showed corneal scar, and 1 eye (3.9%) showed epithelial ingrowth. Uncorrected distance visual acuity was 20/25 or better in 24 eyes (92.3%), and spherical equivalent was within ±1.0 D in 20 eyes (76.9%). The efficacy index of the EBMD group did not significantly differ from the control group, while the safety index was significantly lower. CONCLUSIONS Manifestations of EBMD can occur after KLEx and can affect clinical outcomes. Most cases showed favorable results with appropriate nonsurgical treatment; however, some cases had long-term complications such as corneal scarring.
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Affiliation(s)
- Bu Ki Kim
- From the Onnuri Smile Eye Clinic, Seoul, South Korea (Kim); Onnuri Eye Hospital, Jeollabuk-do, South Korea (Chung)
| | - Young Taek Chung
- From the Onnuri Smile Eye Clinic, Seoul, South Korea (Kim); Onnuri Eye Hospital, Jeollabuk-do, South Korea (Chung)
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Di Girolamo N. Biologicals and Biomaterials for Corneal Regeneration and Vision Restoration in Limbal Stem Cell Deficiency. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2401763. [PMID: 38777343 DOI: 10.1002/adma.202401763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/15/2024] [Indexed: 05/25/2024]
Abstract
The mammalian cornea is decorated with stem cells bestowed with the life-long task of renewing the epithelium, provided they remain healthy, functional, and in sufficient numbers. If not, a debilitating disease known as limbal stem cell deficiency (LSCD) can develop causing blindness. Decades after the first stem cell (SC) therapy is devised to treat this condition, patients continue to suffer unacceptable failures. During this time, improvements to therapeutics have included identifying better markers to isolate robust SC populations and nurturing them on crudely modified biological or biomaterial scaffolds including human amniotic membrane, fibrin, and contact lenses, prior to their delivery. Researchers are now gathering information about the biomolecular and biomechanical properties of the corneal SC niche to decipher what biological and/or synthetic materials can be incorporated into these carriers. Advances in biomedical engineering including electrospinning and 3D bioprinting with surface functionalization and micropatterning, and self-assembly models, have generated a wealth of biocompatible, biodegradable, integrating scaffolds to choose from, some of which are being tested for their SC delivery capacity in the hope of improving clinical outcomes for patients with LSCD.
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Affiliation(s)
- Nick Di Girolamo
- Mechanisms of Disease and Translational Research, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia
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Jiang Y, Cai Y, Zhang X, Chen L, Zhou X, Chen Y. A Two-Decade Bibliometric Analysis of Laser in Ophthalmology: From Past to Present. Clin Ophthalmol 2024; 18:1313-1328. [PMID: 38765459 PMCID: PMC11100493 DOI: 10.2147/opth.s458840] [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: 01/21/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
Background Laser therapy has been proven as an effective technique for managing ophthalmological disorders. To guide future research, we conducted a bibliometric analysis of laser applications in eye diseases from 1990 to 2022, aiming to identify key themes and trends. Methods We retrieved 3027 publications from the Web of Science Core Collection (WoSCC). Bibliometrix was used for science mapping of the literature, while VOSviewer and CiteSpace were applied to visualize co-authorship, co-citation, co-occurrence, and bibliographic coupling networks. Results From a co-citation reference network, we identified 52 distinct clusters. Our analysis uncovered three main research trends. The first trend revolves around the potential evolution of corneal laser surgery techniques, shifting from the treatment of refractive errors to broader applications in biomedical optics. The second trend illustrates the advancement of laser applications in treating a range of disorders, from retinal and ocular surface diseases to glaucoma. The third trend focuses on the innovative uses of established technologies. Conclusion This study offers significant insights into the evolution of laser applications in ophthalmology over the past 30 years, which will undoubtedly assist scientists in directing further research in this promising field.
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Affiliation(s)
- Yaping Jiang
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yuying Cai
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xin Zhang
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Li Chen
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Institute for Medical and Engineering Innovation, Eye & ENT Hospital, Fudan University; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, People’s Republic of China
| | - Yihui Chen
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Association of myopia and astigmatism with postoperative ocular high order aberration after small incision lenticule extraction. BMC Ophthalmol 2024; 24:211. [PMID: 38741093 DOI: 10.1186/s12886-024-03475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To investigate the correlation between higher-order aberrations (HOA) after small incision lenticule extraction (SMILE) and the severity of myopia and astigmatism, along with the relevant factors. These findings will provide valuable insights for decreasing the occurrence of HOA after SMILE and enhancing visual quality. METHODS A total of 75 patients (150 eyes) with myopia and astigmatism who underwent SMILE were categorized into four groups based on the severity of myopia and astigmatism: Myopia Group 1 (Group M1, spherical diopter ranged from -1.00 D to -4.00 D), Myopia Group 2 (Group M2, spherical diopter ranged from -4.10 D to -10.00 D), Astigmatism Group 1 (Group A1, cylindrical diopter ranged from 0 D to -1.00 D), and Astigmatism Group 2 (Group A2, cylindrical diopter ranged from -1.10 D to -3.00 D). A comprehensive assessment was performed to examine the association between HOA and various relevant factors, including a detailed analysis of the subgroups. RESULTS Group M1 had significantly lower levels of total eye coma aberration (CA), corneal total HOA (tHOA), internal tHOA, and vertical CA ( Z 3 - 1 ) after SMILE than Group M2 (P < 0.05). Similarly, Group A1 had significantly lower levels of total eye tHOA, CA, trefoil aberration (TA), corneal tHOA, TA, and vertical TA ( Z 3 - 3 ) after SMILE than Group A2 (P < 0.05). Pearson correlation analysis indicated a statistically significant positive relationship between the severity of myopia/astigmatism and most HOA (P < 0.05). Subgroup evaluations demonstrated a notable increase in postoperative HOA associated with myopia and astigmatism in Groups M2 and A2 compared with the control group. Lenticule thickness, postoperative central corneal thickness (CCT), postoperative uncorrected distance visual acuity (UDVA), and postoperative corneal Km and Cyl were strongly correlated with most HOA. Age, eyes, and postoperative intraocular pressure (IOP) were only associated with specific HOA. CONCLUSION HOA positively correlated with the severity of myopia and astigmatism after SMILE. However, this relationship was not linear. HOA after SMILE was influenced by various factors, and additional specialized investigations are required to establish its clinical importance.
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Affiliation(s)
- Yifan Du
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Mo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Ge Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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Yang X, Liu Y, Xiao K, Song Q, Xu Y, Li J, Zhou Y. Effect of Cyclotorsion Compensation in Small Incision Lenticule Extraction Surgery for the Correction of Myopic Astigmatism: A Systematic Review and Meta-Analysis. Ophthalmol Ther 2024; 13:1271-1288. [PMID: 38498276 DOI: 10.1007/s40123-024-00921-2] [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: 12/28/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Small incision lenticule extraction (SMILE) has made notable advancements in addressing myopic astigmatism. Nevertheless, the potential impact of cyclotorsion on surgical outcomes cannot be overlooked. This study aims to assess the effectiveness of cyclotorsion compensation technology in SMILE surgery for the correction of myopic astigmatism, examining its influence on postoperative visual quality. METHODS A systematic review and meta-analysis were conducted. A comprehensive literature search was performed using databases, including PubMed, Web of Science, EMBASE, Cochrane Library, EBSCO, Scopus, CNKI, VIP, and Wan Fang. Studies meeting the criteria were selected and included. Data were independently extracted by three authors. Clinical outcome parameters were analyzed using Review Manager version 5.3. RESULTS This meta-analysis included ten studies. The results showed that, compared with the control group (cyclotorsion compensation was not performed in SMILE), the following indicators in the cyclotorsion compensation group were: residual astigmatism (RA) [weighted mean difference (MD) = 0.73, 95% confidence interval (CI) + 0.26 to + 1.19, P = 0.002], spherical equivalent (SE) (MD = 1.99, 95% CI + 0.77 to + 3.21, P = 0.001), coma (MD = -0.06, 95% CI -0.08 to -0.04, P < 0.00001), higher-order aberrations (HOAs) (MD = -0.04, 95% CI -0.06 to -0.02, P < 0.0001), follow-up 6-month angle of error (AE) (MD = -2.67, 95% CI -3.71 to -1.63, P < 0.00001), and follow-up 6-month uncorrected distance visual acuity (UDVA) (MD = -0.05, 95% CI -0.08 to -0.01, P = 0.005), and the differences in results were statistically significant. However, the differences among correction index, index of success (IOS), targeted induced astigmatism (TIA), magnitude of error (ME), and spherical aberration (SA) were not statistically significant. CONCLUSION Cyclotorsion compensation proves to be effective and predictable for correcting myopic astigmatism. The cyclotorsion compensation group demonstrated advantages over the control group in terms of postoperative residual astigmatism, and it induced fewer coma aberrations. Whether cyclotorsion compensation can lead to better visual quality remains to be seen, and further research on correcting myopic astigmatism through cyclotorsion compensation is warranted.
