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Abing AA, Oh A, Ong LF, Marvasti AH, Tran DB, Lee JK. Surgical options and clinical outcomes for high myopia. Curr Opin Ophthalmol 2024; 35:284-291. [PMID: 38700946 DOI: 10.1097/icu.0000000000001053] [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 Higher degrees of myopia are currently being treated with refractive surgery. However, there is limited characterization and outcomes data for this cohort. This article aims to review the literature on highly myopic patients who had refractive surgery and present a retrospective analysis of 149 patients (270 eyes) with high to extreme myopia (≤-5.0D SE) who underwent refractive surgery [laser-assisted subepithelial keratomileusis (LASIK), photorefractive keratectomy (PRK), or implantable collamer lense (ICL)] at a single practice. RECENT FINDINGS There is substantial literature on the efficacy of LASIK, PRK, and phakic intraocular lenses for refractive error correction, but a dearth of studies on patients with high to extreme myopia undergoing different types of refractive surgery. Our study reveals that this cohort of patients has excellent outcomes with minimal complications. SUMMARY Our study reveals that the average preoperative myopia was highest in ICL patients (-10.03D), followed by PRK (-7.21D), and LASIK (-7.04D) patients. Not surprisingly, eyes with high myopia and thin corneas were offered and elected ICLs for their procedure. Highly myopic patients achieved outcomes consistent with data reported in the literature- average postoperative uncorrected visual acuity was 20/20 for LASIK and ICL eyes and 20/25 for PRK eyes.
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Affiliation(s)
| | - Alyce Oh
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Lauren F Ong
- California Northstate University College of Medicine, Elk Grove, California, USA
| | | | - Dan B Tran
- Coastal Vision Medical Group, Orange, California
| | - Jimmy K Lee
- Coastal Vision Medical Group, Orange, California
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Lai X, Liu X, Zeng T, Huang Y, Yang X. Comparison of visual outcomes and optical aberrations after SMILE with intraoperative Kappa angle adjustments between small and large Kappa angles. Sci Rep 2024; 14:14551. [PMID: 38914606 PMCID: PMC11196622 DOI: 10.1038/s41598-024-65366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
This study compares postoperative visual outcomes and optical aberrations after Small Incision Lenticule Extraction (SMILE) in patients with both small (S-Kappa: Kappa angle < 0.2 mm) and large Kappa (L-Kappa: Kappa angle ≥ 0.2 mm) angles. The evaluated aberrations include total higher-order aberrations (HOAs), horizontal coma (HC), vertical coma (VC), and spherical aberrations (SA), with procedures incorporating intraoperative Kappa angle adjustments. We retrospectively analyzed patient records undergoing SMILE utilizing linear mixed models (LMM). We assessed adjusted mean uncorrected distance visual acuity (UDVA), Strehl ratio (SR), total HOAs, VC, and SA at pupils of 3 mm and 6 mm for both S-Kappa and L-Kappa. The disparities between S-Kappa and L-Kappa were evaluated by LMM's adjusted mean differences. The differences in optical metrics were also assessed in eyes grouped by myopia levels: low, moderate, and high. A sensitivity analysis was conducted on a threshold of Kappa angle at 0.3 mm. Eight-five patients (169 eyes) were analyzed, and no significant pre-operative difference was found in UDVA (p = .222) or spherical equivalent (p = .433). Post-operative differences were found in SR at 3 mm pupil size (-0.06, p = .022), total HOA 3 mm (0.15, p = .022), HC 3 mm (0.04, p = .042), VC 3 mm and 6 mm (-0.08, p = .041; 0.04, p = .041). The stratified analysis for high myopia revealed significant differences in UDVA (-0.04, p = .037), HC 3 mm (0.07, p = .03), VC 6 mm (-0.21, p = .001), and SA 3 mm and 6 mm (0.07, p = .037; -0.09, p = .037). Sensitivity analysis showed no significant difference using a 0.3 mm Kappa threshold. While some optical aberrations exhibited statistical differences between S-Kappa and L-Kappa, their clinical significance is limited. Thus, a large Kappa angle might not substantially influence post-operative optical aberrations when intraoperative Kappa angle adjustments are implemented.
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Affiliation(s)
- Xiaojuan Lai
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Xi Liu
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China.
| | - Tao Zeng
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Yi Huang
- Department of Ophthalmology, The Second People's Hospital of Yibin, Yi'bin, 644000, China
| | - Xin Yang
- The University of Alabama, Tuscaloosa, AL, 35487, USA
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Zhang T, Zhu L, Zuo HJ, Chen ZJ, Ji Y, Yang X, Lu XR, Wu Q, Wang Q, Xia JY, Li M, Zhou CJ, Wang Y, Hu K, Wan WJ. Effectiveness and the nomogram of small incision lenticule extraction in the correction of myopic anisometropia in adults. Int J Ophthalmol 2023; 16:1838-1844. [PMID: 38028522 PMCID: PMC10626354 DOI: 10.18240/ijo.2023.11.16] [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: 02/13/2023] [Accepted: 08/18/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To evaluate the safety, effectiveness, and predictability of small incision lenticule extraction (SMILE) for the treatment of anisometropia, and to explore the personalized design scheme of SMILE in correcting adult myopia anisometropia based on the nomogram. METHODS It's a prospective cohort study. Patients with anisometropic myopia of refractive difference ≥ 2.0 diopters (D) who underwent SMILE between September 2020 and March 2021 were enrolled. Clinical features and visual function were assessed preoperatively and at 1wk, 1, 3, and 6mo after the operation. The examination included tests for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive errors, effectiveness index (preoperative CDVA/postoperative UDVA), safety index (postoperative CDVA/preoperative CDVA), nomogram and stereoscopic function. Paired t-test, Wilcoxon signed-rank test and repeated-measures analyses of variance were used for continuous variables, and Pearson Chi-squared test was used for categorical variables. RESULTS The study involved 45 consecutive patients (average age: 25.0±6.9y; 82 out of 90 eyes underwent SMILE, while 8 eyes were not operated). The average preoperative spherical equivalent (SE) was -4.74±0.22 D. Six months after surgery, the effectiveness index was 1.05±0.12, and the safety index was 1.09±0.11. Seventy eyes (85.4%) exhibited SE correction error within ±0.5 D. The percentage of eyes with Titmus stereoscopic function equal to or less than 200″ significantly increased from 55.6% preoperatively to 88.9% postoperatively (P<0.05). There was statistically significant difference between higher myopia eyes and contralateral eyes in average nomogram value/spherical refraction ratio. CONCLUSION SMILE is safe, effective and predictable in correcting myopic anisometropia, and it improves stereoscopic visual function of anisometropia patients. The precise and individualized design of the nomogram is a vital element to ensure the balance of both eyes after SMILE.
