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Xu J, Liu M, Liu Q. Outcomes of Astigmatic Correction with and without Two Different Cyclotorsion Compensation Methods in Small Incision Lenticule Extraction Surgery. Photodiagnosis Photodyn Ther 2024:104272. [PMID: 39002831 DOI: 10.1016/j.pdpdt.2024.104272] [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: 05/17/2024] [Revised: 06/30/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE To compare the astigmatic correction outcomes of small incision lenticule extraction (SMILE) surgery with or without two different cyclotorsion compensation methods. METHODS This is a prospective randomized clinical trial. Patients with myopic astigmatism that underwent SMILE surgery were randomly divided into static cyclotorsion compensated group (SCC group), slit-lamp group and control group. In the SCC and slit-lamp groups, the intraoperative cyclotorsion was manually compensated with different limbal marking methods. In the control group, the cyclotorsion was not compensated. Visual acuity and manifest refraction were measured preoperatively and postoperatively. Astigmatic outcomes were estimated with vector analysis. RESULTS A total of 94 eyes from 94 patients were analyzed postoperatively at the 3-month follow-up. Their mean preoperative cylinder was -1.56±0.86 D (range: -4.25 to -0.25 D). The mean preoperative spherical equivalent was -5.95±1.72 D (range: -10.50 to -2.75 D). All groups showed favorable results in the correction of myopic astigmatism. No statistically differences were found among three groups in postoperative visual acuity, refractive outcomes or vector parameters. CONCLUSION Cyclotorsion compensation with two different manual limbal marking methods was helpful in aligning the surgical position in SMILE, but it was not as effective as expected for the correction of myopic astigmatism under well controlled surgical positioning.
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Affiliation(s)
- Jiping Xu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Manli Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Quan Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China.
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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024; 35:278-283. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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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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Wei C, Liu J, Zhang C, Liu JY, Lu YM. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis. J Fr Ophtalmol 2024; 47:104085. [PMID: 38377878 DOI: 10.1016/j.jfo.2024.104085] [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: 07/23/2023] [Accepted: 09/18/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. METHODS A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta-analysis. RESULTS A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P=0.18), the proportion of eyes within±0.50 diopter of target refraction postoperatively (P=0.10), or the postoperative magnitude of cylinder (P=0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P=0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P=0.03) than SMILE. In terms of aberrations, higher order aberrations (P=0.46), spherical aberrations (P=0.22) and trefoil (P=0.56) were not statistically different, while WFG-LASIK induced less coma than SMILE surgery (P=0.02). CONCLUSION Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma.
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Affiliation(s)
- C Wei
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - C Zhang
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Y Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - Y M Lu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China.
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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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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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Yang YZ, Li FF, Wu SQ, Dai Q, Bao FJ, Cheng D, Zhu J, Ye YF. Comparison of myopic astigmatic correction after cross-assisted SMILE, FS-LASIK, and transPRK. J Cataract Refract Surg 2023; 49:1242-1248. [PMID: 37616187 PMCID: PMC10664787 DOI: 10.1097/j.jcrs.0000000000001294] [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: 02/21/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To compare astigmatic correction among cross-assisted small-incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (transPRK). SETTING The Eye Hospital of Wenzhou Medical University, Zhejiang, China. DESIGN Prospective comparison study. METHODS 154 right eyes of 154 patients with astigmatism of -1.00 to -2.75 diopters (D) were included in this study. 64 eyes, 42 eyes, and 48 eyes were receiving SMILE, FS-LASIK, and transPRK, respectively. The SMILE group used cross-axial alignment for head positioning for astigmatism correction. In the FS-LASIK and transPRK groups, static and dynamic cyclotorsion control were used. Changes in ocular parameters and vector analysis were assessed at 6 months postoperatively. RESULTS The safety and efficacy indices were comparable among the 3 groups at 6 months postoperatively. Residual astigmatism was smallest in the SMILE group (-0.23 ± 0.25 D) compared with that in FS-LASIK (-0.40 ± 0.28 D, P = .009) and transPRK groups (-0.42 ± 0.32 D, P = .001). 53 (82.8%), 36 (85.7%), and 37 (77.1%) eyes achieved an angle of error within ±5 degrees, respectively ( P = .55). Notably, vector analysis showed that the difference vector, the magnitude of the error, and its absolute value were significantly smaller in the SMILE group than those in the other groups ( P < .05). In addition, the higher-order aberrations, especially coma, were significantly induced postoperatively in each group ( P < .001). CONCLUSIONS Residual astigmatism magnitude was smallest by cross-assisted SMILE, followed by FS-LASIK and transPRK, and the astigmatism axial correction was comparable among groups.
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Affiliation(s)
- Yi-Zeng Yang
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fen-Fen Li
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shuang-Qing Wu
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qi Dai
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fang-Jun Bao
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Dan Cheng
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jun Zhu
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yu-Feng Ye
- From the National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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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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Hashemi H, Asgari S, Khabazkhoob M, Heidari Z. Vector analysis of astigmatism correction after PRK, FS-LASIK, and SMILE for myopic astigmatism. Int Ophthalmol 2023; 43:3999-4009. [PMID: 37405568 DOI: 10.1007/s10792-023-02804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To compare astigmatic correction among photorefractive keratectomy (PRK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and small-incision lenticule extraction (SMILE). METHODS This prospective study enrolled 157 eyes that underwent three procedures (59 PRK, 47 FS-LASIK, and 51 SMILE) for the treatment of myopia with low to high astigmatism (- 0.25 to - 4.50 D). Ocular residual astigmatism (ORA) was calculated by vector analysis using refractive (RA) and corneal astigmatism. Vector analysis results were compared in different procedures in the two RA groups (low ≤ 1.00 D and high > 1.00 D) at 3 and 12 months postoperatively. RESULTS There were no significant between-group differences in postoperative safety and efficacy outcomes (all P > 0.05). No significant differences were found in postoperative cylinders between all surgical groups (all p > 0.05), except for 3 months postoperative ORA in FS-LASIK (P = 0.004). At 12 months, 77%, 59.2%, and 50% of eyes attain emmetropia in the FS-LASIK, SMILE, and PRK groups, respectively. Vector analysis showed comparable values for surgical induced astigmatism, target induced astigmatism, mean error, and angle of error between groups at 12 months. Significant differences were observed only in the correction index and difference vector parameters in the astigmatic > 1.00 D group at 3 months (P < 0.001), and FS-LASIK was preferable. CONCLUSIONS One-year outcomes revealed that PRK, FS-LASIK, and SMILE were all equally effective in correcting myopic astigmatism. However, FS-LASIK demonstrated more favorable astigmatism correction in eyes with astigmatism > 1.00D in early postoperatively.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Ophthalmology, Bu-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran; Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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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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Yang S, Huang T, Wang Y, Ning K, Long Q, Wang Z, Li Y, Chen D. Short-Term Impact of Different Corneal Incision Positions on Postoperative Astigmatism and Visual Quality After SMILE Surgery. Ophthalmol Ther 2023; 12:2453-2464. [PMID: 37328617 PMCID: PMC10441924 DOI: 10.1007/s40123-023-00748-3] [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: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the short-term impact of different incision positions on astigmatism and visual quality after small incision lenticule extraction (SMILE) surgery. METHODS This prospective study enrolled patients who decided to have SMILE to correct myopia. Patients were randomly allocated into three groups of different incision positions (group A, B, and C with incision position at 90°, 120°, and 150° respectively). Preoperative and postoperative visual acuity, spherical equivalent, and high-order aberrations (HOAs) were measured and compared among groups. Astigmatism was analyzed with the ASSORT Group Analysis Calculator based on the Alpins method. RESULTS A total of 148 eyes were included for analysis (48 eyes in group A, 50 eyes in group B, and 50 eyes in group C). At 1 month postoperatively, the mean uncorrected distance visual acuity (UDVA) logMAR in group A, B, and C was - 0.03, - 0.03, and - 0.04, respectively. The mean corrected distance visual acuity (CDVA) logMAR in group A, B, and C was - 0.03, - 0.04, and - 0.04, respectively (P > 0.05). The mean postoperative spherical equivalent (SE) values were - 0.01 ± 0.38, - 0.07 ± 0.39, and - 0.16 ± 0.49 (D) in group A, B, and C, respectively (P > 0.05). There was no statistically significant difference in preoperative and postoperative magnitude of astigmatism among different groups (P > 0.05). Significant differences were found in the distribution of astigmatism axis among the three groups at 1 day (P = 0.02) and 1 week (P = 0.02) postoperatively. However, such differences were no longer significant at 1 month after surgery (P > 0.05). No significant differences were found in HOAs among different groups 1 month after surgery (P > 0.05). CONCLUSION Different incision positions have no effect on postoperative astigmatism and visual quality 1 month after SMILE surgery, though differences were found in the distribution of the astigmatism axis within 1 week after the surgery.