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Affiliation(s)
- Xinwei Yang
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China.
- Refractive Surgery Department, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Ying Liu
- Clinical School of Medicine, Chengdu University of Chinese Medicine, Chengdu, China
| | - Kaimin Xiao
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Qiuyi Song
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Yunxi Xu
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Jialing Li
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China
| | - Yuehua Zhou
- Eye College, Chengdu University of Traditional Chinese Medicine, No. 37, Twelve Bridge Road, Jinniu District, Chengdu, Sichuan, China.
- Refractive Surgery Department, Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Foo VHX, Liu YC, Ang M, Htoon HM, Ting DSJ, Mehta JS. Comparative Study of Primary SMILE, SMILE Enhancement, and Femtosecond Laser-Assisted LASIK on Higher Order Aberrations and Corneal Densitometry. J Refract Surg 2024; 40:e291-e303. [PMID: 38717083 DOI: 10.3928/1081597x-20240314-01] [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: 06/20/2024]
Abstract
PURPOSE To compare differences in corneal densitometry (CD) and higher order aberrations (HOAs) in eyes that underwent small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for the treatment of myopia and myopic astigmatism at postoperative months 3, 6, and 12, and to evaluate their changes in a separate cohort of eyes after SMILE enhancement. METHODS In this prospective, randomized, paired-eye clinical trial, consecutive eligible participants were randomized to undergo SMILE or FS-LASIK in either eye. Main outcome measures were CD and HOAs preoperatively and at 3, 6, and 12 months postoperatively. A separate cohort of consecutive patients who had SMILE and underwent enhancement were also included for comparison. RESULTS For CD, no significant differences were found between SMILE and FS-LASIK up to month 12. For HOA measured by wavefront aberrometry, both SMILE and FS-LASIK had an increase in total root mean square (RMS) HOAs, spherical aberration (SA), and vertical coma up to month 12. SMILE had an additional increase in vertical quatrefoil, and FS-LASIK had an increase in horizontal coma at month 12. FS-LASIK had higher SA than SMILE, whereas SMILE had higher vertical quatrefoil than FS-LASIK at month 12. Central and posterior zone CD had significantly decreased after SMILE enhancement compared to after primary SMILE up to 2 years after enhancement. RMS HOAs, lower order aberrations, and SA were all increased after SMILE enhancement compared to after primary SMILE. CONCLUSIONS SMILE induced lower SA but higher vertical quatrefoil than FS-LASIK at 1 year. Both SMILE and FS-LASIK had similar increases in RMS HOAs and vertical coma up to 1 year. There were no differences in CD between both groups. SMILE enhancement additionally had decreased central and posterior CD but greater RMS HOAs and SA compared to primary SMILE. [J Refract Surg. 2024;40(5):e291-e303.].
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Li Y, Yang Y, Shen M, Wang C, Chang L, Liu T, Wang Y. Investigation of the optimal cutting depth in small incision lenticule extraction based on a collagen fibril crimping constitutive model of the cornea. J Biomech 2024; 169:112145. [PMID: 38761745 DOI: 10.1016/j.jbiomech.2024.112145] [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: 11/01/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
To investigate the optimal cutting depth (Cap) in small incision lenticule extraction from the perspective of corneal biomechanics, a three-dimensional finite element model of the cornea was established using a stromal sub-regional material model to simulate small incision lenticule extraction. The displacement difference PΔ at the central point of the posterior corneal surface before and after lenticule extraction, as well as the von Mises stress at four points of different thicknesses in the center of the cornea, were analyzed using the finite element model considering the hyperelastic property and the difference in stiffness between the anterior and posterior of the cornea. The numerical curves of PΔ-Cap and von Mises Stress-Cap relations at different diopters show that the displacement difference PΔ has a smallest value at the same diopter. In this case, the von Mises stress at four points with different thicknesses in the center of the cornea was also minimal. Which means that the optimal cutting depth exsisting in the cornea. Moreover, PΔ-Cap curves for different depth of stromal stiffness boundaries show that the optimal cap thickness would change with the depth of the stromal stiffness boundary. These results are of guiding significance for accurately formulating small incision lenticule extraction surgery plans and contribute to the advancement of research on the biomechanical properties of the cornea.
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Affiliation(s)
- Yikuan Li
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350, China
| | - Yaqing Yang
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350, China
| | - Min Shen
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350, China.
| | - Congzheng Wang
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350, China
| | - Le Chang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin 300020, China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China
| | - Taiwei Liu
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin 300350, China; Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240, China
| | - Yan Wang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin 300020, China; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.
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14
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Li A, Yang X, Wang W, Huang W, Ding H, Nie K, Zhong T, Hu S, Yang Z, Zhong X. Comparative visual outcomes of the first versus second eye following small-incision lenticule extraction (SMILE). BMC Ophthalmol 2024; 24:158. [PMID: 38600456 PMCID: PMC11007869 DOI: 10.1186/s12886-024-03414-9] [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: 11/28/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND This study aimed to compare the visual outcomes of the first operated eyes with those of the second operated eyes following small-incision lenticule extraction (SMILE). METHODS A total of 202 patients (404 eyes) underwent SMILE using the tear film mark centration method for myopia and myopic astigmatism correction. Baseline characteristics, objective optical quality, decentered displacement, induced corneal aberrations, and modulation transfer function (MTF) values were assessed. Linear regression analyzed the relationship between decentration and visual quality parameters, including corneal aberrations and MTF values. RESULTS No significant difference was observed in objective visual quality, efficacy, and safety indexes between the two groups (all P > 0.05). The average decentered displacement for the first and second surgical eyes was 0.278 ± 0.17 mm and 0.315 ± 0.15 mm, respectively (P = 0.002). The horizontal coma in the first surgical eyes were notably lower than in the second (P = 0.000). MTF values at spatial frequencies of 5, 10, 15, and 20 cycles/degree (c/d) were higher in the first surgical eyes compared to the second (all P < 0.05). Linear regression indicated that high-order aberrations (HOAs), root mean square (RMS) coma, spherical aberration, horizontal coma, vertical coma, and eccentric displacement were all linearly correlated. Furthermore, MTF values exhibited a linear relationship with eccentric displacement across these spatial frequencies. CONCLUSIONS There was no discernible difference in visual acuity, efficacy, or safety between the two operated eyes. Nonetheless, the first operated eyes exhibited reduced decentered displacement and demonstrated superior outcomes in terms of horizontal coma and MTF values compared to the second operated eyes following SMILE. The variations in visual quality parameters were linearly correlated with decentered displacement.
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Affiliation(s)
- Anzhen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Xiaowei Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Wenbin Huang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Hui Ding
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Ke Nie
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Tan Zhong
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Shisi Hu
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Zhenduo Yang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Xingwu Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China.
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15
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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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16
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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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Tsatsos M, Giachos I, Prousali E, Jacob S, Ziakas N. Something to SMILE about. Is small incision lenticule extraction (SMILE) ready to become the gold standard in laser refractive surgery? no. Eye (Lond) 2024; 38:633-635. [PMID: 37731051 PMCID: PMC10920905 DOI: 10.1038/s41433-023-02746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- M Tsatsos
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - I Giachos
- Dr Agarwal's Hospital, Corneal Department, Chennai, India
| | - E Prousali
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Jacob
- Dr Agarwal's Hospital, Corneal Department, Chennai, India
| | - N Ziakas
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Mäkinen P, Nättinen J, Aapola U, Pietilä J, Uusitalo H. Comparison of early changes in tear film protein profiles after small incision lenticule extraction (SMILE) and femtosecond LASIK (FS-LASIK) surgery. Clin Proteomics 2024; 21:11. [PMID: 38368345 PMCID: PMC10874072 DOI: 10.1186/s12014-024-09460-1] [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: 05/31/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (LASIK) are widely used surgical methods to correct myopia with comparable efficacy, predictability, and safety. We examined and compared the early changes of tear protein profiles after SMILE and FS-LASIK surgery in order to find possible differences in the initial corneal healing process. METHODS SMILE operations for 26 eyes were made with Visumax femtosecond laser. In FS-LASIK surgery for 30 eyes, the flaps were made with Ziemer FEMTO LDV Z6 femtosecond laser and stromal ablation with Wavelight EX500 excimer laser. Tear samples were collected preoperatively, and 1.5 h and 1 month postoperatively using glass microcapillary tubes. Tear protein identification and quantification were performed with sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS). RESULTS Immediately (1.5 h) after we found differences in 89 proteins after SMILE and in 123 after FS-LASIK operation compared to preoperative protein levels. Of these differentially expressed proteins, 48 proteins were common for both surgery types. There were, however, quantitative differences between SMILE and FS-LASIK. Upregulated proteins were mostly connected to inflammatory response and migration of the cells connected to immune system. One month after the operation protein expressions levels were returned to baseline levels with both surgical methods. CONCLUSIONS Our study showed that immediate changes in protein profiles after SMILE and FS-LASIK surgeries and differences between the methods are connected to inflammatory process, and the protein levels quickly return to the baseline within 1 month. The differences in protein profiles between the methods are probably associated with the different size of the epithelial wound induced.