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Affiliation(s)
- Tong Zhang
- Chongqing Medical University, Chongqing 400000, China
| | - Lu Zhu
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Hang-Jia Zuo
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Zhi-Jun Chen
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Yan Ji
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Xin Yang
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Xiao-Rong Lu
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Qiong Wu
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Qing Wang
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Jiu-Yi Xia
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Meng Li
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Chun-Jiang Zhou
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Yao Wang
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Ke Hu
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, China
| | - Wen-Juan Wan
- Chongqing Medical University, Chongqing 400000, China
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing 400000, 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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Zhu L, Ji Y, Yang X, Lu X, Wu Q, Wang Q, Xia J, Li M, Hu K, Wan W. Corneal morphological changes after small incision lenticule extraction for myopic anisometropia. Front Med (Lausanne) 2022; 9:977586. [PMID: 36091674 PMCID: PMC9449128 DOI: 10.3389/fmed.2022.977586] [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: 06/24/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis research aims to study the corneal morphological changes in adult patients with myopic anisometropia after small incision lenticule extraction (SMILE) and the safety, efficacy, and predictability of clinical outcomes.MethodsThis was a prospective cohort study. Patients with myopic anisometropia [refractive difference >2.0 diopters (D)] were included in this study who underwent SMILE at our hospital from September 2019 to March 2021. For the two eyes of each patient, the one with higher myopia was defined as group A, and the fellow eye was group B. The follow-up time points were set as 1 week, 1 month, 3 months, and 6 months after the surgery. The data collected were uncorrected and best-corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), efficacy and safety indexes, posterior corneal elevation (PCE), anterior and posterior corneal radius of curvature in the 3 mm area at the center of the thinnest point of the cornea (ARC and PRC), and higher-order aberrations (HOAs).ResultsThe study included 36 patients (72 eyes), and the mean age was 25.2 ± 6.4 years. The preoperative SEs were −6.45 ± 1.25 D in group A and −3.76 ± 1.29 D in group B. Six months after surgery, the SEs in groups A and B were −0.09 ± 0.50 D and 0.07 ± 0.47 (P = 0.059), respectively. The efficacy indexes were 1.06 ± 0.16 in group A and 1.07 ± 0.14 in group B (P = 0.750). The safety indexes were 1.08 ± 0.14 in group A and 1.12 ± 0.15 in group B (P = 0.173). The PCE was significantly reduced at 6 months after surgery in pagebreak both groups (P < 0.05). The ARC was significantly higher than before the surgery (P < 0.05) in the two groups. The two groups showed significant increases in total HOAs, coma 90°, and spherical aberrations (P < 0.05).ConclusionSMILE is predictable, effective, and safe in correcting myopic anisometropia. The postoperative changes in HOAs are characteristic.
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Lee S, Bae S, Jung M. Effect of preoperative keratometry on visual outcomes after small-incision lenticule extraction for myopia. Int Ophthalmol 2022; 42:1719-1726. [PMID: 34997880 PMCID: PMC9156449 DOI: 10.1007/s10792-021-02167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between preoperative keratometry (K) and postoperative refraction and compare the visual outcomes after small-incision lenticule extraction (SMILE) between preoperative flat and steep corneas. METHODS This study involved 814 consecutive eyes of 409 patients who underwent SMILE. A month later, a linear regression analysis of the relationship between preoperative K and the residual spherical equivalent (SE) along with eyes divided by a single standard deviation between flat and steep corneas (< 41.85 D, > 44.57 D, respectively) was conducted. Eyes were distinguished based on the degree of myopia. RESULTS One month after surgery, no significant correlation existed between mean preoperative K and residual SE (P = 0.459). Linear regression analysis showed a weak negative correlation between flat corneas (r2 = 0.042, P = 0.025) rather than steep corneas (P = 0.908). Eyes with preoperative low myopia (< 3.00 D) (r2 = 0.233, P = 0.001) had a weak correlation compared with moderate and high myopia (P = 0.272, P = 0.257, respectively). Twelve months later, the predictability, safety, and efficacy did not vary between preoperative flat and steep corneas (P > 0.05). CONCLUSIONS One month after SMILE for myopia, the corneas were flatter in the preoperative flat corneas or all the low myopic corneas, and they were more overcorrected. However, preoperative corneal curvature does not influence visual outcomes at 1 year after SMILE.
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Affiliation(s)
- Seongjun Lee
- Nuri Eye Hospital, 61 Dunsan-ro, Daejeon, Seo-gu, 35233, South Korea
| | - Sinwoo Bae
- Nuri Eye Hospital, 61 Dunsan-ro, Daejeon, Seo-gu, 35233, South Korea
| | - Moonsun Jung
- Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju, Chungcheongbuk-do, 28644, South Korea.
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Comparison of visual outcomes between 120-µm and 140-µm cap thicknesses 12 months after small incision lenticule extraction. Lasers Med Sci 2022; 37:2667-2673. [PMID: 35217941 DOI: 10.1007/s10103-022-03534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
To compare visual and refractive outcomes as well as changes in high-order aberrations in patients with 120- versus 140-µm cap thicknesses 12 months after small incision lenticule extraction. Ninety-four patients were randomized to receive small incision lenticule extraction with either a 120-µm cap thickness (n = 47) or a 140-µm cap thickness (n = 47) to treat myopia or myopic astigmatism, if not both. In an analysis of right eyes only during the 12-month follow-up period, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and high-order aberrations were evaluated. The distribution of patients by age and sex between the groups did not differ significantly (P = .803 and P = .680, respectively). CDVA, spherical and cylindrical refraction, and changes in total high-order aberration, spherical aberration, coma, and trefoil were similar between the groups at 6 and 12 months, postoperatively. However, UDVA was statistically significantly higher in patients with 140-μm cap thicknesses than with 120-μm cap thicknesses at 6 and 12 months postoperatively (P < .001 and P < .001, respectively). Patients with 140-µm cap thickness showed greater improvement in UDVA than ones with 120-µm cap thickness at 12-month follow-up (P = .005). Both 120- and 140-μm cap thicknesses in small incision lenticule extraction were safe and effective thicknesses for correcting myopia or myopic astigmatism. The patients with 140-μm cap thickness had better improvement in UDVA after 12-month follow-up compared to patients with 120-μm cap thickness.