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Affiliation(s)
- Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Tianze Huang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Yuchen Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ken Ning
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Qing Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Zhonghai Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing, 100005, China.
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Chuckpaiwong V, Chansue E, Lekhanont K, Tanehsakdi M, Jongkhajornpong P, Nonpassopon M. 12-Month Outcomes of Small Incision Lenticule Extraction With Proper Head Positioning but No Reference Marking for the Correction of Astigmatism. J Refract Surg 2023; 39:683-692. [PMID: 37824301 DOI: 10.3928/1081597x-20230824-01] [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: 10/14/2023]
Abstract
PURPOSE To investigate the 12-month outcomes of small incision lenticule extraction (SMILE) with proper head positioning but no reference marking for correcting astigmatism. METHODS This was a retrospective cohort study of 3,541 patients (5,953 eyes) who underwent SMILE between July 2010 and April 2021. Patient positioning on the treatment bed was meticulously done in every patient to avoid face turn, head tilt, and chin-up or chin-down posture. The corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction, astigmatic outcomes, and adverse events were evaluated at 1, 3, and 12 months postoperatively. RESULTS The mean preoperative manifest spherical equivalent and manifest cylinder were -5.15 ± 2.24 diopters (D) (range: -0.13 to -12.88 D) and -1.00 ± 0.77 D (range: -0.25 and -6.00 D), respectively. Of all eyes, 88.4% and 98.6% had the spherical equivalent within ±0.50 and ±1.00 D of emmetropia at 12 months. The percentage of eyes with UDVA of 20/20 or better was 92.5%. Six eyes (0.1%) lost two or more lines of CDVA at the 12-month visit. The predictability of cylinder correction was excellent, with 88.1% within ±0.50 D and 98.9% within ± 1.00 D of astigmatism correction at 12 months. The mean correction index (CI) at 12 months was 1.09 ± 0.45 (range: 0.17 to 4.99), indicating a slight astigmatism overcorrection. The high cylinder group tended to have undercorrection with greater residual astigmatism, whereas the low cylinder group was likely to have overcorrection with lesser residual astigmatism (P < .001). No serious adverse events were observed. CONCLUSIONS SMILE with proper head positioning but no reference marking produces safe, efficient, predictable, and stable outcomes for astigmatism correction over a 12-month period. [J Refract Surg. 2023;39(10):683-692.].
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Sachdev GS, Patekar KB, Ramamurthy S. Comparative analysis of visual outcomes following small-incision lenticule extraction with or without cyclotorsion compensation in eyes with high astigmatism: Contralateral eye study. Indian J Ophthalmol 2023; 71:2469-2473. [PMID: 37322663 PMCID: PMC10418031 DOI: 10.4103/ijo.ijo_224_23] [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: 01/24/2023] [Revised: 03/02/2023] [Accepted: 03/23/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To compare the visual outcomes in patients undergoing small-incision lenticule extraction (SMILE) for correction of myopic astigmatism (≥-1.50 D) with or without manual cyclotorsion compensation. Methods A prospective, double-blinded, randomized, contralateral study was conducted in the refractive services of a tertiary eye care center. Eligible patients with bilateral high myopic astigmatism (≥1.5 D) and intraoperative cyclotorsion (≥5°) undergoing SMILE between June 2018 and May 2019 were included. Cyclotorsion compensation was performed using triple centration method before femtosecond laser delivery. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) measurement, manifest refraction, slit-lamp biomicroscopy, and corneal tomography were performed preoperatively and at 1 and 3 months' postoperative visit. Astigmatic outcomes were analyzed using Alpins criteria. Results A total of 30 patients (60 eyes) were included in this study. The patients underwent bilateral SMILE surgery, with manual cyclotorsion compensation in one eye (CC group, n = 30 eyes) and no cyclotorsion compensation in the other eye (NCC group, n = 30 eyes). Preoperative astigmatism and intraoperative cyclotorsion were -2.0 D and 7.03° ± 1.06° (CC) and -1.75 D and 7.24° ± 0.98° (NCC) (P = 0.472 and 0.240, respectively). No significant differences were noted in mean refractive spherical equivalent (MRSE), UDVA, CDVA, and refractive error between the two groups at 3 months' postoperative visit. Astigmatic outcomes measured using Alpins criteria demonstrated no significant difference between the two cohorts. Conclusion The cyclotorsion compensation technique provided no additional advantage in terms of astigmatic outcomes or postoperative visual quality, in eyes with high preoperative astigmatism and intraoperative cyclotorsion.
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Affiliation(s)
- Gitansha S Sachdev
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Komal B Patekar
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Shreyas Ramamurthy
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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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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Cui G, Di Y, Yang S, Chen D, Li Y. Efficacy of small-incision lenticule extraction surgery in high astigmatism: A meta-analysis. Front Med (Lausanne) 2023; 9:1100241. [PMID: 36743675 PMCID: PMC9892059 DOI: 10.3389/fmed.2022.1100241] [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: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy of small-incision lenticule extraction (SMILE) in improving vision and visual quality and correcting astigmatism for the treatment of high astigmatism. Methods Eligible studies and studies comparing the efficacy of SMILE with femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) or transepithelial photorefractive keratectomy (T-PRK) for high astigmatism (≥2.00 D) were identified in PubMed, Embase, and the Cochrane Central Register of Controlled Trials, searched from their inception to 29 May 2022. The references of all searched studies were checked as supplements. The risk of bias was evaluated for each eligible study. The literature was screened according to the inclusion and exclusion criteria, and relative data were extracted. Data were extracted and analyzed by ReviewManager 5.4. The primary outcome was post-operative uncorrected distance visual acuity (UDVA). The secondary outcomes included corneal aberrations and vector parameters. The weight mean difference (WMD) and their 95% confidence intervals (95% CI) were used to assess the strength of the association. Results A total of six studies including 380 astigmatism eyes were involved, with 211 high-astigmatism eyes and 31 low-astigmatism eyes undergoing SMILE surgery, 94 high-astigmatism eyes undergoing FS-LASIK surgery, and 44 high-astigmatism eyes undergoing T-PRK surgery. Compared with non-SMILE, SMILE induced more astigmatism (weighted mean difference [WMD] = -0.07, 95% CI [-0.12 to -0.02], P = 0.005) and fewer sphere aberrations (WMD = -0.12, 95% CI [-0.17 to -0.08], P < 0.00001). The post-operative UDVA, sphere, spherical equivalent (SE), and higher order aberrations in different surgeries were likewise equivalent. The difference vector and index of success were significantly higher, and the surgically induced astigmatism vector, correction index, and magnitude of error were significantly lower in SMILE. Conclusion This meta-analysis suggests that SMILE, FS-LASIK, and T-PRK show excellent efficacy, predictability, and safety for myopia. SMILE exhibited less astigmatism refraction predictability and less surgically induced spherical aberrations. There may be more under-correction in SMILE. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term.
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Affiliation(s)
- Ge Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Di Chen,
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Ying Li,
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Han T, Fu D, Xu Y, Ding X, Chen Z, Yu Z, Zhou X. Effect of incision location on with-the-rule astigmatism correction after SMILE. Eur J Ophthalmol 2022; 33:11206721221143260. [PMID: 36464663 DOI: 10.1177/11206721221143260] [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: 02/17/2024]
Abstract
PURPOSE To explore the influence of two different incision positions of small incision lenticule extraction (SMILE) on astigmatism correction. METHODS A total of 86 eyes of 86 patients who underwent SMILE surgery were included in this retrospective study. The criteria included that the preoperative astigmatism axis to be within 165° to 180° or 5° to 15°. All eyes were divided into two groups according to the incision position. The incisions of 34 eyes were either located on the superior temporal side of the right eye or superior nasal side of the left eye (120° group), and 52 eyes were located on the superior side (90° group). Vector analysis was used to analyze pre- and postoperative 3-month astigmatism, while subgroup analysis was applied according to the preoperative astigmatism. RESULTS No significant difference of preoperative parameters was found between the two groups (P > 0.05). The efficacy and safety indexes were 1.11 ± 0.16 and 1.15 ± 0.16 in the 120° group, the numbers were 1.15 ± 0.17 and 1.16 ± 0.14 in the 90° group (P = 0.629 and P = 0.871). There was no significant difference in target-induced astigmatism (TIA), TIA axis, surgically induced astigmatism (SIA) magnitude, SIA axis, distance vision (DV) magnitude, DV axis, correction index (CI), angle of error (AofE), |AofE|, magnitude of error (MofE), index of success (IOS), or flattening index (FI) between 120° group and 90° group (P > 0.05). No significant difference was found in the subgroup analysis (P > 0.05). CONCLUSIONS The incision position has limited astigmatic effect, and the operation-induced astigmatism of SMILE surgery after 3 months was little.