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Affiliation(s)
- Petri Mäkinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland.
| | - Janika Nättinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Aapola
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Pietilä
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland
| | - Hannu Uusitalo
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- TAUH Eye Center, Tampere University Hospital, Tampere, Finland
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20
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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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21
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Liu J, Lu Y, Liu J, Wei C. Meta-analysis of efficacy, safety, stability and predictability of Small Incision Lenticule Extraction (SMILE) for myopia. Lasers Med Sci 2024; 39:57. [PMID: 38329555 DOI: 10.1007/s10103-024-04007-0] [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: 05/10/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
In order to investigate the postoperative efficacy, safety, stability, and predictability of SMILE surgery as a treatment for myopia, a comprehensive search was conducted in April 2023 across prominent databases, including PubMed, EMBASE, Web of Science, and Cochrane Library. The search aimed to select relevant studies of randomized controlled trials (RCTs) comparing clinical outcomes between SMILE and other corneal refractive surgeries for myopia. Upon conducting the initial search, a total of 324 records were retrieved from the aforementioned databases. These records were subjected to a meticulous selection process, adhering to predetermined inclusion criteria, resulting in 17 studies being ultimately included for analysis. By pooling the results of these studies, the comparison between SMILE surgery and alternative corneal refractive surgeries demonstrated similar outcomes in terms of efficacy, safety, stability, predictability, and higher-order aberrations (HOAs) concerning the correction of myopia. Furthermore, it was observed that the SMILE procedure exhibited a lesser impact on corneal sensation and corneal nerve density compared to other corneal refractive surgeries. Based on these findings, SMILE surgery may be considered as a treatment option with a slight superiority over conventional corneal surgery for myopia.
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Affiliation(s)
- Jiayan Liu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China.
| | - Yamei Lu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Jia Liu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Cong Wei
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
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22
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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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Zhao Y, Zhao W, Wang J, Zhang Z, Zhou X, Zhao J. Characteristics of disk halo size and its correlation with lenticule quality in small incision lenticule extraction for moderate to high myopia. Graefes Arch Clin Exp Ophthalmol 2024; 262:313-321. [PMID: 37405512 PMCID: PMC10805804 DOI: 10.1007/s00417-023-06133-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: 11/25/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To investigate changes in disk halo size after small incision lenticule extraction (SMILE) and the correlation between halo size and lenticule quality in moderate to high myopia. METHODS Thirty eyes of 30 consecutive patients (mean age, 24.9 ± 4.5 years; mean spherical equivalent, -6.85 ± 1.18 D) undergoing SMILE were included in this prospective study. Lenticule surface quality was accessed with a scanning electron microscopy by a scoring system. Halo size was measured preoperatively and at 1, 3, and 6 months postoperatively. Multiple linear regression analysis was performed to explore associations between halo size and a range of factors, including lenticule quality. RESULTS Disk halo size increased slightly at 1 month and then recovered continually from 3 to 6 months postoperatively, with no difference between halo size during the preoperative period and at 6 months postoperatively (P > 0.05). One month after SMILE, halo size (1 cd/m2, 5 cd/m2) was associated only with uncorrected distance visual acuity (P ≤ 0.004). A halo size of 5 cd/m2 at 3 months postoperatively correlated with the anterior surface quality of the lenticule (P = 0.046). At 6 months postoperatively, a halo size of 1 cd/m2 was associated only with the baseline, accounting for 11.9% of the variability (P = 0.041); no correlations were found for the halo size of 5 cd/m2. CONCLUSIONS Disk halo size after SMILE was enlarged at an early stage postoperatively and subsequently declined to the baseline level during a 6-month follow-up. The quality of the lenticule surface influenced halo size changes in the early phase.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Wuxiao Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jifang Wang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhe Zhang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jing Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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24
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Yoon H, Magnago T, Yeom DJ. Three-Month Clinical Outcomes to Correct Myopia or Myopic Astigmatism Using a Femtosecond Laser for Lenticule Creation With Automated Centration and Cyclotorsion Compensation. J Refract Surg 2024; 40:e30-e41. [PMID: 38190561 DOI: 10.3928/1081597x-20231212-03] [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: 01/10/2024]
Abstract
PURPOSE To individually evaluate the clinical outcomes for right and left eyes in the first 3 months after laser-assisted lenticule extraction for myopia and myopic astigmatism with the use of the new ATOS femtosecond laser system (Smart-Sight; SCHWIND eye-tech-solutions). METHODS A total of 331 eyes from 168 patients (166 right eyes and 165 left eyes) consecutively treated with SmartSight lenticule extraction were retrospective analyzed after a 3-month follow-up period. Patients' mean age was 26 ± 6 years (range: 18 to 47 years) and mean preoperative spherical equivalent (SEQ) was -5.07 ± 1.92 diopters [D] (range: -1.50 to -11.25 D) with a mean astigmatism of -1.04 ± 0.85 D (range: 0.00 to -4.00 D). At 3 months of follow-up, visual acuity, SEQ and cylinder, safety index, efficacy index, corneal higher order aberrations, and intraocular pressure (IOP) were analyzed. Furthermore, refractive and visual outcomes were also analyzed for the right and left eyes individually. All lenticule extraction treatments were performed with the SmartSight treatment method of the SCHWIND ATOS femtosecond laser. RESULTS At 3 months after surgery, mean SEQ was -0.12 ± 0.19 D and 98% of eyes were within ±0.50 D of the SEQ. All eyes were within ±1.00 D of the SEQ. Astigmatism of 0.50 D or less was achieved in 99% of eyes. The change in Snellen lines (difference between preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity) showed a gain of one or more lines in 13% and in 85% of the eyes the same was achieved. There was a loss of one or more lines at 3 months of follow-up in 1.6%. The safety index was 1.03 and efficacy index was 1.02. No significant difference between the right and left eyes was found. CONCLUSIONS The 3-month follow-up data show that SmartSight treatment for correction of myopia and myopic astigmatism with the SCHWIND ATOS is a safe, efficient, and accurate procedure. It provided excellent results in terms of visual recovery, predictability, and higher order aberrations. [J Refract Surg. 2024;40(1):e30-e41.].
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Chan JS, Han E, Lim CHL, Kurz AC, Shuman J, Liu YC, Riau AK, Mehta JS. Incisional surface quality of electron-beam irradiated cornea-extracted lenticule for stromal keratophakia: high nJ-energy vs. low nJ-energy femtosecond laser. Front Med (Lausanne) 2023; 10:1289528. [PMID: 38162883 PMCID: PMC10754972 DOI: 10.3389/fmed.2023.1289528] [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: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Corneal lenticules can be utilized as an additive material for stromal keratophakia. However, following extraction, they must be reimplanted almost immediately or cryopreserved in lenticule banks. Electron-beam (E-beam) irradiated corneas permit room-temperature storage for up to 2 years, enabling keratophakia to be performed on demand. This study aims to compare the performance of high nano Joule (nJ)-energy (VisuMax) and low nJ-energy (FEMTO LDV) femtosecond laser systems on the thickness consistency and surface quality and collagen morphology of lenticules produced from fresh and E-beamed corneas. Methods A total of 24 lenticules with -6.00 dioptre power were cut in fresh human donor corneas and E-beamed corneas with VisuMax and FEMTO LDV. Before extraction, the thickness of the lenticules was measured with anterior segment-optical coherence tomography (AS-OCT). The incisional surface roughness of extracted lenticules was analyzed using atomic force microscopy (AFM) and scanning electron microscopy (SEM). Multiphoton microscopy was then used to assess the surface collagen morphometry. Results The E-beamed lenticules that were cut using FEMTO LDV were significantly thicker than the fresh specimens as opposed to those created with VisuMax, which had a similar thickness as the fresh lenticules. On the vertex, they were ∼11% thicker than the fresh lenticules. The surface roughness (Rq) of E-beamed lenticules incised with FEMTO LDV did not differ significantly from the fresh lenticules. This contrasted with the VisuMax-fashioned lenticules, which showed notably smoother surfaces (∼36 and ∼20% lower Rq on anterior and posterior surfaces, respectively) on the E-beamed than the fresh lenticules. The FEMTO LDV induced less cumulative changes to the collagen morphology on the surfaces of both fresh and E-beamed lenticules than the VisuMax. Conclusion It has been previously demonstrated that the low nJ-energy FEMTO LDV produced a smoother cutting surface compared to high nJ-energy VisuMax in fresh lenticules. Here, we showed that this effect was also seen in the E-beamed lenticules. In addition, lower laser energy conferred fewer changes to the lenticular surface collagen morphology. The smaller disparity in surface cutting quality and collagen disturbances on the E-beamed lenticules could be beneficial for the early visual recovery of patients who undergo stromal keratophakia.