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[Regression and ablation profiles in corneal refractive surgery]. J Fr Ophtalmol 2021; 44:1059-1075. [PMID: 34148702 DOI: 10.1016/j.jfo.2020.08.041] [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: 05/15/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.
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Refractive outcomes comparing small-incision lenticule extraction and femtosecond laser-assisted laser in situ keratomileusis for high myopia. J Cataract Refract Surg 2021; 46:419-427. [PMID: 32142040 DOI: 10.1097/j.jcrs.0000000000000075] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the long-term refractive effects of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on the correction of high myopia and astigmatism. SETTING The Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN Retrospective case series. METHODS Patients had SMILE or FS-LASIK for high myopia. Subgroup analyses of high myopia (-6.00 to -8.75 diopters [D]) and extremely high myopia (≥-9.00 D) were performed. The main outcome measure was refractive predictability, compared between SMILE and FS-LASIK groups. Secondary outcomes included efficacy, safety, and residual astigmatism. RESULTS This study included 121 patients (121 eyes: 75 in the SMILE group and 46 in the FS-LASIK group). No differences were found in terms of refractive predictability between SMILE and FS-LASIK in eyes with high myopia: 56% vs 58.7% achieved ± 0.50 D of attempted correction (P = .771) and 81.3% vs 76.1% achieved ± 1.00 D of attempted correction (P = .489). Efficacy indices of the SMILE and FS-LASIK groups were 1.02 ± 0.24 and 1.03 ± 0.24 (P = .742), respectively; safety indices were 1.23 ± 0.22 and 1.20 ± 0.24 (P = .324), respectively. Logarithm of the minimum angle of resolution uncorrected distance visual acuity and spherical equivalent in the high myopia subgroup were better than in the extremely high myopia subgroup after both SMILE and FS-LASIK (P < .01). CONCLUSIONS SMILE and FS-LASIK were both effective in correcting high myopia and myopic astigmatism. However, both techniques may require further nomogram adjustments when treating eyes with extremely high myopia.
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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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Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas. Eye (Lond) 2020; 35:2302-2309. [PMID: 33139876 DOI: 10.1038/s41433-020-01256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy. SETTING Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN Retrospective case series. METHODS The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated. RESULTS The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time. CONCLUSION SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.
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Romito N, Trinh L, Goemaere I, Borderie V, Laroche L, Bouheraoua N. Corneal Remodeling After Myopic SMILE: An Optical Coherence Tomography and In Vivo Confocal Microscopy Study. J Refract Surg 2020; 36:597-605. [DOI: 10.3928/1081597x-20200713-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/12/2020] [Indexed: 11/20/2022]
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13
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A comparison of the effects of different cap thicknesses on corneal nerve destruction after small incision lenticule extraction. Int Ophthalmol 2020; 40:1905-1911. [PMID: 32601964 DOI: 10.1007/s10792-020-01362-z] [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: 02/01/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the features of corneal nerve destruction after small incision lenticule extraction (SMILE) with different cap thicknesses (100 and 120 μm). METHODS Nine consecutive patients (18 eyes) received SMILE with a 120-μm cap thickness and nine patients (18 eyes) with a 100-μm cap thickness were recruited. Confocal microscopy was used to evaluate the density and microscopic morphological changes of central corneal subbasal nerves preoperatively and at postoperative week 1. RESULTS The postoperative corneal subbasal nerve densities decreased significantly in both 120 μm and 100 μm groups. No statistical difference was detected in reduction of subbasal nerve density between two groups (P = 0.299). The number of subbasal nerve fibers significantly decreased in both groups. The reductions were not significantly different between two groups (P = 0.293). CONCLUSIONS Using a 120-μm cap thickness during SMILE preserves no more central corneal subbasal nerve fibers compared to a 100-μm cap thickness.
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Weng S, Xiang D, Lin L, Lin H, Liu F, Liu Q. Optimal Parameters of Scanning Mode in Small Incision Lenticule Extraction (SMILE): Clinical Results and Ultrastructural Analysis. J Refract Surg 2020; 36:34-41. [DOI: 10.3928/1081597x-20191114-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022]
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Qin Q, Wu Z, Bao L, Chen H, Yang L, He Z, Huang Z. Evaluation of visual quality after EVO-ICL implantation for hypermyopia: An observational study. Medicine (Baltimore) 2019; 98:e17677. [PMID: 31689784 PMCID: PMC6946539 DOI: 10.1097/md.0000000000017677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this retrospective study was to evaluate the visual quality, objective scattering index, aberration, etc after Implantable Collamer Lens with center hole (EVO-ICL) implantation to treat patients with hypermyopia (diopter > -10 D).A total of 30 eyes underwent EVO-ICL implantation. The uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), equivalent spherical degree, aberration, visual quality parameters, and corneal endothelial cell density were compared preoperative and postoperative. Fill in the National Eye Institute Refractive Error Quality of Life Instrument-42 before and after surgery.The modulation transfer function (MTF), Optical Quality Analysis System (OQAS) II values (OV 100%, 20%, 9%), and Stahl ratio 1 and 3 months after surgery were higher than the respective preoperative values. The objective scatter index value increased 1 week after surgery, but decreased 1 and 3 months after surgery compared with the preoperative values. Total aberration (TA), total low-order aberration (tLOAs), and defocus decreased at 1 week and 3 months after EVO-ICL implantation. Total high-order aberration (tHOAs) and spherical aberration were significantly increased 1 week after surgery and decreased 3 months after surgery, and the difference was statistically significant. Astigmatism, coma, and clover were not significantly different in each time period. TA, tLOAs, tHOAs, defocus, and spherical aberration were higher at 1 week than 3 months after surgery. At 3 months after surgery, the scores of the patients' NEI-RQL-42 scale were all improved except that the glare was lower than that before surgery. There was no significant difference in the density of corneal endothelial cells before and 3 months after surgery.For patients with hypermyopia, the postoperative subjective and objective visual quality of EVO-ICL implantation was better than preoperative.
