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Lin Q, Shen Z, Zhou X. Intensive topical steroid regimen for enhanced very early recovery after small incision lenticule extraction. Int Ophthalmol 2023; 43:4097-4103. [PMID: 37561251 PMCID: PMC10520117 DOI: 10.1007/s10792-023-02827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This study aims to investigate the topical steroid regimen after small incision lenticule extraction (SMILE) for its effect on very early restoration of visual quality. METHODS A total of 180 patients (360 eyes) who underwent SMILE were enrolled. These patients were randomly assigned to three groups, with 60 patients in each group. The only difference among these three groups was the administration of 0.1% fluorometholone (FML) eye drops within two hours after SMILE: no FML in group A, 0.1% FML once every hour in group B and 0.1% FML once every half hour in group C. The corrected distance visual acuity (CDVA), objective scattering index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and incidence of subjective symptoms were evaluated preoperatively, at 2, 4 and 24 h and one week after SMILE. RESULTS The CDVA, MTF cut-off and SR values were significantly higher in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). Furthermore, the OSI and incidence of subjective symptoms were significantly lower in group C, when compared to the other two groups, at 2 and 4 h after SMILE (p < 0.05). However, no significant differences in CDVA, MTF cut-off, SR, OSI and the incidence of subjective symptoms were detected among the three groups at 24 h and one week after SMILE (p > 0.05). CONCLUSION The administration of 0.1% FML eye drops every half hour within two hours after SMILE accelerates the restoration of visual and optical quality, and reduces the incidence of subjective symptoms during the very early phase after surgery.
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Affiliation(s)
- Qinghong Lin
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China
| | - Zhengwei Shen
- Department of Refractive Surgery, Bright Eye Hospital, Fuzhou, 350000, China.
- Department of Refractive Surgery, Wuhan Bright Eye Hospital, No.179 Zhongshan Road, Wuhan, 430000, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, No.83 Fenyang Road, Shanghai, 200000, China.
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Comparison of Corneal Densitometry and Visual Quality after Small Incision Lenticule Extraction (SMILE) and Laser Epithelial Keratomileusis (LASEK): One-Year Comparative Study. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3430742. [PMID: 36778055 PMCID: PMC9911227 DOI: 10.1155/2023/3430742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Purpose To investigate changes in corneal densitometry (CD) and visual quality following small incision lenticule extraction (SMILE) and laser epithelial keratomileusis (LASEK) in patients with mild-to-moderate myopia. Methods A retrospective analysis was performed on 24 and 25 patients (46 eyes each) who underwent SMILE and LASEK, respectively, for mild-to-moderate myopia. The visual quality and CD values were recorded. Using the Pentacam Scheimpflug system, CD values were collected in three concentric optical zones at the depths of the anterior, central, and posterior layers. Efficacy, safety, predictability, corneal wavefront aberrations, and QoV scores were measured to evaluate visual quality. A correlation analysis was performed between changes in CD and clinical characteristics. Results There were no statistical differences in efficacy and safety indices between the two groups. At 3 months postoperatively, a pronounced reduction in several zones was observed in the LASEK group (p < 0.05), whereas no obvious change was observed in the SMILE group. There were obvious changes in the CD values in several zones in the SMILE and LASEK groups (p < 0.05) after 1 year. The magnitude of the CD changes in the anterior and central corneal layers was smaller in the SMILE group than in the LASEK group (all p < 0.05). Lower HOAs, spherical aberration, and horizontal comas of the anterior and whole corneal surfaces were observed in the SMILE group. QoV scores were similar between the two groups. Conclusion CD decreased in the SMILE and LASEK groups after 1 year; there was a smaller reduction in SMILE than in LASEK. SMILE and LASEK did not differ significantly in terms of safety and effectiveness in correcting mild-to-moderate myopia.