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Affiliation(s)
- Jian S. Chan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Evelina Han
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Chris H. L. Lim
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Ophthalmology, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Jeremy Shuman
- Lions World Vision Institute, Tampa, FL, United States
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | - Andri K. Riau
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
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Igras E, Czarnota-Nowakowska B, O’Caoimh R. Comparison of the Clinical Effectiveness of Correcting Different Types of Astigmatism with Small Incision Lenticule Extraction. J Clin Med 2023; 12:6941. [PMID: 37959406 PMCID: PMC10648579 DOI: 10.3390/jcm12216941] [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: 10/08/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Few studies have reported the differential outcomes of Small Incision Lenticule Extraction (SMILE) on myopic astigmatism. Given this, we examined the effectiveness of SMILE for up to one year, comparing with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism, conducting a retrospective review of patients who underwent correction of myopic astigmatism using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) at two refractive clinics in Poland between 2016-2017. Patients were aged ≥21 with stable refractive errors between -0.5 and -10.0 diopter (D) with astigmatism up to 5D. The mean age of the 209 patients (355 eyes) available was 32 years; 58.4% were female. Of these, 247 had WTR, 62 oblique, and 46 ATR astigmatism. The mean pre-operative spherical equivalent (SE) was -5.4 ± 2.57D and the cylinder -1.7 ± 1.0D. The mean SE for WTR reduced from -5.60 ± 2.37D to -0.31 ± 0.67D at 2 months and -0.38 ± 0.70D at 12 months; the mean cylinder improved from -1.90 ± 1.10D to -0.31 ± 0.39D and -0.36 ± 0.43D, respectively. Eyes with oblique astigmatism also improved from a mean SE of -5.8 ± 3.4 D to -0.82 ± 1.50D and -0.69 ± 1.15D and a cylinder of -1.4 ± 0.73D to -0.17 ± 0.33D at 2 months and -0.1 ± 0.32D at 12. For ATR, the mean SE improved from -4.0 ± 1.8D to -0.08 ± 0.22D and -0.04 ± 0.12D; and the mean cylinder from -1.25 ± 0.53 to -0.02 ± 0.09D -0.08 ± 0.21D at 2 and 12 months, respectively. There were statistically significant improvements in SE, manifest sphere and cylinder refraction, and UDVA and CDVA scores for each cylinder type at 2 months with ATR cylinders having better outcomes. Although missing data limited interpretation at one year, differences were maintained. The magnitude of error calculations suggests that WTR was more prone to under-correction, particularly for high astigmatism (>1.5D). SMILE for myopic astigmatism reliably corrects SE, irrespective of the subtype of astigmatism.
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Affiliation(s)
- Estera Igras
- Estera Igras, Optegra Eye Health Care Laser Clinic, Mickiewicza Street 140, 71-153 Szczecin, Poland
| | | | - Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland;
- Clinical Research Facility Cork, University College Cork, Mercy University Hospital, T12 WE28 Cork, Ireland
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Randleman JB. The Most Cited Modern Articles in Refractive Surgery (2010-2020). J Refract Surg 2023; 39:784-790. [PMID: 37937756 DOI: 10.3928/1081597x-20230925-01] [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: 11/09/2023]
Abstract
PURPOSE To provide a comprehensive analysis of the most highly cited modern articles in refractive surgery, those published between 2010 and 2020, and compare these results to a list of the most highly cited articles in refractive surgery from all timepoints. METHODS The Scopus database was searched for articles pertaining to refractive surgery using multiple search terms to identify the top 100 most cited articles in refractive surgery published between 2010 and 2020. Articles were reviewed for relevance and ranked based on total citations accrued. RESULTS The 100 most cited modern articles in refractive surgery were identified. The article with the most citations by Sekundo et al has garnered nearly 600 citations to date. Almost all articles (88%) included in the top 100 had 200 or more citations. Intraocular lens (34 articles), keratorefractive lenticule extraction (ie, small incision lenticule extraction) (27 articles), and laser in situ keratomileusis (17 articles) were the predominant topics. Aarhus University in Denmark generated the most articles (5), whereas numerous articles originated from multiple countries, including the United States (16), United Kingdom (10), France (8), Spain (8), China (7), and Germany (7). CONCLUSIONS This list provides a comprehensive assessment of the most cited modern articles in refractive surgery and demonstrates key focuses and trends in the field over the past decade. Intraocular lens and keratorefractive lenticule extraction were the primary topics. There was a broader representation of procedures, topics, authors, and country of origin as compared to prior work. [J Refract Surg. 2023;39(11):784-790.].
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Leccisotti A, Fields SV, De Bartolo G. Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application. Cornea 2023; 42:1247-1256. [PMID: 36156507 DOI: 10.1097/ico.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of centration and alignment (Ziemer CLEAR). METHODS This was a retrospective, consecutive, noncomparative case series study. Patients undergoing CLEAR for spherical equivalent (SE) between -3 and -10 D, evaluating SE, defocus equivalent, refractive astigmatism, visual acuity, and centration at 10 months were evaluated in the study. RESULTS Fifty-three eyes of 42 patients (mean age 40.4 ± 8.6 years) were included, with preoperative SE -5.99 ± 1.49 D and mean corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR. With no suction losses, an intact lenticule was extracted in all eyes. In 6 eyes, peripheral adhesion was resolved by lenticulerrhexis, and in 1 eye, the incision was opened by a crescent blade. Moderate interface inflammation occurred in 3 eyes. At day 1, in the 42 eyes with uneventful surgery, the mean CDVA was 20/27, whereas in the 11 eyes with extra surgical manipulations, it was 20/36 ( P = 0.04). At 10 months, for the 53 eyes, the mean uncorrected distance visual acuity was 0.05 ± 0.09 logMAR; in 37 eyes (70%), it was 20/25 or better; and the mean CDVA was 0.04 ± 0.06 logMAR. Eight eyes (15%) lost 1 logMAR line. The mean SE was -0.13 ± 0.15 D. The mean defocus equivalent was 0.33 ± 0.32 D, with 46 eyes (87%) ≤0.50 D and 52 eyes (98%) ≤1 D. Refractive astigmatism was ≤0.50 D in 48 eyes (90%). The efficacy index was 1.00, and the safety index was 0.98. The mean decentration from the corneal vertex was 0.28 ± 0.07 mm. CONCLUSIONS The application yielded good predictability, efficacy, and safety. Slower visual recovery was observed after extra surgical manipulations.