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Affiliation(s)
- Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Ye Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xuan Ding
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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Li FF, Yang YZ, Bao FJ, Cheng D, Zhu J, Ye YF. Comparison of Astigmatic Correction With and Without Cross-axis Alignment During Small Incision Lenticule Extraction. J Refract Surg 2022; 38:624-631. [DOI: 10.3928/1081597x-20220830-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sun L, Jhanji V, Li S, Li J, Ji R, Zeng H, Ng TK, Zhang M, Zhang R. Vector analysis of astigmatic correction after single-step transepithelial photorefractive keratectomy and femtosecond-assisted laser in-situ keratomileusis for low to moderate myopic astigmatism. Indian J Ophthalmol 2022; 70:3483-3489. [PMID: 36190031 PMCID: PMC9789874 DOI: 10.4103/ijo.ijo_649_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose This study aimed to evaluate the outcomes of astigmatic correction by single-step transepithelial photorefractive keratectomy (TransPRK) and femtosecond-assisted laser in-situ keratomileusis (Femto-LASIK) surgeries. Methods A total of 218 subjects received TransPRK or Femto-LASIK surgery for the treatment of myopia and astigmatism (-2.25 to -0.25 D). Refraction errors and uncorrected (UDVA) and corrected distance visual acuity (CDVA) were examined before and at 3 months after surgery. Astigmatism changes were assessed by vector analysis. Results Preoperative parameters of the TransPRK group were similar to the Femto-LASIK group. UDVA and CDVA at 3 months were similar between both groups. Manifest refraction (MR) spherical equivalent in the TransPRK group (0 ± 0.20 D) was slightly lower compared with the Femto-LASIK group at 3 months (0.11 ± 0.25 D, P = 0.001). MR cylinder was -0.06 ± 0.19 D in the TransPRK group and -0.02 ± 0.15 D in the Femto-LASIK group at 3 months (P = 0.135). The index of success (IS) was 0.15 ± 0.36 in the TransPRK group and 0.06 ± 0.17 in the Femto-LASIK group (P = 0.125). The correction index (CI) was 1.03 ± 0.19 in the TransPRK group and 1.01 ± 0.11 in the Femto-LASIK group (P = 0.815). Conclusion For low to moderate myopic astigmatism, TransPRK provided a comparable astigmatic treatment effect as Femto-LASIK. Myopic astigmatism was both slightly overcorrected after TransPRK and Femto-LASIK surgeries.
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Affiliation(s)
- Lixia Sun
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Vishal Jhanji
- UPMC Eye Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Senmao Li
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Jinyu Li
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Ruifeng Ji
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Hongqiang Zeng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China,Correspondence to: Dr. Mingzhi Zhang, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hongkong, Dong Xia North Road, Shantou, Guangdong Province, China. E-mail:
Dr. Riping Zhang, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hongkong, Dong Xia North Road, Shantou, Guangdong Province, China. E-mail:
| | - Riping Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong Province, China,Correspondence to: Dr. Mingzhi Zhang, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hongkong, Dong Xia North Road, Shantou, Guangdong Province, China. E-mail:
Dr. Riping Zhang, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hongkong, Dong Xia North Road, Shantou, Guangdong Province, China. E-mail:
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Han T, Zhao L, Shen Y, Chen Z, Yang D, Zhang J, Sekundo W, Shah R, Tian J, Zhou X. Twelve-year global publications on small incision lenticule extraction: A bibliometric analysis. Front Med (Lausanne) 2022; 9:990657. [PMID: 36160168 PMCID: PMC9493269 DOI: 10.3389/fmed.2022.990657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the development process of small incision lenticule extraction (SMILE) surgery in a 12-year period. Methods We conducted a literature search for SMILE research from 2011 to 2022 using the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC). The VOS viewer, and CiteSpace software were used to perform the bibliometric analysis. Publication language, annual growth trend, countries/regions and institutions, journals, keywords, references, and citation bursts were analyzed. Results A total of 731 publications from 2011 to 2022 were retrieved. Annual publication records grew from two to more than 100 during this period. China had the highest number of publications (n = 326). Sixty-five keywords that appeared more than four times were classified into six clusters: femtosecond laser technology, dry eye, biomechanics, visual quality, complications, and hyperopia. Conclusion The number of literatures has been growing rapidly in the past 12 years. Our study provides a deep insight into publications on SMILE for researchers and clinicians with bibliometric analysis for the first time.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Liang Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yang Shen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhi Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jiaoyan Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Walter Sekundo
- The Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany
| | - Rupal Shah
- New Vision Laser Centers, Vadodara, Gujarat, India
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Jinhui Tian,
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Xingtao Zhou,
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20
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Fu M, Li M, Xian Y, Yu Z, Zhang H, Choi J, Niu L, Wang X, Zhou X. Two-Year Visual Outcomes of Evolution Implantable Collamer Lens and Small Incision Lenticule Extraction for the Correction of Low Myopia. Front Med (Lausanne) 2022; 9:780000. [PMID: 35492322 PMCID: PMC9043127 DOI: 10.3389/fmed.2022.780000] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the 2-year visual quality of Evolution Implantable Collamer Lens (EVO-ICL) and small incision lenticule extraction (SMILE) for the correction of low myopia. Methods In this prospective study, we included 25 eyes of 25 patients (7 men) who underwent EVO-ICL and 36 eyes of 36 patients (16 men) who underwent SMILE between January 2018 and December 2018. Subjective and objective visual outcomes were compared between ICL and SMILE. All patients were followed for 2 years. Results At the postoperative 2-year visit, the percentage of patients with uncorrected distance visual acuity (UDVA) greater than or equal to preoperative corrected distance visual acuity (CDVA) was comparable in the ICL group (80%, 20/25) and SMILE group (88.89%, 32/36). Spherical equivalent (SE) was within ± 0.50 D in 96% (24/25) of the ICL group and 94.44% (34/36) of the SMILE group. No eyes lost more than 2 lines of CDVA. Postoperative high-order aberrations (HOAs) were significantly increased in the ICL group (p < 0.01) and in the SMILE group (p < 0.01). The most common visual complaint was halo after ICL and starburst after SMILE. There was no correlation between HOAs and visual complaints (p > 0.05). Conclusion Evolution Implantable Collamer Lens provides comparable safety, efficacy, long-term visual stability, and high patient satisfaction when compared to SMILE in correcting low myopia. EVO-ICL could be a favorable alternative for low myopia. Key messages What was known? What this paper adds?
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Affiliation(s)
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yiyong Xian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | | | - Joanne Choi
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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21
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Zhou J, Gu W, Gao Y, He G, Zhang F. Vector analysis of high astigmatism (≥ 2.0 diopters) correction after small-incision lenticule extraction with stringent head positioning and femtosecond laser-assisted laser in situ keratomileusis with compensation of cyclotorsion. BMC Ophthalmol 2022; 22:157. [PMID: 35382779 PMCID: PMC8985270 DOI: 10.1186/s12886-022-02384-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of this study was to compare the astigmatic correction by vector analysis in patients with high myopic astigmatism after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) with cyclotorsion compensation or small-incision lenticule extraction (SMILE) with stringent head positioning. Setting Beijing Aier-Intech Eye Hospital, Beijing, China. Design A retrospective case series. Methods Patients who had correction of myopic astigmatism of 2 diopters (D) or more treated with either FS-LASIK with cyclotorsion compensation or SMILE with stringent head positioning were included. The results of vision and refraction were analyzed and compared between groups with the right eye. Results The study enrolled 94 patients (41eyes in an FS-LASIK with compensation of cyclotorsion group and 53 eyes in a SMILE with stringent head positioning control group. The mean preoperative manifest cylinder was -2.65 ± 0.77D in the FS-LASIK group and 2.51 ± 0.56D in the SMILE group (P = 0.302). At 12 months, there was no significant between-group difference in uncorrected distance visual acuity (UDVA, P = 0.274) and postoperative spherical equivalent (SEQ) (P = 0.107). 46.3% and 24.5% of eyes in the FS-LASIK and SMILE groups were within 0.25 D were within 0.25D postoperative cylinder, respectively, and 78% and 66% of eyes in these two groups were within 0.5 D postoperative cylinder (P = 0.027, P = 0.202). The vector analysis showed comparable between-group target-induced astigmatism (TIA) (P = 0.114), surgically induced astigmatism (SIA) (P = 0.057), difference vector (DV, P = 0.069), and the angle of error (AE) (P = 0 .213) values. The index of success (IOS) was 0.18 in the FS-LASIK group and 0.24 in the SMILE group (P = 0.024), with a significant difference between the two groups. Conclusion FS-LASIK with compensation of cyclotorsion showed a favorable correction of high myopic astigmatism (≥ 2.0 D) compared to SMILE with stringent head positioning at 12 months.