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Affiliation(s)
- Qin Qin
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School
- Department of Ophthalmology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University
- Department of Ophthalmology, Jinling Medical School of Nanjing Medical University
- Department of Ophthalmology, Jinling Hospital
| | - Zhengcan Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lianyun Bao
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School
| | - Hui Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School
| | - Liping Yang
- Department of Ophthalmology, Jinling Medical School of Nanjing Medical University
- Department of Ophthalmology, Jinling Hospital
| | - Zifang He
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Medical School of Nanjing Medical University
- Department of Ophthalmology, Jinling Hospital
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Lau YTY, Shih KC, Tse RHK, Chan TCY, Jhanji V. Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism. Ophthalmol Ther 2019; 8:373-386. [PMID: 31325106 PMCID: PMC6692806 DOI: 10.1007/s40123-019-0202-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is the most commonly performed laser refractive surgical technique worldwide for the treatment of myopia and myopic astigmatism. In recent years, small incision lenticule extraction (SMILE) has emerged as a promising alternative to LASIK, requiring only a single femtosecond laser to create an intrastromal lenticule, which is then removed via a small incision. The technique obviates the need for a corneal flap. A number of published studies have compared the two techniques in terms of visual, refractive and ocular surface outcomes. This review compares the clinical outcomes between LASIK and SMILE in treating myopia and myopic astigmatism based on studies published in the last 5 years. Twenty-two studies were included, all of which were observational in nature. Results suggest that the two techniques have comparable visual outcomes in terms of safety, efficacy and predictability, although recovery in visual acuity may be slower in SMILE-treated than LASIK-treated eyes. SMILE is found to result in less severe postoperative dry eye symptoms and faster recovery of corneal sensitivity than LASIK. It is important to note, however, that the SMILE technique is limited by the lack of a cyclotorsion-compensation system and option for customized treatment profile. The heterogeneity of results in this review may be attributable to the use of different LASIK platforms in different studies. Few studies compared the outcomes regarding severity of myopia. Future prospective randomized controlled trials with a larger sample size and longer follow-up period will be highly beneficial for progress in this field.
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Affiliation(s)
- Yumi Tsz-Ying Lau
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
| | - Ryan Hin-Kai Tse
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Tommy Chung-Yan Chan
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, USA
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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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Shah R. History and Results; Indications and Contraindications of SMILE Compared With LASIK. Asia Pac J Ophthalmol (Phila) 2019; 8:371-376. [PMID: 31567264 PMCID: PMC6784775 DOI: 10.1097/01.apo.0000580132.98159.fa] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
Small incision lenticule extraction (SMILE) is a new paradigm for refractive surgery, and was first performed by Sekundo and Blum in 2008. It uses only a femtosecond laser to carve out a lenticule within the corneal stroma, and then achieves refractive correction by extracting the lenticule through a small incision. A number of studies have shown that SMILE leads to stable and efficacious outcomes, combined with high safety. Long-term studies also indicate that SMILE has excellent outcomes combined with high safety. Although relatively safe, SMILE can have some intraoperative and postoperative complications, including suction loss during the procedure, lenticule tears, incision tears, epithelial ingrowth, diffuse lamellar keratitis, and residual refractive error. Studies indicate that SMILE leads to less postoperative dry eyes. It is thus preferred over laser-assisted in-situ keratomileusis (LASIK) in cases wherein there is mild dry eye preoperatively. It is also preferred over LASIK in cases wherein the patient is likely to engage in contact sports. LASIK may be preferred over SMILE for the treatment of hyperopia, and in cases of significant higher order wavefront aberrations or topographic irregularities.
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Visual and refractive outcomes of 100 small incision lenticule extractions (SMILE) in moderate and high myopia: a 24-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2019; 257:1561-1567. [PMID: 31119423 DOI: 10.1007/s00417-019-04349-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE We aimed to present the visual results obtained in 100 small incision lenticule extraction (SMILE) refractive surgeries, demonstrate whether the technique is effective in the treatment of moderate and high myopia, and observe the follow-up of these patients over 24-month period. METHODS One hundred eyes of 50 consecutive patients were treated with SMILE. The preoperative spherical equivalent refraction was - 5.64 ± 1.23 D. During the postoperative period, patients were examined at 3, 6, 12, and 24 months. We analysed the efficacy, safety, predictability, and stability of the technique. RESULTS The Snellen visual acuity of 99% of the patients was 20/20 or better after 24 months of follow-up. Two eyes had a loss of two lines of visual acuity; 1% of the patients had a loss of one line of visual acuity. The postoperative spherical refraction was - 0.04 ± 0.35 D (- 1.00 to 0.50 D). The postoperative spherical equivalent refraction was - 0.19 ± 0.38 D (- 1.25 to 0.50 D). Eighty-three percent of the eyes were within ± 0.50 D, and 87% obtained a residual astigmatism of 0.50 D or less. CONCLUSION The SMILE technique was demonstrated to be an effective, predictable, safe, and stable technique in the treatment of moderate-to-severe myopia during the 24-month follow-up. Long-term follow-up should be undertaken to observe possible refractive regressions.
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Yang X, Liu F, Liu M, Liu Q, Weng S, Lin H. 15-Month Visual Outcomes and Corneal Power Changes of SMILE in Treating High Myopia With Maximum Myopic Meridian Exceeding 10.00 D. J Refract Surg 2019; 35:31-39. [PMID: 30633785 DOI: 10.3928/1081597x-20181126-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the long-term visual and refractive outcomes, optical quality, and stability of the cornea and axial length after small incision lenticule extraction (SMILE) for the correction of high myopia with a maximum myopic meridian exceeding 10.00 diopters (D). METHODS Via a prospective cohort study, 53 eyes (53 patients) with a maximum myopic meridian exceeding 10.00 D were corrected with a VisuMax femtosecond laser (version 3.0; Carl Zeiss Meditec AG, Jena, Germany) at the Zhongshan Ophthalmic Center of Sun Yat-sen University. Refractive outcomes, aberrations, axial length, and corneal curvature were evaluated preoperatively and at 1, 3, and 15 months postoperatively. RESULTS At 15 months postoperatively, the efficacy and safety indexes were 0.91 ± 0.25 and 1.15 ± 0.18, respectively. A total of 72% of eyes were within ±0.50 D and 89% were within ±1.00 D of the attempted spherical equivalent, respectively. From 1 to 15 months postoperatively, the significant regression was -0.24 ± 0.28 D (P < .001) on manifest refraction and -0.43 ± 0.54 D (P < .001) on anterior corneal curvature. In addition, a significant increase of 0.20 µm (P = .016) was observed in the spherical aberration. No significant change was observed in posterior corneal curvature (P > .999), including mean keratometry or astigmatism, or in the ocular axis length from 1 to 15 months postoperatively (26.82 ± 0.93 and 26.82 ± 0.95 mm, respectively, P > .99). CONCLUSIONS SMILE had long-term safety, efficacy, and predictability when treating high myopia with a maximum myopic meridian exceeding 10.00 D. Both a manifest refraction regression of -0.24 D and a significant spherical aberration increase of 0.20 µm were observed between 1 and 15 months postoperatively, due to the increased anterior corneal curvature. [J Refract Surg. 2019;35(1):31-39.].