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Affiliation(s)
- Antonio Leccisotti
- Siena Eye Laser, Poggibonsi, Siena, Italy
- Scuola di Specializzazione in Oftalmologia, Università di Siena, Siena, Italy; and
- School of Biomedical Sciences, Ulster University, Coleraine, UK
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Zheng K, Wang J, Zheng X, Han Y, Zhou X. Three patterns for identifying the posterior plane of a lenticule during SMILE. Int Ophthalmol 2023; 43:3533-3538. [PMID: 37354360 PMCID: PMC10504096 DOI: 10.1007/s10792-023-02760-9] [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: 12/09/2022] [Accepted: 05/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To describe three patterns of posterior plane edge identification in small-incision lenticule extraction and to prevent lenticule mis-dissection. METHODS Femtosecond laser application was performed for small-incision lenticule extraction (SMILE) by one surgeon. The surgical videos of SMILE were recorded and re-watched by the surgeon after operation. RESULTS Small-incision lenticule extraction was performed in 52 eyes of 28 patients, and no patient had cap-lenticular adhesion. Three patterns of posterior plane of lenticule were noticed when the surgical videos were re-watched. A "double lines" attached to the dissector were visible, signifying the reflective tape of the edge of the lenticule and the cap. During the expansion of the posterior lamellar separation, a fusiform opening between the lenticule edge and the underlying matrix layer was assumed to be a "leaf sign." With some unintentional operation, the posterior lamella was pushed away from the surgeon. The edge of the lenticule away from the anatomical part, the marking of the femtosecond laser cut, and the edge of the cap layer showed three reflective bands, which formed a "triple lines." The "double lines," "leaf sign," and "triple lines" were observed in 30 eyes (57.7%), 21 eyes (40.4%), and 1 eye (1.9%), respectively. CONCLUSION These three signs cover possible situations and provide visual landmarks to identify the correct dissection of the posterior plane, which can help shorten the learning curve of novice doctors.
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Affiliation(s)
- Ke Zheng
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Wang
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaohong Zheng
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yinan Han
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
| | - Xingtao Zhou
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Beijing, China.
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China.
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30
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Shen Y, Wang J, Zhou X, Yu Z, Hong J, Le Q. Impact of Dry Eye Disease on the Uncorrected Distance Visual Acuity after Small Incision Lenticule Extraction. J Clin Med 2023; 12:6179. [PMID: 37834823 PMCID: PMC10573338 DOI: 10.3390/jcm12196179] [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: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to explore the impact of dry eye disease (DED) on the uncorrected distance visual acuity (UDVA) and refractive status after small incision lenticule extraction (SMILE). This prospective cohort study enrolled 29 patients (DED group, 11 eyes; non-DED group, 18 eyes) who underwent SMILE in our center from July to September 2022. The examinations on DED, refractive status and UDVA were performed before surgery, and on day 7 and 20 after surgery. The results showed that on day 20 after SMILE, subjects in the non-DED group reported greater changes of ocular surface disease index value increase and tear-film breakup time reduction compared to baseline than those in the DED group (p < 0.001 and p = 0.048, respectively). Compared to preoperative status, DED patients had greater improvements of UDVA and better optometric outcomes on day 20 after surgery than non-DED subjects (p = 0.008 and 0.026, respectively). Multiple linear regression analysis showed age, contact lens daily wearing time, and tear meniscus height before surgery were of the highest value to predict UDVA on day 20 after SMILE in contact lens wearers (p = 0.006, 0.010 and 0.043, respectively). In conclusion, preoperative tear function could affect UDVA after SMILE. The impact of DED on UDVA and refraction should be taken into consideration before surgery.
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Affiliation(s)
- Yan Shen
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
| | - Jiajia Wang
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
| | - Xingtao Zhou
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Zhiqiang Yu
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Jiaxu Hong
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
| | - Qihua Le
- Department of Ophthalmology, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China; (Y.S.); (J.W.); (X.Z.); (Z.Y.)
- Research Center, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
- Myopia Key Laboratory of Ministry of Health, Eye, Ear, Nose & Throat Hospital of Fudan University, Shanghai 200031, China
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Moshirfar M, Zhang S, Pandya S, Stoakes IM, Hoopes PC. Incidence and Management of Epithelial-Related Complications After SMILE. Clin Ophthalmol 2023; 17:2777-2789. [PMID: 37750098 PMCID: PMC10518173 DOI: 10.2147/opth.s426547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE). Patients and Methods A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups. Results Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively). Conclusion In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Stephanie Zhang
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Shreya Pandya
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Isabella M Stoakes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
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Montanino A, van Overbeeke S, Pandolfi A. Modeling the biomechanics of laser corneal refractive surgery. J Mech Behav Biomed Mater 2023; 145:105998. [PMID: 37418971 DOI: 10.1016/j.jmbbm.2023.105998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/27/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
We present a finite element model of the human cornea used to simulate corneal refractive surgery according to the three most diffused laser procedures, i. e., photo-refractive keratectomy (PRK), laser in-situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). The geometry used for the model is patient-specific in terms of anterior and posterior surfaces of the cornea and intrastromal surfaces originated by the planned intervention. The customization of the solid model prior to finite element discretization avoids the struggling difficulties associated with the geometrical modification induced by cutting, incision and thinning. Important features of the model include the identification of the stress-free geometry and an adaptive compliant limbus to account for the surrounding tissues. By the way of simplification, we adopt a Hooke material model extended to the finite kinematics, and consider only the preoperative and short-term postoperative conditions, disregarding the remodeling and material evolution aspects typical of biological tissues. Albeit simple and incomplete, the approach demonstrates that the post-operative biomechanical state of the cornea, after the creation of a flap or the removal of a small lenticule, is strongly modified with respect to the preoperative state and characterized by displacement irregularities and stress localizations.
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Affiliation(s)
- Andrea Montanino
- Department of Structures for Engineering and Architecture, University of Naples "Federico II", Via Toledo 402, Napoli, Italy.
| | - Sanne van Overbeeke
- Department of Mechanical Engineering, University of Technology Eindhoven, 5612 AZ Eindhoven, The Netherlands.
| | - Anna Pandolfi
- Department of Civil and Environmental Engineering, Politecnico di Milano, 20133 Milano, Italy.
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Mohr KM, Gyldenkerne AN, Hjortdal JØ. Impact of Small Incision Lenticule Extraction for High Myopia on Intraocular Pressure Measurements With Pneumotonometry. J Refract Surg 2023; 39:606-611. [PMID: 37675911 DOI: 10.3928/1081597x-20230728-01] [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: 09/08/2023]
Abstract
PURPOSE To evaluate the medium-term impact of small incision lenticule extraction (SMILE) on air-puff tonometry (APT) and how it may be corrected. METHODS In this controlled prospective study, 69 eyes from 69 patients treated with SMILE for high myopia (mean: -7.22 diopters) were included. Central corneal thickness (CCT), spherical equivalent refraction (SEQ), corneal power, and intraocular pressure (IOP) (assessed by APT) were measured before and 3 months after surgery. RESULTS The measured IOP decreased significantly after SMILE surgery (mean: -6.43 mm Hg), indicating a significant underestimation of the true IOP by APT. There was a significant correlation between change in SEQ, CCT, and apparent IOP. Correcting the apparent IOP measurement by applying a multiple regression correction did not provide significantly better estimates compared to adding 6.4 mm Hg to the measurement. CONCLUSIONS This study showed that previous SMILE surgery should be considered when interpreting APT measurements, because the measurements underestimate the true IOP. Multiple regressions cannot estimate the true IOP with certainty. For screening purposes, adding 6.4 mm Hg to the apparent IOP of a patient treated for high myopia may be sufficient. [J Refract Surg. 2023;39(9):606-611.].
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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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Yang F, Dong Y, Bai C, Alzogool M, Wang Y. Bibliometric and visualized analysis of myopic corneal refractive surgery research: from 1979 to 2022. Front Med (Lausanne) 2023; 10:1141438. [PMID: 37575980 PMCID: PMC10416457 DOI: 10.3389/fmed.2023.1141438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Myopic corneal refractive surgery is one of the most prevalent ophthalmic procedures for correcting ametropia. This study aimed to perform a bibliometric analysis of research in the field of corneal refractive surgery over the past 40 years in order to describe the current international status and to identify most influential factors, while highlighting research hotspots. Methods A bibliometric analysis based on the Web of Science Core Collection (WoSCC) was used to analyze the publication trends in research related to myopic corneal refractive surgery. VOSviewer v.1.6.10 was used to construct the knowledge map in order to visualize the publications, distribution of countries, international collaborations, author productivity, source journals, cited references, keywords, and research hotspots in this field. Results A total of 4,680 publications on myopic corneal refractive surgery published between 1979 and 2022 were retrieved. The United States has published the most papers, with Emory University contributing to the most citations. The Journal of Cataract and Refractive Surgery published the greatest number of articles, and the top 10 cited references mainly focused on outcomes and wound healing in refractive surgery. Previous research emphasized "radial keratotomy (RK)" and excimer laser-associated operation methods. The keywords containing femtosecond (FS) laser associated with "small incision lenticule extraction (SMILE)" and its "safety" had higher burst strength, indicating a shift of operation methods and coinciding with the global trends in refractive surgery. The document citation network was clustered into five groups: (1) outcomes of refractive surgery: (2) preoperative examinations for refractive surgery were as follows: (3) complications of myopic corneal refractive surgery; (4) corneal wound healing and cytobiology research related to photorefractive laser keratotomy; and (5) biomechanics of myopic corneal refractive surgery. Conclusion The bibliometric analysis in this study may provide scholars with valuable to information and help them better understand the global trends in myopic corneal refractive surgery research frontiers. Two stages of rapid development occurred around 1991 and 2013, shortly after the innovation of PRK and SMILE surgical techniques. The most cited articles mainly focused on corneal wound healing, clinical outcomes, ocular aberration, corneal ectasia, and corneal topography, representing the safety of the new techniques.