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Affiliation(s)
- Jihong Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, 100730, Beijing, China.,Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Wei Gu
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Yan Gao
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Guoli He
- Beijing Aier-Intech Eye Hospital, Beijing, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, 100730, Beijing, China.
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22
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Jabbarvand M, Khodaparast M, Moravvej Z, Shahraki K, Ahmadi H, Shahraki K, Jamali A, Narooie-Noori F. Vector analysis of moderate to high myopic astigmatism after small-incision lenticule extraction (SMILE): 12-month follow-up. Eur J Ophthalmol 2022; 32:3312-3320. [PMID: 35175136 DOI: 10.1177/11206721221080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism. STUDY DESIGN Prospective interventional case series. METHODS This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of - 0.5 D or more and astigmatism between - 1.0 D and -5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. RESULTS The preoperative mean spherical equivalent was -5.48 ± 2.17 D (range - 1.75 to - 10.00 D) and the mean cylinder was -2.02 ± 1.09 D (range - 1.00 to - 5.00 D). The mean postoperative cylinder value was -0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. CONCLUSION SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Mehdi Khodaparast
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Zahra Moravvej
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Eye Research Center, Eye Department, Amiralmomenin Hospital, School of Medicine, 37554Guilan University of Medical Sciences, Rasht, Iran
| | - Kianoush Shahraki
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Hanie Ahmadi
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Department of Ophthalmology, 92948Mazandaran University of Medical sciences, Sari, Iran
| | - Kourosh Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
| | - Foroozan Narooie-Noori
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
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23
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Chang JY, Lin PY, Hsu CC, Liu CJL. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc 2022; 85:145-151. [PMID: 34861667 DOI: 10.1097/jcma.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
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Affiliation(s)
- Jin-Yu Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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24
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Comparison of the Clinical Outcomes between Combined Femtosecond Laser-Assisted In Situ Keratomileusis and Corneal Cross Linking versus Combined Small-Incision Lenticule Extraction and Corneal Cross Linking. J Ophthalmol 2022; 2022:6994355. [PMID: 35140987 PMCID: PMC8820861 DOI: 10.1155/2022/6994355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to compare femtosecond laser-assisted in situ keratomileusis with prophylactic cross linking (FS-LASIK Xtra) and small-incision lenticule extraction with prophylactic cross linking (SMILE Xtra) in terms of their postoperative clinical outcomes. Methods In this retrospective study, 24 patients (48 eyes) with myopia and myopia astigmatism were recruited from 2017 to 2018. All patients underwent comprehensive ophthalmic examinations preoperatively and follow-up visits at one and three months. Four patients (eight eyes) in each group were followed up for 12 months. The following were assessed at each visit: uncorrected distance visual acuity (UDVA), manifest refractive spherical equivalent (MRSE), keratometry values, biomechanical properties, anterior and posterior curvature, and corneal pachymetry. Results The FS-LASIK Xtra and SMILE Xtra groups both included 24 eyes of 12 patients. At 1, 3, and 12 months after surgery, a UDVA of 20/20 or better was achieved for 91.7%, 91.7%, and 87.5% of individuals, respectively, in the FS-LASIK group and 95.8%, 100%, and 100% in the SMILE group, respectively. For 75% of eyes in the FS-LASIK Xtra group and 100% of eyes in the SMILE Xtra group, the achieved MRSE was within ±1.00D of attempted correction. The LASIK Xtra group had a significantly higher mean MRSE than the SMILE Xtra group at 3 and 12 months after surgery (P=0.006, 0.01), and the SMILE Xtra group had significantly higher K1 and K2 values than the FS-LASIK group at one month after surgery (P=0.024, 0.023). Corneal thickness decreased significantly at one month postoperatively and started to increase over the next 12 months in both groups (P=0.001). The biomechanical properties showed no significant intergroup differences at the 12-month follow-up. Conclusions FS-LASIK Xtra and SMILE Xtra are safe and effective in the correction of myopia and myopia astigmatism, and both procedures have the same effect on postoperative corneal morphology and biomechanics.
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25
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Comparison of astigmatic correction with and without limbal marking during small incision lenticule extraction. J Cataract Refract Surg 2022; 48:924-928. [DOI: 10.1097/j.jcrs.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
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26
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Nicula CA, Nicula D, Bolboacă SD, Bulboacă AE. One year outcomes after small incision lenticule extraction ReLEX in the correction of myopia and myopic astigmatism. BMC Ophthalmol 2021; 21:423. [PMID: 34879853 PMCID: PMC8656009 DOI: 10.1186/s12886-021-02195-9] [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: 01/24/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To report the visual and refractive outcomes of small incision lenticule extraction ReLEX (SMILE) technique using VisuMax femtosecond laser in myopia and myopic astigmatism patients. Material and methods A non-randomized clinical study has been conducted on patients with myopia and myopic astigmatism who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser system (Carl Zeiss Meditec AG, Jena, Germany) at Oculens Clinic, Cluj-Napoca, Romania. Patients older than 18 years, with ocular astigmatism up to -5 diopters (D), spherical equivalent up to -10.00 D, corrected distance visual acuity (CDVA) of 0.3 or better before the surgery, stable refraction for one year, and with a minimum calculated post operator residual stromal bed of 250μ were included in the study. Results The study involved a total of 25 myopic eyes (median of sphere diopters equal with -4D) and 67 myopic astigmatic eyes (median of cylinder diopters equal with -1.5 D). The mean refractive spherical equivalent (MRSE) on patients with myopic eyes reduced from -4.25D (median) to -0.5D at one month follow-up, -0.25 D at 6 and 12 months. The mean refractive spherical equivalent (MRSE) on patients with astigmatic myopic eyes reduced from-6.25 D to -0.67 D at one month, -0.62 D at six and twelve months. The value of sphere decreased postoperatively on myopic eyes with a median of -0.25D at one, six and twelve months. The value of cylinder decreased postoperatively on myopic astigmatic eyes with a median of -0.50 D at one month, -0.25 D at six months and -0.50 D at 12 months. At 6 and 12 months, 20 (80.0%) of myopic eyes were maintained within ±0.5 D and 22 (88.0%) with ±1D. On both groups (myopic eyes and myopic astigmatic eyes), statistically significant differences were observed when the keratometric baseline values were compared to each follow-up (P-values < 0.0001), without any significant differences between follow-ups (P-values>0.15). At 1-month follow-up, uncorrected distance visual acuity (UDVA) was better than or equal to 0.5 in 88.0% of myopic eyes and 82.1% of myopic astigmatic eyes. UDVA remained stable in all cases of myopic eyes at six months and the percentage increased at 92.0% in myopic eyes. UDVA slightly increased at 6-months (85.1%) and remained at the same value at 12-months in myopic astigmatism eyes. Conclusions SMILE proved an effective and safe refractive corneal procedure and provided a predictable and stable correction of myopia and myopic astigmatism. SMILE technique demonstrated very good outcomes in terms of keratometric, cylinder, spherical measurements.
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Affiliation(s)
- Cristina Ariadna Nicula
- Department of Ophthalmology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Victor Babeș Str., no. 8, 400012, Cluj-Napoca, Romania.,Oculens Clinic, Calea Turzii, No. 134-136, 400501, Cluj-Napoca, Romania
| | - Dorin Nicula
- Oculens Clinic, Calea Turzii, No. 134-136, 400501, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Louis Pasteur Str., no. 6, 400349, Cluj-Napoca, Romania.
| | - Adriana Elena Bulboacă
- Department of Pathophysiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Victor Babeș Str., no. 8, 400012, Cluj-Napoca, Romania
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27
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Comparison of refractive and visual outcomes between image-guided assisted small incision lenticule extraction and wavefront-optimized femtosecond laser in situ keratomileusis in treatment of high astigmatism. J Cataract Refract Surg 2021; 48:765-770. [PMID: 34694256 DOI: 10.1097/j.jcrs.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare refractive and visual results of image-guided assisted small-incision lenticule extraction (IGA-SMILE) and wavefront-optimized femtosecond laser in situ keratomileusis (FS-LASIK) in the treatment of high astigmatism. SETTINGS Osmangazi Aritmi Hospital, Bursa, Turkey. DESIGN Retrospective. METHODS This retrospective case-matched study included 64 eyes that had undergone IGA-SMILE and 64 eyes that had undergone wavefront optimized FS-LASIK. The mean preoperative myopia and astigmatism were -4.05 ±1.98 diopter (D) and 3.11 ±1.06 D in the IGA-SMILE group and -4.21 ±2.23 D and -3.15 ±0.62 D in the FS-LASIK group. One year later, visual and refractive results were compared in the groups. Vector analysis based on Alpins method was done to evaluate astigmatic treatment. RESULTS At one year, the residual astigmatism was -0.21 ± 0.25 D in the IGA-SMILE and -0.21 ± 0.24 D in the FS-LASIK group (p=0.305). In the IGA-SMILE group, 57 (89.1%) eyes achieved uncorrected distance visual acuity (UDVA) of 20/20 or better, as did 56 (85.9%) eyes in the FS-LASIK group. Vector analysis results demonstrated that the difference vectors were 0.22 ±0.24 D and 0.21 ±0.22 D (p=0.230), the correction indexes were 0.95 ±0.08 and 0.95 ±0.08 (p=0.239), the indices of success were 0.08 ±0.09 and 0.08±0.09 (p=0.248), in the IGA-SMILE and the FS-LASIK groups, respectively. CONCLUSION The combination of an image-guided system with SMILE resulted in high efficacy and safety indices that were comparable to FS-LASIK surgery.