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Kind R, Kiraly L, Taneri S, Troeber L, Wiltfang R, Bechmann M, Meyer B, Greene B, Sekundo W. Flushing versus not flushing the interface during small-incision lenticule extraction. J Cataract Refract Surg 2019; 45:562-568. [PMID: 30846349 DOI: 10.1016/j.jcrs.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/29/2018] [Accepted: 12/02/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the differences in outcomes between interface flushing with a balanced salt solution after refractive lenticule removal in simultaneous uneventful bilateral small-incision lenticule extraction (SMILE). SETTING Six study centers in Germany. DESIGN Prospective case series. METHODS Patients with myopia or myopic astigmatism of similar magnitude in both eyes with a spherical equivalent less than or equal to 10.0 diopters (D), preoperative corrected distance visual acuity (CDVA) of 0.80 decimal or better, and anisometropia less than or equal to 2.0 D were enrolled and followed for 3 months. One eye of each patient was treated with interface flushing after dry extraction of the lenticule. Flushing was performed with 1.0 cc balanced salt solution using a single-use 27-gauge cannula. The uncorrected distance visual acuity (UDVA) at 1 day, 1 week, and 3 months; the CDVA at 3 months; and postoperative differences at the slitlamp examination were recorded. Statistical analyses were performed with logarithm of the minimum angle of resolution values using paired t tests. The P value for significance was less than 0.05. RESULTS The study analyzed 470 eyes. One day postoperatively, the mean UDVA was 0.81 in the non-flush group and 0.83 in the flush group (P = .110). At the last visit 3 months postoperatively, the mean UDVA was 1.04 and 1.05, respectively (P = .172). No significant differences in the rate of postoperative complications were found. CONCLUSION Interface irrigation with 1.0 cc of balanced salt solution after the removal of the refractive lenticule has neither advantages nor disadvantages in terms of visual recovery, postoperative complications, or final visual acuity.
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Affiliation(s)
- Ralf Kind
- Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany.
| | | | - Suphi Taneri
- SMILE EYES, Muenster, Germany; SMILE EYES, Zentrum Fuer Refraktive Chirurgie, Muenster, Germany
| | | | | | | | | | - Brandon Greene
- Institute of Medical Biometry and Epidemiology, Philipps University of Marburg, Marburg, Germany
| | - Walter Sekundo
- Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany; SMILE EYES, Marburg, Germany
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Zhang Q, Wang J, Li M, Ding X, Tao L. Assessment of surgical outcomes of femtosecond laser-assisted in situ keratomileusis in patients with low compliance to postoperative follow-up: a retrospective observational study in a tertiary hospital in China. BMJ Open 2019; 8:e021702. [PMID: 30798286 PMCID: PMC6278781 DOI: 10.1136/bmjopen-2018-021702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Poor follow-up after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) is common in general clinical practice. We aimed to assess the surgical outcomes of patients with poor compliance to FS-LASIK follow-up but who returned to the clinic with additional prompting at a 1-year visit. We also compared their surgical outcomes with those of patients who returned unprompted. DESIGN Retrospective and observational study. SETTING An urban tertiary hospital in China. PARTICIPANTS We reviewed the medical records of myopic patients who underwent binocular FS-LASIK. These patients were all recommended, but not compulsively required, to return for termly postoperative examinations including measurement of uncorrected distance visual acuity (UDVA), refraction and assessment of complications. According to records of follow-up visits, 1009 eligible patients were categorised as follows: (1) 124 who returned unprompted at the 1-year visit (group 1) and (2) 885 lost to follow-up at the 1-year visit. We randomly selected and called back 105 (group 2) out of the 885 patients for an extra postoperative examination. RESULTS At the 1-year visit, the visual outcomes of the two groups of patients were comparable. No differences in postoperative UDVA were found between the two groups (-0.02±0.06 logarithm of the minimum angle of resolution (logMAR) and -0.02±0.05 logMAR for groups 1 and 2, respectively, p=0.175). Patients in group 2 showed greater hyperopic dioptres than patients in group 1 (0.37±0.59 D vs -0.29±0.69, p<0.0001). No vision-threatening complications were observed in either group of patients. CONCLUSIONS The visual and refractive outcomes of patients who were lost to follow-up after FS-LASIK surgery were good and comparable to those who returned unprompted. The results indicated that rigorous postoperative follow-up may be unnecessary in general clinical practice, except for patients who are at a high risk for postoperative complications.
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Affiliation(s)
- Qing Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mohan Li
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liming Tao
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Qin Q, Bao L, Yang L, He Z, Huang Z. Comparison of visual quality after EVO-ICL implantation and SMILE to select the appropriate surgical method for high myopia. BMC Ophthalmol 2019; 19:21. [PMID: 30732575 PMCID: PMC6367781 DOI: 10.1186/s12886-019-1029-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/04/2019] [Indexed: 11/11/2022] Open
Abstract
Background This study sought to compare the visual quality between intraocular collamer lens (EVO-ICL) implantation and small-incision lenticule extraction (SMILE) and determine the appropriate surgical method to treat patients with high myopia (− 6.25 to − 10 D). Methods A total of 48 eyes underwent EVO-ICL implantation and another 48 eyes underwent SMILE. The uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA) and equivalent spherical degree were compared across the SMILE (− 6.25 to − 10 D) and EVO-ICL (− 6.25 to − 10 D) implantation groups. Preoperative and postoperative visual quality parameters were compared between and within groups. Results The OQAS II values (OV 100%) one week and one month after surgery and the modulation transfer function (MTF), OV 20% and OV 9% values one week after surgery in the SMILE group were lower than the respective preoperative values. The objective scatter index (OSI) value increased one week as well as one month after surgery compared with the preoperative values. The MTF cut-off value of the SMILE group was lower than that of the EVO-ICL implantation group three months after surgery. Conclusions For patients with high myopia, the postoperative visual quality of EVO- ICL implantation was slightly better than that of SMILE.