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Affiliation(s)
- Fang Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yi Dong
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Chen Bai
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Mohammad Alzogool
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
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Abdel-Radi M, Shehata M, Mostafa MM, Aly MOM. Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques. Eye (Lond) 2023; 37:1545-1552. [PMID: 35864163 PMCID: PMC10219954 DOI: 10.1038/s41433-022-02174-4] [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: 11/24/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY (Clinical Trials.gov Identifier): NCT04710082.
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Affiliation(s)
| | - Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
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Chen H, Mao X, Xu D, Guo C, Dai J. The dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction. BMC Ophthalmol 2023; 23:223. [PMID: 37208645 DOI: 10.1186/s12886-023-02964-8] [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: 01/14/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND To investigate the dynamic changes and influencing factors of visual symptoms after small incision lenticule extraction (SMILE). METHODS This was a prospective observational study. Visual symptoms including glare, haloes, starbursts, hazy vision, fluctuation, blurred vision, double vision and focusing difficulties were evaluated before and 1, 3, 6 months after SMILE using a questionnaire. Generalized linear mixed models were used to assess the effects of preoperative characteristics and objective visual quality parameters on postoperative visual symptoms. RESULTS 73 patients/146 eyes were enrolled. Preoperatively, the most common symptoms were glare (55% of eyes), haloes (48%), starbursts (44%) and blurred vision (37%). At 1 month postoperatively, the incidence and extent scores of glare, haloes, hazy vision and fluctuation rose significantly. At 3 months, the incidence and extent scores of glare, haloes and hazy vision restored to baseline. And at 6 months, the extent scores of fluctuation returned to baseline. Other symptoms (e.g., starbursts) did not change before and 1, 3, 6 months after SMILE. Preoperative visual symptoms were associated with postoperative symptoms, as patients with a symptom preoperatively had higher postoperative scores for that symptom. Age was related to postoperative extent of double vision (coefficient = 0.12, P = 0.046). There were no significant associations between postoperative visual symptoms and preoperative SE, scotopic pupil size, angle kappa (with intraoperative adjustment), postoperative HOAs or scattering indexes. CONCLUSIONS The incidence and extent scores of hazy vision, glare, haloes and fluctuation increased at the first month after SMILE, and recovered to baseline at 3 or 6 months. Preoperative visual symptoms were associated with the postoperative symptoms and should be fully considered before SMILE.
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Affiliation(s)
- Han Chen
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, No.180 Fenglin Road, Shanghai, 200032, China
| | - Dongye Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Chenwen Guo
- Department of Ophthalmology, Zhongshan Hospital of Fudan University (Xiamen Branch), Xiamen, Fujian, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital of Fudan University, No.180 Fenglin Road, Shanghai, 200032, China.
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Shemesh R, Dichter S, Mezer E, Wygnanski-Jaffe T. The 100 Most Frequently Cited Articles on Myopia. J Ophthalmol 2023; 2023:7131105. [PMID: 37215949 PMCID: PMC10195181 DOI: 10.1155/2023/7131105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To provide a bibliographical-historical perspective and main interest in the field of myopia. Methods In this bibliographic study, the Web of Science Database was searched from 1999 to 2018. Recorded parameters included journal name, impact factor, year and language, number of authors, type and origin, methodology, number of subjects, funding, and topics. Results Epidemiological assessments were the leading type of article (28%), and half of the papers were prospective studies. The number of citations for multicenter studies was significantly higher (P = 0.034). The articles were published in 27 journals, with the majority in Investigative Ophthalmology, Vision Sciences (28%), and Ophthalmology (26%). Etiology, signs and symptoms, and treatment equally encompassed the topics. Papers addressing etiology, specifically genetic and environmental factors (P = 0.029), signs and symptoms (P = 0.001), and prevention, specifically public awareness (47%, P = 0.005), received significantly more citations. Treatment to decrease myopia progression was a much more common topic (68%) than refractive surgery (32%). Optical treatment was the most popular modality (39%). Half of the publications came from 3 countries: the United States (US), Australia, and Singapore. The highest ranked and cited papers came from the US (P = 0.028) and Singapore (P = 0.028). Conclusions To our knowledge, this is the first report of the top-cited articles on myopia. There is a predominance of epidemiological assessments and multicenter studies originating from the US, Australia, and Singapore, assessing etiology, signs and symptoms, and prevention. These are more frequently cited, emphasizing the great interest in mapping the increase in the incidence of myopia in different countries, public health awareness, and myopia control.
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Affiliation(s)
- Rachel Shemesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Sarah Dichter
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eedy Mezer
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Tamara Wygnanski-Jaffe
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
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Xie M, Deng Y, Sun C, Qiu L, Tang J. Higher-order aberrations and visual quality after incision lenticule extraction surgery with intraoperative angle kappa adjustments between small and large kappa patients: A 2-year follow-up. Indian J Ophthalmol 2023; 71:1849-1854. [PMID: 37203043 PMCID: PMC10391436 DOI: 10.4103/ijo.ijo_3017_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 evaluate the postoperative visual outcomes, that is, corneal higher-order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small-incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty-four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results At 24 months postoperatively, the mean spherical equivalent (SE) refraction was - 0.32 ± 0.40 and - 0.31 ± 0.35 in the S-kappa group (kappa <0.3 mm) and the L-kappa group (kappa ≥0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.
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Affiliation(s)
- Mengzhen Xie
- Department of Ophthalmology, West China Hospital, Sichuan University; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengshu Sun
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lemei Qiu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Reinstein DZ, Archer TJ, Potter JG, Gupta R, Wiltfang R. Refractive and Visual Outcomes of SMILE for Compound Myopic Astigmatism With the VISUMAX 800. J Refract Surg 2023; 39:294-301. [PMID: 37162399 DOI: 10.3928/1081597x-20230301-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To report the first refractive and visual outcomes of small incision lenticule extraction (SMILE) using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec AG). METHODS This was a retrospective analysis of consecutive eyes treated by SMILE using the VISUMAX 800 femtosecond laser at London Vision Clinic, EuroEyes Group, London, United Kingdom. Inclusion criteria were patients aged younger than 45 years, a corrected distance visual acuity (CDVA) of 20/20 or better, and the 3-month postoperative timepoint data being available for analysis. Standard outcomes analysis and vector analysis by the Alpins method were performed. RESULTS During the study period, 128 eyes of 66 consecutive patients were treated. Three-month data were available for 118 eyes (92%), and 10 eyes (8%) were lost to follow-up. The mean attempted spherical equivalent refraction (SEQ) was -4.65 ± 1.91 diopters (D) (range: -1.90 to -10.05 D) and the mean cylinder was -0.98 ± 0.78 D (range: 0.00 to -4.00 D). The mean age was 30 ± 5 years (range: 20 to 43 years), with 54% women and 46% men. Postoperative SEQ was within ±0.50 D in 86% and ±1.00 D in 100% of eyes. Uncorrected distance visual acuity was 20/20 or better in 91% of eyes. One line of CDVA was lost in 8% of eyes, and no eyes lost two or more lines. There was a small but statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. CONCLUSIONS Early outcomes data for SMILE with the second generation VISUMAX 800 femtosecond laser demonstrated an effective and safe option equivalent to published first generation VisuMax outcomes for the treatment myopia and astigmatism. [J Refract Surg. 2023;39(5):294-301.].