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Comparative study of small-incision lenticule extraction with and without prophylactic corneal crosslinking: 1-year outcomes. J Cataract Refract Surg 2021; 47:1196-1204. [PMID: 34468458 DOI: 10.1097/j.jcrs.0000000000000594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare myopia and astigmatic correction after small-incision lenticule extraction (SMILE) with or without prophylactic crosslinking (SMILE Xtra). SETTING Shenyang Aier Eye Hospital, Central South University, China. DESIGN Retrospective study. METHODS Patients with comparable manifest sphere and cylinder undergoing SMILE Xtra or SMILE were enrolled. The crosslinking (CXL) energy was 2.7 J/cm2. Only right eyes were selected. Visual and refractive changes were evaluated for 1 year. Astigmatic correction was analyzed using Alpins method. RESULTS Thirty-six eyes undergoing SMILE Xtra and 40 eyes undergoing SMILE were enrolled. The uncorrected distance visual acuity at 1-day visit was lower after SMILE Xtra than that after SMILE (P = .01). At 12 months, the mean manifest refraction spherical equivalent (MRSE) and manifest cylinder were 0.08 ± 0.32 diopters (D) and -0.29 ± 0.23 D in SMILE Xtra group, whereas -0.25 ± 0.29 D and -0.22 ± 0.19 D in SMILE group (P < .01 and P = .135), respectively. Thirty-four eyes (94%) and 32 eyes (89%) in SMILE Xtra group and 36 eyes (91%) and 39 eyes (98%) in SMILE group exhibited target MRSE and manifest cylinder within ±0.50 D (P = .771 and P = .294), respectively. Compared with SMILE group, spherical correction index (SCI), correction index (CI), and difference vector were higher in SMILE Xtra group since 1-week follow-up (all P < .05). SCI and CI were slightly more than 1.0 after SMILE Xtra even at postoperative 12-month follow-up. CONCLUSIONS With CXL protocol of 30 mW/cm2 for 90 seconds, SMILE Xtra exhibited comparable astigmatic correction with SMILE up to 1-year follow-up, although slight spherical equivalent and astigmatic overcorrection were evident after SMILE Xtra.
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Jun I, Kang DSY, Arba-Mosquera S, Reinstein DZ, Archer TJ, Jean SK, Kim EK, Seo KY, Lee HK, Kim TI. Comparison of clinical outcomes between vector planning and manifest refraction planning in SMILE for myopic astigmatism. J Cataract Refract Surg 2021; 46:1149-1158. [PMID: 32347695 DOI: 10.1097/j.jcrs.0000000000000100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare clinical outcomes of small-incision lenticule extraction (SMILE) between manifest refraction (MR) and vector planning for myopic astigmatism with high ocular residual astigmatism (ORA). SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Prospective, randomized, comparative case series. METHODS Patients with myopic astigmatism and ORA of 0.75 diopters (D) or greater were randomized into the MR or vector planning group and underwent SMILE without applying any nomogram for cylinder correction. Visual acuity, MR, corneal topography, and corneal aberration were measured preoperatively and postoperatively. Outcomes at 6 months postoperatively were compared between the groups. RESULTS The study comprised 114 patients (114 eyes): 58 eyes in MR planning and 56 eyes in vector planning. The mean uncorrected and corrected distance visual acuity, safety and efficacy indices were comparable between the 2 groups. Postoperative refractive cylinder reached statistically significant differences between the groups (-0.22 ± 0.18 D and -0.14 ± 0.16 D in the MR and vector planning groups, respectively, P = .02). Postoperative corneal toricity and ORA reached statistically significant lower in the vector planning group. CONCLUSIONS In myopic astigmatism with high ORA, MR and vector planning in SMILE were effective with comparable visual outcomes; vector planning showed statistically significant lower postoperative refractive and corneal astigmatism and ORA. Use of vector planning may improve refractive outcomes in SMILE cases with high ORA. However, the results may have been different had a nomogram adjustment been applied, as is often used for cylinder corrections with SMILE.
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Affiliation(s)
- Ikhyun Jun
- From the Department of Ophthalmology (Jun, E. K. Kim, Seo, Lee, T.-i. Kim), The Institute of Vision Research, Department of Ophthalmology (Jun, E.K. Kim, T.-i. Kim), Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Eyereum Eye Clinic (Kang, Jean), Seoul, South Korea; Research and Development (Arba-Mosquera), Biomedical Engineering Office, SCHWIND eye-tech-solutions, Kleinostheim, Germany; London Vision Clinic (Reinstein, Archer), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, NY, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Biomedical Science Research Institute, University of Ulster (Reinstein, Archer), Coleraine, Northern Ireland
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Zhang R, Wei H, Jhanji V, Sun L, Li J, Jiang J, Zhuang S, Zhang M. Comparison of corneal aberrations and refractive outcomes after small-incision lenticule extraction and femtosecond-assisted laser-assisted in situ keratomileusis. Int Ophthalmol 2021; 41:2521-2531. [PMID: 33783676 DOI: 10.1007/s10792-021-01810-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSES To retrospectively compare the short-term refractive outcomes and corneal aberrations after small-incision lenticule extraction (SMILE) and femtosecond-assisted laser-assisted in situ keratomileusis (FS-LASIK) combined with smart pulse technology (SPT) in patients with compound myopic astigmatism. METHODS A total of 91 eyes (91 patients) were included, 43eyes in FS-LASIK group and 48 eyes in the SMILE group. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive results and corneal topography were evaluated 1 and 3 months postoperatively. Corneal aberrations of anterior corneal surface were calculated from the topography data over 6 mm-diameter. RESULTS There was no significant difference in UCVA, BCVA, and refractive results between the two groups. There were no statistical difference in TIA (target induced astigmatism), SIA (surgery induced astigmatism), DV (difference vector), ME (magnitude of error), AE (angle of error), AE (absolute value) and CI (correction index) between both groups at 1 and 3 months. Coma and spherical aberration improved in all the patients in both groups at 1 and 3 months postoperatively. The amount of induced spherical aberrations was higher in FS-LASIK group compared to SMILE group. CONCLUSIONS Both FS-LASIK and SMILE achieved similar refractive outcomes in patients with myopia and compound myopic astigmatism. FS-LASIK combined with SPT resulted in higher spherical aberration than SMILE in early postoperative period.
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Affiliation(s)
- Riping Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.