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Jee KJ, Ling J, Bafna S, Chester T, Augustine J, Wiley WF. Prospective, Randomized, Fellow Eye-Controlled Study of Postoperative Pain and Inflammation Control with an Intracanalicular Dexamethasone 0.4 mg Ophthalmic Insert Following Small Incision Lenticule Extraction. Clin Ophthalmol 2022; 16:3895-3904. [PMID: 36444207 PMCID: PMC9700473 DOI: 10.2147/opth.s390815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/11/2022] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare postoperative anterior chamber inflammation, pain, and patient preference following small incision lenticule extraction (SMILE) in eyes treated with a dexamethasone 0.4 mg intracanalicular insert (DEX) or topical prednisolone acetate (PRED). PATIENTS AND METHODS In this prospective, randomized, fellow eye-controlled trial, 20 patients underwent same-day, bilateral SMILE. One randomly-selected eye of each patient received DEX placed immediately postoperatively, and the fellow eye received topical PRED tapered over 2 weeks. Postoperative evaluations were performed on day 1, week 1, month 1, and month 3. Primary outcomes included postoperative pain, incidence of anterior chamber cell and flare, and patient preference of steroid therapy. RESULTS No eyes in either group had any clinically evident cell or flare at any postoperative time point. Mean pain scores (0-10 by subjective report) and incidence of any pain were statistically similar at all postoperative visits. Uncorrected distance visual acuity improved in all eyes, 91% of which achieved 20/25 or better. No eyes lost any lines of corrected distance visual acuity. Three eyes developed a steroid-related rise in intraocular pressure, all of which resolved with 2 of the 3 eyes requiring topical therapy. At 1 week, 1 month, and 3 months, 70%, 65%, and 53% of patients preferred DEX over PRED therapy, respectively. CONCLUSION The DEX insert was preferred by more patients and controlled postoperative inflammation and pain comparably to topical PRED in eyes undergoing SMILE. There were no statistically significant differences in visual outcomes between the two groups.
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Xu C, Yang D, Zhao W, Long Z, Zhang Z, Shen Y, Zhou X, Zhao J. Long-term changes in corneal densitometry and associated factors following small incision lenticule extraction for moderate and high myopia. Front Med (Lausanne) 2022; 9:945894. [PMID: 36160150 PMCID: PMC9492929 DOI: 10.3389/fmed.2022.945894] [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: 05/17/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate long-term trends in corneal densitometry and associated influencing factors following small incision lenticule extraction (SMILE). Methods A comparative study was performed among 72 eyes of 38 patients undergoing SMILE. Eyes were divided into moderate myopia [mean spherical equivalent (SE),−4.22 ± 0.68D] and high myopia (mean SE,−7.63 ± 1.09 D) groups. Visual acuity, manifest refraction, corneal topography and corneal densitometry (CD) were evaluated preoperatively and 3 years postoperatively. Results The efficacy indices at last postoperative follow-up (42.47 ± 0.51 months) were 0.92 ± 0.21 and 0.97 ± 0.22, the safety indices were 1.12 ± 0.17 and 1.14 ± 0.21 for high and moderate myopia, respectively (all P > 0.05). CD values in the 0–6 mm zone of the posterior corneal layer was statistically significantly lower than the preoperative values in both groups. Postoperative CD values (0–2 mm zone) in the posterior layer of the high myopia group were statistically significantly lower than in the moderate myopia group (P = 0.025); CD values (2–6 mm zone) in the anterior layer were higher in the high myopia group (P = 0.026). Correlation analyses showed that CD values in the 0–2 mm middle layer were negatively correlated with lenticule thickness in high myopia (r = −0.411, P = 0.016); there was a negative correlation between the CD values (0–6 mm) and corneal oblique trefoil in this group (P < 0.05). Conclusion Corneal transparency in the 0–6 mm zone of the posterior cornea increased following SMILE in moderate and high myopia. Long-term CD values in high myopia may be correlated with oblique trefoil and lenticule thickness.
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Affiliation(s)
- Changqin Xu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Department of Ophthalmology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Dongmei Yang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Wuxiao Zhao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhigang Long
- Department of Ophthalmology, Liuzhou Red Cross Hospital, Liuzhou, China
| | - Zhe Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), 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 and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Xingtao Zhou
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia, NHC Key Laboratory of Myopia (Fudan University), Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Jing Zhao
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Liu J, Tonk RS, Huang AM, Han E, Karp CL, Zeng M, Zou H, Zheng Y, Luo W, Sha X, Liu Z. Transient effect of suction on the retinal neurovasculature in myopic patients after small-incision lenticule extraction. J Cataract Refract Surg 2021; 46:250-259. [PMID: 32126039 DOI: 10.1016/j.jcrs.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To characterize retinal neurovasculature changes after small-incision lenticule extraction (SMILE) in myopic patients. SETTING Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, China. DESIGN Prospective interventional study. METHODS The corrected distance visual acuity/uncorrected distance visual acuity, corrected intraocular pressure (CIOP), and corneal tomography were evaluated at baseline (PRE), postoperative day (POD) 1, and POD 7. Ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were measured. The vessel area densities (VADs, %), vessel skeleton densities (VSDs, %), vessel diameter index (VDI), and fractal dimensions (Dbox) of the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were measured in a circular area (ϕ 2.5 mm) centered on the fovea. RESULTS A total of 38 myopic patients were recruited. The GCIPL thickness was increased after SMILE at POD 1 and POD 7 (P < .01) but no significant changes in the pRNFL thickness. The VAD, VSD, and Dbox of the SVP were decreased at POD 1 (P < .01), but not at POD 7. The VDI in small vessels of the SVP and DVP was decreased at POD 1 (P < .05) and increased at POD 7 (P < .05). Changes in CIOP were positively correlated with changes in the GCIPL thickness. Changes in CIOP were negatively correlated with changes in the VAD of small vessels and the Dbox of total vessels in the DVP. Changes in CIOP were negatively correlated with the VSD and VDI of small vessels in the DVP and changes in the VDI of big vessels in the SVP. CONCLUSIONS The transient fluctuations in the retinal neurovasculature after SMILE may represent a characteristic homeostasis pattern in patients after refractive surgery.