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Affiliation(s)
- Qin Qin
- Department of Ophthalmology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.,Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, 210008, China.,Department of Ophthalmology, Jinling Medical School of Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.,Department of Ophthalmology, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China
| | - Lianyun Bao
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, 210008, China
| | - Liping Yang
- Department of Ophthalmology, Jinling Medical School of Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.,Department of Ophthalmology, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China
| | - Zifang He
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, 210008, China
| | - Zhenping Huang
- Department of Ophthalmology, Jinling Medical School of Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. .,Department of Ophthalmology, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.
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Zhang YL, Cao LJ, Chen HW, Xu XH, Li ZN, Liu L. Comparison of changes in refractive error and corneal curvature following small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis surgery. Indian J Ophthalmol 2018; 66:1562-1567. [PMID: 30355861 PMCID: PMC6213686 DOI: 10.4103/ijo.ijo_366_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare visual acuity, refractive error, corneal curvature, and the stability of these parameters during the early postoperative period following small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. Methods One hundred and five eyes and 110 eyes were enrolled in SMILE and FS-LASIK group, respectively. Uncorrected and best-corrected distance visual acuity (UCVA and BCVA), manifest refraction, corneal curvature, intraocular pressure, and slit-lamp examinations were performed preoperatively, 1 day, 1 week, 1 month, and 3 months postoperatively. Results No significant differences in postoperative UCVA or BCVA were observed between the SMILE and FS-LASIK groups at any time point. SMILE group had significant better postoperative spherical equivalent (SE) values than FS-LASIK group at 1 day, 1 week, and 1-month follow-up. However, there was no significant difference in postoperative SE values at 3-month follow-up. Significant differences in mean postoperative corneal curvature were observed during all follow-up examinations. Conclusion SMILE surgery was associated with more accurate postoperative refractive correction up to 1 month following surgery. SMILE surgery also resulted in less significant corneal curvature changes than FS-LASIK. Furthermore, FS-LASIK was associated with decreased stability of postoperative refractive error and corneal curvature relative to SMILE.
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Affiliation(s)
- Ya L Zhang
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Li J Cao
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Hong W Chen
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Xiang H Xu
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Zhao N Li
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
| | - Lei Liu
- Department of Ophthalmology, The Second People's Hospital of Jinan, 148 Jingyi Road, Jinan, Shandong Province, People's Republic of China
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Visual and Refractive Outcomes of Small-Incision Lenticule Extraction in High Myopia: 5-Year Results. J Ophthalmol 2018; 2018:5893126. [PMID: 30420916 PMCID: PMC6215553 DOI: 10.1155/2018/5893126] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/12/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. Materials and Methods Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. Results Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was −7.47 ± 1.10 D (range −6.00 to −10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was −0.43 ± 0.47 (0.50 to −1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. Conclusion SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up.
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Piñero DP, Teus MA. Clinical outcomes of small-incision lenticule extraction and femtosecond laser-assisted wavefront-guided laser in situ keratomileusis. J Cataract Refract Surg 2018; 42:1078-93. [PMID: 27492109 DOI: 10.1016/j.jcrs.2016.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Small-incision lenticule extraction and wavefront-guided femtosecond-assisted laser in situ keratomileusis (LASIK) provide good visual outcomes and an efficacious correction of myopia or myopic astigmatism with similar levels of safety. Some differences in predictability and the percentage of eyes gaining lines of corrected distance visual acuity are present. A higher level of coma is present after small-incision lenticule extraction, with no clear differences between techniques in spherical aberration. Better contrast sensitivity is achieved in the early postoperative period after wavefront-guided femtosecond laser-assisted LASIK, possibly because of less intrastromal light backscattering and Bowman layer microdistortions. Corneal sensitivity decreased less after small-incision lenticule extraction because of less severe decrease in subbasal nerve density, which has a significant effect on symptomatology and dry-eye tests (P < .05). Significant corneal biomechanical changes occurred after both techniques (P < .05), with no scientific evidence supporting the superiority of 1 technique over the other. FINANCIAL DISCLOSURE Dr. Piñero received an unrestricted educational grant from Abbott Medical Optics, Inc. Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David P Piñero
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain.
| | - Miguel A Teus
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain
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Han T, Xu Y, Han X, Zeng L, Shang J, Chen X, Zhou X. Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism. Br J Ophthalmol 2018; 103:565-568. [PMID: 30061116 PMCID: PMC6691872 DOI: 10.1136/bjophthalmol-2018-312140] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
Aims To compare long-term clinical outcomes following small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism correction. Methods In this retrospective study, we enrolled a total of 101 patients (101 eyes) who underwent SMILE or FS-LASIK 3 years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction and corneal wavefront aberrations. Results No significant differences in patient characteristics were found between the two groups. At the 3-year follow-up, UDVA was better than or equal to 20/20 in 90% and 85% (p=0.540) of the eyes; the efficacy indexes were 1.05±0.19 and 1.01±0.21 in the SMILE and FS-LASIK groups, respectively (p=0.352). Safety indexes were 1.19±0.17 and 1.15±0.20 in the SMILE and FS-LASIK groups, respectively (p=0.307). Eighty per cent and 65% of eyes were within ±0.50 D of the attempted spherical equivalent correction after SMILE and FS-LASIK, respectively (p=0.164). Vector analysis revealed no significant differences in astigmatic correction between the two groups (p>0.05). Surgically induced spherical aberration was higher in the FS-LASIK group than in the SMILE group (p<0.001). Conclusion Long-term follow-up analysis suggested that both SMILE and FS-LASIK were safe and equally effective for myopic and astigmatic correction.