| | - Heng Wei
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Vishal Jhanji
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lixia Sun
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jinyu Li
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jingjing Jiang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Suoqing Zhuang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
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Functional Optical Zone and Visual Quality After Small-Incision Lenticule Extraction for High Myopic Astigmatism. Ophthalmol Ther 2021; 10:273-288. [PMID: 33548046 PMCID: PMC8079587 DOI: 10.1007/s40123-021-00330-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/09/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction The aim of this study was to compare the functional optical zone (FOZ) after correction of high myopic astigmatism and low myopic astigmatism by small-incision lenticule extraction (SMILE). Methods In this prospective study, 30 patients who received SMILE for high myopic astigmatism correction (cylinderical diopters ≤ − 2.0D) were enrolled in the high astigmatism group (HA). The control group comprised 40 patients who underwent SMILE for low myopic astigmatism correction (LA; cylinderical diopters ≥ − 0.5D). FOZ was delineated as the area outlined by a change of 0.5D relative to the power at the corneal vertex on the total corneal refractive power map. An ellipse-fitting program (MatLab) was used to calculate some parameters of the FOZ. Visual quality evaluations were also conducted, including evaluations of wavefront aberrations, optical quality, and intraocular scattering, and completion of a quality of life questionnaire. All of the right eyes were analyzed in the study. Results The preoperative average treatment spherical equivalent (− 5.77 ± 1.86D vs. − 6.49 ± 1.49D; P = 0.074), lenticule thickness (120.87 ± 23.27 μm vs. 118.53 ± 21.66 μm; P = 0.666), and programmed optical zone (6.58 ± 0.17 mm vs. 6.65 ± 0.18 mm; P = 0.104) were comparable between the HA and LA groups. The long axes (6.99 ± 1.14 mm vs. 5.32 ± 0.61 mm; P < 0.001), short axes (4.66 ± 0.96 mm vs. 4.23 ± 0.64 mm; P = 0.047), and area (25.90 ± 8.03 mm2 vs. 17.92 ± 4.36 mm2; P < 0.001) of the FOZ were significantly larger in the HA group than in the LA group. The centration of the FOZ were comparable between the two groups (0.62 ± 0.25 mm vs. 0.70 ± 0.25 mm; P = 0.194). Postoperative spherical aberration was lower in the HA group than in the LA group (0.07 ± 0.05 μm vs. 0.14 ± 0.10 μm; P = 0.001). There was no significant difference in the ocular scatter index (0.80 ± 0.46 vs. 0.73 ± 0.46; P = 0.447), modulated transfer function (MTF)cutoff (37.89 ± 9.79 cpd vs. 39.78 ± 7.45 cpd; P = 0.363), and Strehl in two dimensions (Strehl2D) ratio (0.20 ± 0.04 vs. 0.20 ± 0.04; P = 0.363) between the HA group and the LA group. There were no significant differences in the scores on quality of life between the HA and LA groups (45.88 ± 2.15 vs. 45.64 ± 1.84; P = 0.423). Correlation analysis revealed that increase in the spherical aberration was significantly correlated with the long axes, short axes and area in the FOZ in both groups. Conclusion With a comparable optical design and attempted correction in SMILE, the eyes with higher myopic astigmatism correction achieved larger FOZ than the eyes with lower myopic astigmatism correction. Consequently, less spherical aberration induction was created after higher myopic astigmatism correction. This result may be associated with less corneal volume sculpted by laser for the higher astigmatism treatment, leading to fewer biochemical responses and les change in corneal aspherity. Good retinal image quality and satisfied quality of life were achieved at a comparable level in both study groups.
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Hou X, Du K, Wen D, Hu S, Hu T, Li C, Tang Y, Wu X. Early visual quality outcomes after small-incision lenticule extraction surgery for correcting high myopic astigmatism. BMC Ophthalmol 2021; 21:48. [PMID: 33468105 PMCID: PMC7816348 DOI: 10.1186/s12886-021-01807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate early optical quality outcomes after small-incision lenticule extraction (SMILE) surgery for correcting high myopic astigmatism. Methods This retrospective study enrolled 55 eyes from 37 patients who had preoperative myopic astigmatism of ≥2.00 diopters (D) who had been treated with SMILE surgery. Preoperatively, the mean cylinder was − 2.41 ± 0.54 D (range, − 2.00 D to − 4.50 D). The preoperative and postoperative visual outcomes, refraction, and higher-order aberration (HOA) at 1 and 3 months were compared. Refractive astigmatism changes were analyzed by the Alpins vector method. Results Three months after SMILE surgery, the average cylinder was − 0.14 ± 0.31 D, and the average astigmatism vector was − 0.09 D × 6.34°. The angle of error (AofE) was limited to within ±10°, and the magnitude of error was limited to within ±1.0 D in all patients. The correction index (CI) was 0.98 ± 0.07, the index of success (IOS) was 0.08 ± 0.13, and the flattening index (FI) was 0.97 ± 0.07. Significant positive correlations were found between IOS and |AofE| (P = 0.000); negative correlations were found between FI and |AofE| (P = 0.000). The postoperative total HOA, spherical aberration, vertical coma aberration, and trefoil 30° were increased significantly compared with preoperative measurements, and the increase in HOA was closely related to preoperative astigmatism (P < 0.05). Conclusions SMILE has preferable outcomes for correcting high myopic astigmatism. Axis rotation during the surgery might influence the undercorrection of astigmatism. The increase of HOA after surgery is related to preoperative astigmatism.
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Affiliation(s)
- Xiangtao Hou
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Kaixuan Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Dan Wen
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Shengfa Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Tu Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Chenling Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Yanhui Tang
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Xiaoying Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China.
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Kim BK, Chung YT. Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for high astigmatism. BMC Ophthalmol 2021; 21:23. [PMID: 33422053 PMCID: PMC7796618 DOI: 10.1186/s12886-020-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism. Methods This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method. Results Twenty-four months after the combined procedure, the average spherical equivalent was reduced from − 6.56 ± 2.38 D to − 0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to − 0.02 ± 0.09 and from − 0.03 ± 0.07 D to − 0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was − 5.48 ± 1.17 D, which was reduced to − 2.27 ± 0.97 D and − 0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p < 0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.
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Affiliation(s)
- Bu Ki Kim
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Republic of Korea
| | - Young Taek Chung
- Onnuri Eye Hospital, 325, Baekje-daero, Wansan-gu, Jeonju-si, Jeollabuk-do, Republic of Korea.
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Reinstein D, Archer TJ, Yong Kang DS. Reply to comment on: Comparison of clinical outcomes between vector planning and manifest refraction planning in small-incision lenticule extraction for myopic astigmatism. J Cataract Refract Surg 2021; 47:142-143. [PMID: 33901097 DOI: 10.1097/j.jcrs.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dan Reinstein
- London Vision Clinic, London, United Kingdom Department of Ophthalmology, Columbia University Medical Center, New York, New York, Centre Hospitalier National d'Ophtalmologie, Paris, France, Biomedical Science Research Institute, University of Ulster, Coleraine Northern Ireland
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Moshirfar M, Thomson AC, West WB, Hall MN, McCabe SE, Thomson RJ, Ronquillo YC, Hoopes PC. Initial Single-Site Experience Using SMILE for the Treatment of Astigmatism in Myopic Eyes and Comparison of Astigmatic Outcomes with Existing Literature. Clin Ophthalmol 2020; 14:3551-3562. [PMID: 33154614 PMCID: PMC7607143 DOI: 10.2147/opth.s276899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess a single site’s initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature. Patients and Methods Forty-eight eyes (29 patients) with mean preoperative sphere of −5.11 ± 1.31 diopters (D) and cylinder of −1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >−0.50 to ≤−3.00 D. Results At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to −0.38 ± 0.38 D with 78.1% achieving ≤±0.50 D. Uncorrected distance visual acuity (UDVA) ≥20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of <−1.00 D, ≥−1.00 to <−2.00 D, and ≥−2.00 D, respectively. Mean angle of error was −1.58 ± 11.61° ranging from −24.22° to 37.75°. Conclusion We found SMILE to be an effective and safe means of achieving spectacle independence and improving visual acuity in patients with myopic astigmatism. SMILE has the potential for improved clinical outcomes with better nomogram guidance and advancements in technique. However, surgeons must be aware of the potential for undercorrection in with-the-rule astigmatism and at higher preoperative cylinders and as well as the potential for overcorrection in against-the-rule and lower preoperative cylinder astigmatism.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.,Utah Lions Eye Bank, Murray, UT, USA
| | - Andrew C Thomson
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William B West
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - MacGregor N Hall
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Robert J Thomson
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Arba Mosquera S, Verma S. A review of clinical outcomes following SMILE for the treatment of astigmatism. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1810017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
| | - Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
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Yang X, Liu Q, Lin H, Xie Y, Feng Q. Long-term Vector Outcomes of SMILE in Correcting Moderate to High With-the-Rule Astigmatism Under Astigmatism Axis Marked Condition. J Refract Surg 2020; 36:585-591. [PMID: 32901825 DOI: 10.3928/1081597x-20200714-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the vector outcomes of small incision lenticule extraction (SMILE) in correcting moderate to high myopic astigmatism under astigmatic axis marked condition. METHODS In a prospective, longitudinal, interventional study, 71 eyes (71 patients) that had with-the-rule preoperative cylinder refraction exceeding 1.50 diopters (D) were corrected with the VisuMax femtosecond laser (Carl Zeiss Meditec AG) at Zhongshan Ophthalmic Center. Refractive outcomes and astigmatic vector were evaluated preoperatively and at 1, 3, 6, and 30 months postoperatively. RESULTS At 30 months postoperatively, the efficacy and safety indexes were 1.04 ± 0.18 and 1.15 ± 0.17, respectively. The magnitude of the surgically induced astigmatism (SIA) (2.13 ± 0.71 D at 1 month [P1m-pre = .018], 2.12 ± 0.72 D at 3 months [P3m-pre = .006], 2.13 ± 0.69 D at 6 months [P6m-pre = .010], and 2.19 ± 0.72 D at 30 months [P30m-pre < .001]) was slightly higher than that of the target induced astigmatism (TIA) (2.07 ± 0.69 D). Only the y-coordinate of the SIA vector had a significant overcorrection compared to that of the TIA vector (P1m-pre = .033, P3m-pre = .011, P6m-pre = .012, P30m-pre < .001). The corrected index (CI = |SIA|/|TIA|) varied from 1.03 ± 0.07 at 1 month to 1.06 ± 0.10 at 30 months, which was higher when correcting moderate astigmatism than when correcting high astigmatism (P = .041) at 30 months postoperatively. CONCLUSIONS SMILE had long-term safety, efficacy, predictability, and stability when correcting moderate to high myopic astigmatism under astigmatism axis marked condition. Meanwhile, a cylinder overcorrection was observed due to the overcorrection of y-coordinate astigmatic power, which implied that the vector adjustment of the cylinder refraction nomogram should be considered. [J Refract Surg. 2020;36(9):585-591.].