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Affiliation(s)
- Jiayan Liu
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University (Liu, Zeng, Zou, Zheng, Luo, Sha, Liu), Department of Ophthalmology, the Sixth Affiliated Hospital of Guangzhou Medical University (Liu), Qingyuan, China; and Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Tonk, Huang, Han, Karp), Miami, Florida, USA
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Wei R, Li M, Yang W, Shen Y, Zhao Y, Fu D, Shang J, Zhang J, Choi J, Zhou X. Corneal Densitometry After Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser-Assisted LASIK (FS-LASIK): 5-Year Prospective Comparative Study. Front Med (Lausanne) 2020; 7:521078. [PMID: 33240901 PMCID: PMC7681246 DOI: 10.3389/fmed.2020.521078] [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: 03/09/2020] [Accepted: 10/05/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate long-term changes in corneal densitometry (CD) following small incision lenticule extraction (SMILE) vs. femtosecond laser-assisted LASIK (FS-LASIK) in patients with myopia or myopic astigmatism. Methods: Prospective analysis was performed in 66 eyes of 38 patients (13 males) who underwent SMILE and 54 eyes of 29 patients (5 males) who underwent FS-LASIK. In all patients, an ocular examination was performed preoperatively, and at 6–12 months and 5 years postoperatively. CD was obtained with the Pentacam Scheimpflug imaging system at the 0–2-mm, 2–6-mm, and 6–10-mm zones of the cornea at depth of anterior 120 μm, midcornea, and posterior 60 μm. Correlation analysis was performed between postoperative change in CD and other variables such as age, type of surgery, central corneal thickness, spherical equivalent, lenticule thickness/ablation depth, and changes in wavefront aberrations. Results: At postoperative 6–12 months, a significant reduction at several corneal zones in the FS-LASIK cohort (P < 0.05) was observed. In the SMILE cohort, no significant change in CD relative to baseline was observed. However, at 5 years postoperatively, in both groups, a significant decrease in CD was observed in three zones of three layers (all P < 0.001). The change in CD was similar between groups at postoperative 6–12 months, but at 5 years the magnitude of change was significantly smaller in SMILE than FS-LASIK in the anterior and central layers (all P < 0.05). Conclusion: CD with the Scheimpflug imaging system showed a significant decrease at 5 years after SMILE or FS-LASIK, and the change was significantly less pronounced after SMILE.
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Affiliation(s)
- Ruoyan Wei
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Shen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Joanne Choi
- Department of Ophthalmology, Kresge Eye Institute, Wayne State University, Detroit, MI, United States
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Chen Y, Liao H, Sun Y, Shen X. Short-term changes in the anterior segment and retina after small incision lenticule extraction. BMC Ophthalmol 2020; 20:397. [PMID: 33028265 PMCID: PMC7539406 DOI: 10.1186/s12886-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE). Methods Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density. Results Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p < 0.05), while LT was thickened after surgery (p < 0.05). MT at the fovea decreased 1 day and 1 week after surgery (p < 0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. ΔACD and ΔLT showed no significant correlation 1 day after surgery. ΔACD was negatively correlated with ΔLT and sphere 1 week after surgery (r = − 0.847, p < 0.000; r = − 0.398, p = 0.002). ΔLT was positively correlated with the sphere 1 week after surgery (r = 0.256, p = 0.048). Conclusion The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
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Affiliation(s)
- Yanwei Chen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huaping Liao
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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