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Affiliation(s)
- Tian Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Ye Xu
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xiao Han
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Li Zeng
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Jianmin Shang
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xun Chen
- The Key Lab of Myopia, Ministry of Health, Shanghai, China.,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
| | - Xingtao Zhou
- The Key Lab of Myopia, Ministry of Health, Shanghai, China .,Department of Ophthalmology, The Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry , Shanghai, China
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Moshirfar M, Murri MS, Shah TJ, Linn SH, Ronquillo Y, Birdsong OC, Hoopes PC. Initial Single-Site Surgical Experience with SMILE: A Comparison of Results to FDA SMILE, and the Earliest and Latest Generation of LASIK. Ophthalmol Ther 2018; 7:347-360. [PMID: 29959753 PMCID: PMC6258580 DOI: 10.1007/s40123-018-0137-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The primary objective was to show our initial surgical single-site experience with small incision lenticule extraction (SMILE) after the official enrollment in March 2017 following Food and Drug Administration (FDA) approval for simple myopia in late 2016 in the United States and, subsequently, compare our results to the earliest and most advanced generation of excimer platforms for laser-assisted in situ keratomileusis (LASIK) surgery. Methods This was a retrospective single-site study of 68 eyes from 35 patients who had SMILE surgery. The patients’ preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere, manifest cylinder, intraoperative complications, and preoperative and postoperative visual symptoms were collected. We compared our findings to the results from the FDA SMILE study, and to the three earliest (1999–2000) and three of the most updated (2013–2016) platforms for LASIK. Results The cumulative UDVA was 20/20 and 20/40 or better in 74% and 100% of patients, respectively. The intended target refraction was within ± 0.5 and ± 1.00 D in 80% and 93% of cases, respectively. The prevalence of dry eyes decreased by nearly half from 1-week to the 6-month postoperative interval. Patients noted improvement in glare (17%), halos (17%), fluctuation (25%), and depth perception (8%) at the 6-month interval compared to preoperative levels. Conclusions This study’s findings are consistent with current SMILE reports. Notably, the results are superior to the earliest generation of LASIK, however inferior to the latest excimer platforms. SMILE does meet the efficacy and safety criteria met by FDA; however, there is a definite need for further improvement to reach the superior refractive outcomes produced by the latest generation of LASIK platforms.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA. .,HDR Research Center, Hoopes Vision, Draper, UT, USA.
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tirth J Shah
- University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
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Fu D, Zeng L, Zhao J, Miao HM, Yu ZQ, Zhou XT. Safety and satisfaction of myopic small-incision lenticule extraction combined with monovision. BMC Ophthalmol 2018; 18:131. [PMID: 29855287 PMCID: PMC5984466 DOI: 10.1186/s12886-018-0794-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background To investigate the safety and optical quality of small-incision lenticule extraction (SMILE) combined with monovision, and patient satisfaction with the procedure. Methods The present study assessed a non-random case series involving 60 eyes of 30 patients (mean age 45.53 ± 3.20 years [range 41 to 52 years]) treated bilaterally using the VisuMax 500 system (Carl Zeiss Meditec, Jena, Germany) between January and July 2016. The target refraction was plano for the distance eye, and between − 0.5 and − 1.75 diopters (D) for the near eye. Visual acuity, refraction errors, ocular aberrations, and satisfaction questionnaire scores were calculated 1 year after surgery. Results All surgeries were uneventful, with a mean safety index of 1.03 and 1.04 in dominant and nondominant eyes, respectively. Binocular uncorrected distance visual acuity of all patients was ≥20/32, while binocular uncorrected near visual acuity was ≥20/40 1 year postoperatively. Higher-order aberration (0.45 ± 0.14, 0.51 ± 0.15 μm), spherical (0.18 ± 0.15, 0.21 ± 0.14 μm) and coma aberration (0.31 ± 0.16, 0.27 ± 0.17 μm) were identical between dominant and nondominant eyes after surgery. The overall satisfaction rate was 86.7% (26/30), with large contributions from age (OR = 1.76 95% CI: 1.03–2.53; P = 0.036). Binocular uncorrected distance visual acuity was related to preoperative spherical diopter (r = − 0.500; P = 0.005). Conclusions Monovision appears to be a safe and effective option for myopia patients with presbyopia who are considering the SMILE procedure. Patients with younger age were more satisfied with the procedure.
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Affiliation(s)
- Dan Fu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Li Zeng
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Hua-Mao Miao
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Zhi-Qiang Yu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), No. 83 FenYang Road, Shanghai, 200031, People's Republic of China
| | - Xing-Tao Zhou
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), No. 83 FenYang Road, Shanghai, 200031, People's Republic of China.
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Kim BK, Mun SJ, Lee DG, Choi HT, Chung YT. Management of incision failure during small incision lenticule extraction because of conjunctivochalasis. Am J Ophthalmol Case Rep 2017; 7:134-137. [PMID: 29260098 PMCID: PMC5722160 DOI: 10.1016/j.ajoc.2017.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/31/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Purpose We report a case of incision failure during small incision lenticule extraction (SMILE) and its management. Observations The incision could not be made using the femtosecond laser because of a redundant conjunctiva, so it was instead done manually using a diamond knife. The lenticule was successfully separated and extracted. Three months after the procedure, the uncorrected distance visual acuity was 20/20 and no complication was observed. Conclusions and importance This case demonstrates that the conjunctiva should be carefully examined before SMILE. If a complication occurs because of conjunctivochalasis, it can be resolved with proper management without compromising the patient's visual acuity.
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La prédictibilité du SMILE sur quatre ans chez les myopes forts. J Fr Ophtalmol 2017; 40:561-570. [DOI: 10.1016/j.jfo.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
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Comparison of postoperative visual quality after SMILE and LASEK for high myopia: A 1-year outcome. PLoS One 2017; 12:e0182251. [PMID: 28771544 PMCID: PMC5542625 DOI: 10.1371/journal.pone.0182251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/14/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare the 1-year outcome of visual quality after laser-assisted subepithelial keratomileusis (LASEK) and femtosecond laser-assisted small incision lenticule extraction (SMILE) for high myopia correction. MATERIALS AND METHODS This prospective, comparative study included 24 eyes of 24 patients in the LASEK group, with a mean spherical equivalent (SE) of -7.59 ± 1.32 diopters, and 26 eyes of 26 patients in the SMILE group, with a mean SE of -7.91 ± 1.08 diopters. Visual acuity, corneal topography, contrast sensitivity (CS), and wavefront aberrations were recorded preoperatively and compared with postoperative measurements. Objective scatter index (OSI) and modulation transfer function (MTF) cut-off frequency were measured 1 year postoperatively. RESULTS One year postoperatively, the two groups demonstrated no significant difference in the CS at all spatial frequencies. The increments of higher-order aberrations (HOAs) (HOA = 0.583 ± 0.210 μm), including spherical aberration (SA) (SA = 0.546 ± 0.249 μm), were higher (P < 0.05) in the LASEK group than those in the SMILE group (HOA = 0.451 ± 0.143 μm; SA = 0.450 ± 0.340 μm) after surgery. There were no significant differences in the increments of coma and trefoil aberrations between the two groups. The OSI and MTF cut-off frequency exhibited no significant differences between the two groups postoperatively. No vision-threatening complications were noted at any stage in either group. CONCLUSIONS Both LASEK and SMILE are safe and effective surgical options for the correction of high myopia. SMILE has a lower HOAs and SA induction rate 1 year postoperatively.