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Wan T, Yin H, Wu Z, Yang Y. Vector analysis of small incision lenticule extraction and toric implantable collamer lens implantation for astigmatism correction. Eur J Ophthalmol 2020; 31:994-1001. [PMID: 32468871 DOI: 10.1177/1120672120930607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the efficacy of small incision lenticule extraction (SMILE) and toric implantable collamer lens (TICL) implantation for myopic astigmatism correction using vector analysis. METHODS In this retrospective study, 171 eyes of 171 patients with cylinder ⩾1.0 diopters (D) were recruited, with 97 eyes underwent SMILE and 74 eyes underwent TICL implantation. Preoperative and 3-months postoperative visual and refractive results were examined. The astigmatism correction, graded by the degree of preoperative cylinder was compared between two groups using vector analysis. RESULTS At 3-months postoperatively, the residual cylinder was -0.10 ± 0.21 D in the SMILE group and -0.30 ± 0.32 D in the TCL group (p < 0.05). Furthermore, 98% and 85% of eyes had the cylinder within ±0.5 D in the SMILE and TICL group, respectively. The vector analysis revealed similar target induced astigmatism vector in two groups. However, the difference vector, magnitude of error, angle of error, and index of success were significantly higher (0.30 ± 0.32 D, -0.19 ± 0.25, -2° ± 4.35°, and 0.16 ± 0.17 D, respectively) in the TICL group than the values in the SMILE group (0.10 ± 0.21 D, -0.05 ± 0.20, -0.03° ± 2.13°, and 0.05 ± 0.12, respectively), regardless of the degree of preoperative cylinder (all p < 0.05). For preoperative cylinder < 2.0 D, surgically induced astigmatism vector and correction index in the SMILE group were higher than those in the TICL group (p < 0.05). CONCLUSION Both SMILE and TICL implantation are effective techniques for myopic astigmatism correction. However, the accuracy of correction in the magnitude and axis of astigmatism with SMILE was better than that achieved with TICL implantation.
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Affiliation(s)
- Ting Wan
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Houfa Yin
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyi Wu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yabo Yang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Zhong Y, Li M, Han T, Fu D, Zhou X. Four-year outcomes of small incision lenticule extraction (SMILE) to correct high myopic astigmatism. Br J Ophthalmol 2020; 105:27-31. [PMID: 32201375 DOI: 10.1136/bjophthalmol-2019-315619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the long-term outcomes of small incision lenticule extraction (SMILE) in subjects with myopic astigmatism of ≥2.00 dioptres (D). METHODS Patients who underwent SMILE 4 years prior with astigmatism ≥2.00 D and ≤1.00 D were assigned to the high astigmatic group (HA group) or the low astigmatic group (LA group), respectively. The visual and refractive results as well as corneal wavefront aberrations were measured. RESULTS The preoperative cylinder was -2.47±0.54 D in 43 eyes in the HA group and -0.55±0.28 D in 31 eyes in the LA group. At 4 years, the residual cylinder was -0.31±0.29 D in the HA group and -0.20±0.28 D in the LA group (p=0.088). An uncorrected distance visual acuity of 20/20 was achieved in 88.4% of eyes in the HA group and 93.5% of eyes in the LA group. The efficacy index was 0.99±0.14 and 1.10±0.21 (p=0.025), and the safety index was 1.11±0.20 and 1.22±0.21 in the HA and LA groups, respectively (p=0.012). Eighty-six per cent and 90.3% of eyes were within ±0.50 D of the attempted cylindrical correction in the HA and LA groups, respectively. Vector analysis showed that the magnitude of error was -0.14±0.28 D and -0.05±0.16 D (p=0.085), the angle of error was -0.13±4.48 degrees and -2.57±29.42 degrees (p=0.592), the correction index was 0.94±0.13 and 0.94±0.35 (p=0.959), the index of success was 0.15±0.14 and 0.46±0.62 (p=0.517), and the flattening index was 0.93±0.13 and 0.71±0.59 (p=0.450) in the HA and LA groups, respectively. CONCLUSIONS This study demonstrates that SMILE is effective and safe for correcting high astigmatism. Vector analysis shows a tendency for the undercorrection of astigmatism in subjects with high astigmatism.
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Affiliation(s)
- Yuanyuan Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China
| | - Meng Li
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Tian Han
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China .,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Small-Incision Lenticule Extraction (SMILE) for the Correction of Myopia with Astigmatism: Outcomes of the United States Food and Drug Administration Premarket Approval Clinical Trial. Ophthalmology 2020; 127:1020-1034. [PMID: 32173114 DOI: 10.1016/j.ophtha.2020.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To present outcomes of the United States Food and Drug Administration premarket approval clinical trial of small-incision lenticule extraction (SMILE) for the correction of myopia and astigmatism. DESIGN Prospective, multicenter clinical trial. PARTICIPANTS The study included 357 eyes of 357 patients treated with SMILE (50 for myopia and 307 for myopia with astigmatism). Preoperative sphere ranged between -1.00 and -10.00 diopters (D), with manifest spherical equivalent (MSE) of up to -11.50 D and refractive cylinder of up to -3.00 D. METHODS -Participants were followed up for 12 months. Corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA), stability of the manifest refraction, and vector analysis of refractive cylinder are presented for the 307 eyes treated for myopia with astigmatism. Adverse events (AEs) are presented for all 357 eyes. MAIN OUTCOME MEASURES Corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction, astigmatic outcomes, and adverse events. RESULTS Of the 307 astigmatic eyes enrolled in the study, 304 were treated successfully. In 3 eyes, the procedure was aborted because of intraoperative suction loss. The mean MSE reduced from -5.39±2.30 D at baseline to -0.01±0.24 D at 12 months. Of all eyes, 95.3% were within 0.50 D of emmetropia at 12 months. The percentage of eyes with UDVA of 20/20 or better was 89.0%. No loss of 2 or more lines of CDVA was observed at the 12-month visit. The refractive cylinder reduced from -1.53±0.70 D at baseline to -0.18±0.31 D at 12 months. The mean correction ratio of refractive cylinder was 0.96±0.16 and a slight undercorrection was apparent for higher attempted corrections of astigmatism. Three intraoperative AEs associated with difficult lenticule removal and resultant cap tear occurred, and all resolved without sequelae at postoperative day 1. During the postoperative period, 8 AEs were recorded, but none of them had significant consequences. CONCLUSIONS Small-incision lenticule extraction for the treatment of myopia and astigmatism was safe and effective, and the reported AEs had no significant impact on visual acuity. Slight undercorrection of refractive cylinder requires further attention.
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Hiep NX, Khanh PTM, Quyet D, Thai TV, Nga VT, Dinh TC, Bac ND. Outcomes of Small Incision Lenticule Extraction for Myopic Astigmatic Treatment. Open Access Maced J Med Sci 2019; 7:4272-4277. [PMID: 32215076 PMCID: PMC7084039 DOI: 10.3889/oamjms.2019.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND: Some studies have shown that there is a certain rotation of the eye in the sitting and lying position of the patient. The Visumax system used for the Refractive Lenticule Extraction-Small Incision Lenticule Extraction (ReLEx SMILE) surgery lacks the rotation of eye control function. So, is the ReLEx SMILE surgery for patients with astigmatism safe and effective? AIM: To evaluate the outcomes of the ReLEx SMILE surgery in cases with myopic astigmatism. METHODS: The case series included 120 eyes with myopic astigmatism undergoing ReLEx SMILE surgery from January 2018 to November 2018. The distribution of patients for two subgroups based on the power of astigmatism, low astigmatic group (≤ 1.50D) and high astigmatic group (> 1.50D). All patients were measured UDVA, CDVA, refractive sphere, astigmatism and sphere equivalent before and after surgery one week, one month and three months carefully. The astigmatic correction was evaluated by the vectorial analysis Alpins. RESULTS: The mean efficacy index of the low and high astigmatic group was 1.035 and 1.082 (respectively); the mean safety index was 1.113 and 1.215 (respectively). 93% of eyes in the low astigmatic group had an angle of error (AE) within ± 15 degrees and 100% in high astigmatic group. There was an undercorrection in astigmatic treatment. No complications during and after surgery were recorded. CONCLUSION: ReLEx SMILE surgery for the myopic astigmatic treatment was safe and effective.