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Kaymak H, Devenijn M, Neller K, Cosma C, Sickenberger W, Seitz B, Langenbucher A, Schwahn H. [Post-SMILE-What myopes know about their secondary emmetropic eyes]. DIE OPHTHALMOLOGIE 2023; 120:400-405. [PMID: 36251042 DOI: 10.1007/s00347-022-01741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 04/29/2023]
Abstract
BACKGROUND Small incision lenticule extraction (SMILE) is popular among young myopic adults for long-term correction of myopia; however, the excessive axial lengths of myopic eyes and the associated risks for more serious eye diseases later on remain with surgical correction of the refractive error. These risks are greater the higher the myopia is. Are patients well informed about this and to what extent does further eye growth occur even after SMILE? MATERIAL AND METHODS Myopic young adults who underwent binocular SMILE before 2019 were given the opportunity to have their eyes examined at a follow-up visit (biometry using IOL-Master 700 [Zeiss, Oberkochen, Germany], subjective refraction, examination of the anterior and posterior segments of the eye using the slit lamp) and to participate in a survey. Patients with a preoperative axial length ≥ 25.5 mm and a preoperative axial length < 25.5 mm (high myopia) were statistically evaluated separately. RESULTS A total of 44 patients (age 30.39 ± 2.39 years) appeared at the visit and the SMILE was 3.18 ± 0.82 years ago: The spherical equivalent at the follow-up visit was -0.05 ± 0.21 dpt in the weaker myopes and -0.18 ± 0.23 dpt in the high myopes. Of the respondents 27% estimated that SMILE would reduce the risk of retinal detachment and cataract, with 80% of high myopes underestimating the individual risk of retinal detachment. Also, 57% said they would not see an ophthalmologist until within 1 week if they had symptoms consistent with acute retinal detachment, and only 27% would go to an emergency room immediately. In general, 59% reported having normal health awareness and 41% reported going for annual ophthalmological check-ups. CONCLUSION The collected axial lengths and refractions show no relevant change in the eyes regarding progression of myopia; however, the patients' statements in the survey point out that most patients are not aware of the risk of serious eye diseases (retinal detachment, cataract). Therefore, repeated risk education and close postoperative care are needed, especially in preoperatively highly myopic patients.
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Affiliation(s)
- Hakan Kaymak
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland.
- Breyer Kaymak Klabe Augenchirurgie, Internationale Innovative Ophthalmochirurgie GbR, Theo Champion Str. 1, 40549, Düsseldorf, Deutschland.
| | - Machteld Devenijn
- Breyer Kaymak Klabe Augenchirurgie, Internationale Innovative Ophthalmochirurgie GbR, Theo Champion Str. 1, 40549, Düsseldorf, Deutschland
- Ernst-Abbe-Hochschule, Jena, Deutschland
| | - Kai Neller
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
- Breyer Kaymak Klabe Augenchirurgie, Internationale Innovative Ophthalmochirurgie GbR, Theo Champion Str. 1, 40549, Düsseldorf, Deutschland
| | - Claudia Cosma
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
- Breyer Kaymak Klabe Augenchirurgie, Internationale Innovative Ophthalmochirurgie GbR, Theo Champion Str. 1, 40549, Düsseldorf, Deutschland
| | | | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - Hartmut Schwahn
- Breyer Kaymak Klabe Augenchirurgie, Internationale Innovative Ophthalmochirurgie GbR, Theo Champion Str. 1, 40549, Düsseldorf, Deutschland
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Yao L, Zhang M, Wang D, Zhao Q, Wang S, Bai H. Small Incision Lenticule Extraction (SMILE) and Laser in Situ Keratomileusis (LASIK) Used to Treat Myopia and Myopic Astigmatism: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Semin Ophthalmol 2023; 38:283-293. [PMID: 35912896 DOI: 10.1080/08820538.2022.2107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSES The purpose of this meta-analysis is to systematically compare the safety, efficacy, and predictability of small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). METHODS This study covered the data searched from the PubMed, the EMBASE and the Cochrane Library. The Cochrane Handbook was also referred to as evaluating the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. RESULTS A total of 11 randomized controlled trails (RCTs) were included. The proportion of eyes with refraction within ±0.5D was higher in LASIK group compared with SMILE group (RR, 0.91; 95% CI, 0.83 to 0.99; p = .04). The spherical aberration (SA) was smaller in SMILE group compared with LASIK group (RR, -0.12; 95% CI, -0.23 to -0.01; p = .04). There were no significant differences between two groups with regard to final mean refractive spherical equivalent (SE) (MD, -0.04; 95% CI, -0.12 to 0.03; p = .22), proportion of eyes losing one or more lines of corrected distance visual acuity (CDVA) (RR, 1.14; 95% CI, 0.58 to 2.27; p = .70), proportion of eyes with uncorrected distance visual acuity (UCVA) of 20/20 or better (RR, 0.99; 95% CI, 0.94 to 1.05; p = .71), postoperative mean logMAR UCVA (MD, 0.01; 95% CI, -0.00 to 0.03; p = .13), postoperative refraction within ±1.0D (RR, 1.00; 95% CI, 0.98 to 1.02; p = .60), postoperative astigmatism within ±0.25, 0.5 and 1.0D (RR, 0.80, 0.99, 1.00; 95% CI, 0.35 to 1.83, 0.94 to 1.05, 0.98 to 1.02; p = .60, 0.86, 0.87), postoperative higher order aberrations (HOAs) (RR, 0.00; 95% CI, -0.16 to 0.16; p = .99). CONCLUSION For predictability, LASIK was superior to SMILE. There were comparably safety and efficacy for the correction of myopia and myopic astigmatism in SMILE and LASIK. SA was smaller after SMILE than after LASIK.
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Affiliation(s)
- Lin Yao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | | | - Qian Zhao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | - Haiqing Bai
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, SD, China
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Evereklioglu C, Sener H, Mutlu SN, Gunay Sener AB, Horozoglu F. Top 50 most-cited articles on SMILE surgery between 2010 and 2022: a correlation comparison between conventional bibliometrics and current altmetrics of research impact. Int Ophthalmol 2023:10.1007/s10792-023-02652-y. [PMID: 36869979 DOI: 10.1007/s10792-023-02652-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To conduct a bibliometric and altmetric analysis of the top 50 most-cited articles on small incision lenticule extraction (SMILE) surgery and assess its correlations with other metrics. METHODS The terms "small incision lenticule extraction" or "SMILE" were searched in the title, abstract, and keywords using Web of Science database. The retrieved articles (n = 927, between 2010 and 2022) were analyzed in-depth using altmetric attention scores (AAS), and traditional metrics (citation numbers of articles, impact factor of journals, and other citation-based metrics). A correlation statistics was performed with metrics. The articles' focus was examined quantitatively and the most prolific parameters were identified. Authorship network and country statistics also was examined. RESULTS Citation numbers were between 491 and 45. AASs were between 26 and 0. The altmetric score correlated moderately with citation number (r = 0.44, P = 0.001) and annual mean citations (r = 0.49, P < 0.001), but correlated weakly with impact factor (r = 0.28, P = 0.045), and immediacy index (r = 0.32, P = 0.022). The most articles published from China and the most articles were published in 2014. Modern SMILE surgery was mostly compared to the older LASIK procedure. The highest authorship number of links belonged to Zhou XT. CONCLUSION The first bibliometric and altmetric analysis of SMILE research provides novel directions for future work by showing the current research trends, prolific parameters, and zones with potential for the public's attention, providing useful information about the dissemination of scientific knowledge on SMILE in social media and to the general public.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty, Kayseri, Turkey.
| | - Hidayet Sener
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Fatih Horozoglu
- Department of Ophthalmology, Division of Cataract and Refractive Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
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Jorge FA, Taguchi F, Campos M. The 18-Month Outcomes of a Contralateral, Randomized, Prospective Clinical Trial Comparing Photorefractive Keratectomy and SMILE for Myopia. J Refract Surg 2023; 39:180-186. [PMID: 36892242 DOI: 10.3928/1081597x-20230113-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To compare clinical outcomes and patient satisfaction of photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE) for myopia. METHODS This contralateral, randomized, prospective clinical trial included 86 eyes of 43 patients diagnosed as having spherical equivalent (SE) from -1.00 to -8.00 diopters (D). One eye of each patient was randomly allocated to receive either PRK with 0.02% mitomycin C or SMILE. Visual acuity measurement, slit-lamp microscopy, manifest and cycloplegic refraction, Scheimpflug corneal tomography, contrast sensitivity assessment, ocular wavefront aberrometry, and a satisfaction questionnaire were performed preoperatively and during an 18-month follow-up. RESULTS Forty-three eyes of each group completed the study. After 18 months of follow-up, eyes treated with PRK and SMILE showed comparable results regarding uncorrected distance visual acuity (-0.12 ± 0.07 and -0.25 ± 0.09, respectively), safety, efficacy, contrast sensitivity, and ocular wavefront aberrometry. For predictability, eyes treated with PRK had a statistically lower residual spherical equivalent when compared with eyes treated with SMILE. Residual astigmatism of 0.50 D or less was achieved in 95% of the PRK group and 81% of the SMILE group. At the 1-month follow-up visit, the PRK group presented worse evaluation in relation to vision and foreign body sensation when compared to the SMILE group. CONCLUSIONS Both PRK and SMILE presented as safe and effective strategies for treating myopia with comparative clinical results. Eyes treated with PRK showed lower spherical equivalent and residual astigmatism. In the first month, eyes treated with SMILE showed less foreign body sensation and faster visual recovery. [J Refract Surg. 2023;39(3):180-186.].
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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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Hirabayashi MT, Barnett BP. Solving STODS-Surgical Temporary Ocular Discomfort Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13050837. [PMID: 36899981 PMCID: PMC10000827 DOI: 10.3390/diagnostics13050837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/24/2023] Open
Abstract
The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing.
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Affiliation(s)
- Matthew T. Hirabayashi
- Department of Ophthalmology, University of Missouri School of Medicine, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Brad P. Barnett
- California LASIK & Eye, 1111 Exposition Blvd. Bldg. 200, Ste. 2000, Sacramento, CA 95815, USA
- Correspondence:
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Deng M, Li M, Liu L, Shi Y, Sun L, Ma X, Zou J. Proteomic profiling of human corneal stroma from long-term contact lens wearers reveals activation of inflammatory responses. Cont Lens Anterior Eye 2023; 46:101820. [PMID: 36775668 DOI: 10.1016/j.clae.2023.101820] [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: 10/04/2022] [Revised: 12/26/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the association between proteomic changes and potential pathogenesis in the human cornea with respect to the duration of wearing soft contact lenses (SCLs). METHODS A total of 96 corneal stroma samples, obtained via small incision lenticule extraction (SMILE), were equally grouped according to the duration of wearing SCL: 0Y, did not wear SCL; 5Y, wore SCL for<5 years; 5-10Y, wore SCL for 5-10 years; O10Y, wore SCL for>10 years. Liquid chromatography-tandem mass spectrometry was used to identify and quantify protein profiles in the corneal stroma. Expression levels of CO1A1, CO4A1, NFKB1, and IL6RB were determined using western blot and immunohistochemistry analysis. RESULTS This study quantified a total of 5,668 proteins across samples and identified 2,379 differentially expressed proteins (DEPs) with significantly increased abundance in the three SCL-wearing groups compared with that in the non-SCL-wearing group. Compared with those in the 0Y group, the molecular functions of DEPs in the 5Y, 5-10Y, and O10Y groups were mainly related to translation regulator activity, antigen binding, peptidase inhibitor activity, participation in extracellular matrix (ECM) production, complement activation, and inflammatory responses. Pathway enrichment analysis of DEPs showed that the sphingolipid, phosphatidylinositol 3-kinase-protein kinase B, and hypoxia-inducible factor-1 signaling pathways were activated in the human corneal stroma after long-term SCL use. CONCLUSIONS Inflammation-related proteomic components in human corneal stroma increased after long-term use of SCL and may act as an essential factor in the molecular pathogenesis of corneal stroma damage.
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Affiliation(s)
- Manli Deng
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Min Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Lin Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuehui Shi
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Lina Sun
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyun Ma
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Ophthalmology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
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Randleman JB, Asroui L, Tarib I, Scarcelli G. The Most Cited Articles and Authors in Refractive Surgery. J Refract Surg 2023; 39:78-88. [PMID: 36779469 DOI: 10.3928/1081597x-20221213-01] [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: 02/14/2023]
Abstract
PURPOSE To provide a comprehensive analysis of the most highly cited articles and authors in refractive surgery. METHODS The Scopus database was searched for articles pertaining to refractive surgery using multiple search terms to identify the top 100 most cited articles in refractive surgery. A publicly available database of more than 100,000 scientists that provides standardized information on multiple variables resulting in a composite indicator (C score) was searched to identify refractive surgery authors. A refractive surgery-specific composite score was created using only the authors' publications that were directly related to refractive surgery. RESULTS The 100 most cited articles and 40 refractive surgery authors with the highest ranked C score were identified. The article with the most citations by Trokel et al has garnered nearly 800 citations to date. All articles included in the top 100 had 200 or more citations. The peak publication years were 1998 to 2001. Laser in situ keratomileusis (22), photorefractive keratectomy (18), and postoperative corneal ectasia and/or corneal biomechanics (16) were the most represented topics. Emory University generated the most articles (7) and the majority of publications (48%) originated in the United States. Steven E. Wilson, MD, had the highest refractive C score and Jorge L. Alió, MD, PhD, had the most refractive surgery articles and citations. Among all authors listed, the average number of refractive surgery publications was 97, with 35% of the group having more than 100 refractive surgery articles published. All authors on the list had more than 2,000 citations for their refractive surgery articles, whereas 38% had 4,000 or more citations. CONCLUSIONS This list provides a comprehensive assessment of the most cited articles and authors in refractive surgery and demonstrates key focuses and trends in the field over time. [J Refract Surg. 2023;39(2):78-88.].
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Modified Technique for Small-Incision Lenticule Extraction: Ye's Swing Technique. Ophthalmol Ther 2023; 12:365-376. [PMID: 36402902 PMCID: PMC9834450 DOI: 10.1007/s40123-022-00612-w] [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: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the lenticule integrity and refractive outcomes of a new technique, Ye's swing technique, during small-incision lenticule extraction (SMILE). METHODS This prospective study enrolled patients who underwent the SMILE procedure using a modified technique for lenticule dissection. Per the standard SMILE procedure, the cap cut was opened using a hook, and an anterior dissection was performed with a counterclockwise swing, from 8 to 12 o'clock. A posterior dissection was then performed by swinging counterclockwise, leaving a thin band of the peripheral rim undissected, from 8 to 4 o'clock. The counterclockwise swing was continued to separate the edges of the rim from 4 to 12 o'clock, after which microforceps were used to extract the lenticules. The primary outcome measures were safety and lenticule integrity at the end of the surgery, and the secondary outcome measure was efficacy. Changes in the ocular parameters from the preoperative visit to 1 month postoperative, including uncorrected and corrected distance visual acuity, manifest refraction, lenticule quality, and lenticule residual, were assessed using optical coherence tomography. RESULTS A total of 246 patients (490 eyes) with myopia and myopic astigmatism were included in the present study. The dissected lenticules ranged in size from 52 to 148 µm. Postoperatively, the lenticule was completely and successfully extracted in all cases. There was no incisional edge tearing during lenticule separation. CONCLUSIONS Ye's swing technique is a safe and effective procedure for lenticule dissection and refractive outcomes. We have now adopted this technique as our routine method for performing the SMILE procedure.
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Wang X, Xia L. Evaluation of the Effects of Myopic Astigmatism Correction and Anterior Corneal Curvature on Functional Optical Zone After SMILE. J Refract Surg 2023; 39:135-141. [PMID: 36779466 DOI: 10.3928/1081597x-20221215-01] [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: 02/14/2023]
Abstract
PURPOSE To evaluate the influence of different degrees of myopic astigmatism correction and preoperative anterior corneal curvature on the functional optical zone (FOZ) following small incision lenticule extraction (SMILE). METHODS In this retrospective study, 68 patients (106 eyes) treated with SMILE were grouped according to myopic astigmatism correction: control (0.00 diopters [D]), moderate astigmatism (-0.50 to -2.00 D), and high astigmatism (> -2.00 D). The FOZ was measured and compared between the three groups for 3 months. Correlations between attempted correction, anterior corneal curvature, corneal aberrations, and the FOZ were analyzed. RESULTS The preoperative mean treatment spherical equivalent was comparable among the three groups. The average FOZ was 5.06 ± 0.24 mm in the control group, 5.19 ± 0.25 mm in the moderate astigmatism group, and 5.35 ± 0.20 mm in the high astigmatism group The FOZ showed statistically significant differences among the three groups (P < .001), particularly between the high astigmatism group and the other two groups (P < .001 and .018). Correlation analysis showed that the total higher order aberrations, coma, and spherical aberration change were correlated with the FOZ (P < .001). Preoperative steep keratometry, average keratometry, and corneal astigmatism were significantly correlated with the FOZ (P < .05). The correlation remained after excluding the influence of attempted correction on the FOZ (P < .05). After adjusting for other risk factors using multiple linear regression analysis, there was still a significant positive association between preoperative steep keratometry and the FOZ (P < .001). CONCLUSIONS Patients with higher myopic astigmatism achieved a larger FOZ and less induced horizontal coma than the control and moderate astigmatism groups. A larger FOZ after SMILE can be achieved in eyes with steeper keratometry. [J Refract Surg. 2023;39(2):135-141.].
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