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Affiliation(s)
| | | | - Do Quyet
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Than Van Thai
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
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Schallhorn JM, Seifert S, Schallhorn SC. SMILE, Topography-Guided LASIK, and Wavefront-Guided LASIK: Review of Clinical Outcomes in Premarket Approval FDA Studies. J Refract Surg 2019; 35:690-698. [DOI: 10.3928/1081597x-20190930-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
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Unwanted Astigmatism and High-order Aberrations One Year after Excimer and Femtosecond Corneal Surgery. Optom Vis Sci 2019; 95:1064-1076. [PMID: 30339639 DOI: 10.1097/opx.0000000000001298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
SIGNIFICANCE Small incision lenticule extraction (SMILE) is advanced as the most minimally invasive and least traumatic corneal procedure for correcting refractive errors using a single laser. Although SMILE obtains similar results to femtosecond laser in situ keratomileusis (LASIK) with spherical myopia, it has deficiencies in astigmatism correction. PURPOSE The purpose of this study was to compare refractive outcomes and high-order aberrations (HOAs) between SMILE and femtosecond LASIK corneal procedures at 1 year post-operative. METHODS Ninety-two patients (181 eyes) with myopia/myopic astigmatism underwent either SMILE (group 1) or femtosecond LASIK (group 2). The refractive target was to achieve emmetropia in all cases. Data were analyzed to determine significance of change in refraction and HOAs. Furthermore, astigmatism was subjected to vector analysis using the Thibos (calculation of change, Δ, in J0 and J45 values) and Alpins (calculation of difference, ΔC, between target-induced astigmatism [TIA] and surgically induced astigmatism) methods. RESULTS Forty-five patients (89 eyes) from group 1 and 47 patients (92 eyes) from group 2 completed the study. The main significant (P ≤ .001) findings were as follows: (a) residual astigmatism was greater in group 1; (b) group 1, ΔJ0 = 1.015J0 + 0.040 (R = 0.861), ΔJ45 = 1.082J45 + 0.019 (R = 0.792), ΔC = 0.401TIA + 0.323 (R = 0.489), and mean spherical aberration increased from -0.003 (SD, ±0.059; 95% confidence interval [CI], -0.015 to 0.009) to 0.028 μm (SD, ±0.041; 95% CI, -0.037 to -0.020); and (c) group 2, ΔJ0 = 0.952J0 - 0.005 (R = 0.921), ΔJ45 = 0.962J45 - 0.002 (R = 0.923), ΔC = 0.187TIA + 0.101 (R = 0.272), mean coma reduced from 0.114 (SD, ±0.087; 95% CI, 0.096 to 0.132) to 0.077 μm (SD, ±0.059; 95% CI, 0.065 to 0.089), and trefoil from 0.089 (SD, ±0.049; 95% CI, 0.079 to 0.0990) to 0.056 μm (SD, ±0.047; 95% CI, 0.046 to 0.066). CONCLUSIONS In comparison with SMILE, femtosecond LASIK offered better precision in the overall control of astigmatism and HOAs.
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Shetty N, Dadachanji Z, Narasimhan R, Kundu G, Khamar P, Ahuja P, Kumar V, Kumar V, Shetty R, Nuijts RMMA, Sinha Roy A. Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK. J Refract Surg 2019; 35:624-631. [PMID: 31610003 DOI: 10.3928/1081597x-20190916-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].
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Wang Y, Ma J. Future Developments in SMILE: Higher Degree of Myopia and Hyperopia. Asia Pac J Ophthalmol (Phila) 2019; 8:412-416. [PMID: 31490200 PMCID: PMC6784781 DOI: 10.1097/01.apo.0000580128.27272.bb] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022] Open
Abstract
Small incision lenticule extraction (SMILE) is a novel 1-step refractive procedure with femtosecond laser for the correction of myopia and myopic astigmatism. Although it has shown good clinical results in efficacy, safety, predictability, and stability, there are still some concerns. In this study, we review the published clinical outcomes of high myopia correction and exploration in hyperopia correction. Results have suggested that SMILE has acceptable outcomes in correction for high myopia <10.0 diopters (D), and it is a feasible and effective procedure for the treatment of hyperopia. However, it is unsuitable for the treatment of extremely high myopia because there is undercorrection and regression as existed in laser-assisted in situ keratomileusis (LASIK), and compound hyperopic astigmatism currently could not be corrected either. More technical and clinical improvements are required to make SMILE competitive.
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Affiliation(s)
- Yan Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
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Nagaraja H, Mehta JS, Zhou X, Yam JC, Lam DS. Will SMILE Become the New Benchmark of Corneal Laser Refractive Surgery? Asia Pac J Ophthalmol (Phila) 2019; 8:351-354. [PMID: 31567435 PMCID: PMC6784770 DOI: 10.1097/01.apo.0000579956.14784.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Harsha Nagaraja
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
| | - Jodhbir S. Mehta
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
| | | | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Dennis S.C. Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
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Chow SS, Chow LL, Lee CZ, Chan TC. Astigmatism Correction Using SMILE. Asia Pac J Ophthalmol (Phila) 2019; 8:391-396. [PMID: 31490198 PMCID: PMC6784860 DOI: 10.1097/01.apo.0000580140.74826.f5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022] Open
Abstract
Small incision lenticule extraction (SMILE) was introduced in the recent decade for the treatment of myopia and myopic astigmatism. This flap-free technique has a high efficacy and safety profile and also carries potential advantages over laser in situ keratomileusis such as a better corneal biomechanical stability, reduction in dry eyes rate, and the avoidance of flap complications. However, there have been concerns regarding the precision of astigmatism correction that undercorrection has been reported to be apparent. Various factors that affect astigmatism correction have been identified in the literature. The purpose of this review is to discuss the factors that affect astigmatism correction in SMILE and several techniques to improve the refractive outcomes.
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Affiliation(s)
- Sharon S.W. Chow
- Department of Ophthalmology, Grantham Hospital, Hong Kong, China
| | | | - Chester Z. Lee
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tommy C.Y. Chan
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Fourier Analysis of Corneal Irregular Astigmatism After Small Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted Laser In Situ Keratomileusis. Cornea 2019; 38:1536-1542. [DOI: 10.1097/ico.0000000000002029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xu J, Liu F, Liu M, Yang X, Weng S, Lin L, Lin H, Xie Y, Liu Q. Effect of Cyclotorsion Compensation With a Novel Technique in Small Incision Lenticule Extraction Surgery for the Correction of Myopic Astigmatism. J Refract Surg 2019; 35:301-308. [DOI: 10.3928/1081597x-20190402-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
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Klokova OA, Sakhnov SN, Geydenrikh MS, Damashauskas RO. Quality of life after refractive surgery: ReLEx SMILE vs Femto-LASIK. Clin Ophthalmol 2019; 13:561-570. [PMID: 30988598 PMCID: PMC6440445 DOI: 10.2147/opth.s170277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The safety and effectiveness of complex myopic astigmatism correction using ReLEx SMILE or Femto-LASIK techniques have been well established. The purpose of the current study is to compare quality of life (QoL) outcomes following ReLEx SMILE or Femto-LASIK procedures in parallel with functional vision and anatomic outcomes of treated eyes. Patients and methods This prospective, consecutive series included 118 patients, 18–43 years of age, out of which 56 underwent ReLEx SMILE and 62 underwent Femto-LASIK surgery for correction of myopic astigmatism. All patients underwent standard comprehensive ophthalmic examinations, and additionally, completed The Quality of Life Impact of Refractive Correction Questionnaire to determine the impact the vision-correction treatment had on their QoL. Results In both treatment groups, the postoperative refractive outcomes were comparable, with visual acuity improvements for both groups noted the day following surgery. After laser correction of complex myopic astigmatism using Femto-LASIK and ReLEx SMILE methods, the overall QoL indicators are statistically significant (P<0.01) exceeding preoperative values 1 month after the operation and reaching the maximum values by the end of the observation period (P<0.0001). Conclusion The results of the study suggest that patients require some time to adapt to their new visual function and its impact on their daily living, delaying detectable improvements in QoL. Moreover, these results may suggest a higher satisfaction trend and long-term QoL in patients undergoing ReLEx SMILE in comparison to Femto-LASIK. Long-term results from the study demonstrated high patient satisfaction with both methods.
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