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Jin HY, Wan T, Wu F, Yao K. Comparison of visual results and higher-order aberrations after small incision lenticule extraction (SMILE): high myopia vs. mild to moderate myopia. BMC Ophthalmol 2017; 17:118. [PMID: 28683793 PMCID: PMC5501544 DOI: 10.1186/s12886-017-0507-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/22/2017] [Indexed: 11/21/2022] Open
Abstract
Background To compare the refractive results and higher-order aberrations (HOAs) after small incision lenticule extraction (SMILE) in high myopia and mild to moderate myopia patients. Methods This prospective study included 165 eyes (86 patients) undergoing SMILE. According to the preoperative spherical equivalent (SE), treated eyes were divided into two groups: the high myopia group (more than -6.0 D, group-H) and the mild to moderate group (less than -6.0 D, group-M). Follow-up intervals were at 1 day, 10 days, 1 month and 3 months postoperatively. We obtained the following parameters: uncorrected (UDVA) and corrected distance visual acuity (CDVA), SE, efficacy and safety index, and HOAs. Results Preoperative SE was -7.16 ± 0.93 D in group-H and -4.34 ± 0.97 D in group-M. At 3 months postoperatively, the SE in group-H and group-M was -0.20 ± 0.37 D and 0.01 ± 0.19 D (t = - 4.11, P<0.05), respectively. It was found that 77% and 98% had an UDVA of 20/20, 98% and 99% had a CDVA of 20/20 in group-H and group-M, respectively, while 87% and 95% had a SE within ±0.5 D and ±1.0 D in group-H, and 98% and 100% in group-M. The efficacy indexes were 0.98 ± 0.18 in group-H and 1.05 ± 0.10 in group-M (t = - 3.084, p < 0.05). The safety indexes were 1.06 ± 0.09 and 1.06 ± 0.09 (t = 0.153, p > 0.05), respectively. There were significant increases in total HOAs, 3rd-order coma, and 4th-order spherical aberrations. Conclusions SMILE is an effective and safe surgery for correcting myopia. But the target correction amount in high myopia patients should be adjusted to avoid undercorrection and acquired more satisfaction. SMILE induced increases of HOAs. Trial registration ChiTrial registration number: ChiCTR-OON-16009164. Retrospectively registered: 06.September.2016
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Affiliation(s)
- Hong-Ying Jin
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Ting Wan
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Fang Wu
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310009, China.
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Ji YW, Kim M, Kang DSY, Reinstein DZ, Archer TJ, Choi JY, Kim EK, Lee HK, Seo KY, Kim TI. Lower Laser Energy Levels Lead to Better Visual Recovery After Small-Incision Lenticule Extraction: Prospective Randomized Clinical Trial. Am J Ophthalmol 2017; 179:159-170. [PMID: 28499707 DOI: 10.1016/j.ajo.2017.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE). DESIGN Prospective randomized clinical trial. METHODS A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively. RESULTS Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001). CONCLUSIONS SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.
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Burazovitch J, Naguzeswski D, Beuste T, Guillard M. Predictability of SMILE over four years in high myopes. J Fr Ophtalmol 2017; 40:e201-e209. [DOI: 10.1016/j.jfo.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 04/25/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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Wu W, Wang Y, Zhang H, Zhang J, Li H, Dou R. One-year visual outcome of small incision lenticule extraction (SMILE) surgery in high myopic eyes: retrospective cohort study. BMJ Open 2016; 6:e010993. [PMID: 27655258 PMCID: PMC5051337 DOI: 10.1136/bmjopen-2015-010993] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether the long-term visual outcome of small incision lenticule extraction (SMILE) surgery is consistent with the short-term results in high myopic eyes. DESIGN Retrospective cohort study; data collected from 8 August 2011 to 31 August 2015. SETTING Single refractive surgery centre. PARTICIPANTS A total of 156 eyes were studied: 65 eyes of 39 subjects (22 female/17 male) in the high myopic group (manifest refraction spherical equivalent (MRSE) ≥-6.0 D), and 91 eyes of 54 subjects (29 female/25 male) in the control group (MRSE <-6.0 D). The inclusion criteria were subjects who had follow-ups after 1 day, 1 week, 1 month, 3, 6 months and 1 year with the manifest refraction, uncorrected and corrected distance visual acuity (UDVA/CDVA). There were no statistically significant differences between the two groups in the subjects' gender, age, or cylindrical dioptre, preoperatively (p=0.835, p=0.055, p=0.341, respectively). PRIMARY AND SECONDARY OUTCOME MEASURES UDVA, refractive stability, safety index (postoperative CDVA/preoperative CDVA), and predictability (the percentage of eyes within ±0.50 D). RESULTS In both groups, the 1-year UDVA and safety index were significantly better than results at 1 day (high myopic group: p=0.035, p<0.001; control group: p<0.016, p<0.001); the 1-year predictability showed no significant difference with the short-term results (p=1.00 in both groups). In the high myopic eyes, the 1-year MRSE was significantly worse than the short-term result (p=0.048). To correct it, the added magnitude (D) for the high myopic eyes may equal 0.13×Attempted SE (D)-0.66 D. However, the postoperative MRSE showed no differences from 1 day to 1 year (p=0.612) in the control group. CONCLUSIONS The 1-year visual outcomes were better than the short-term results after the SMILE surgery on the visual acuity and safety. However, the high myopic eyes suffered a significant regression at 1 year, which may be corrected by adding additional magnitude to the SE for high myopic eyes.
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Affiliation(s)
- Wenjing Wu
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yan Wang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Hui Zhang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jiamei Zhang
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Hua Li
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Rui Dou
- Tianjin Ophthalmology and Visual Science Key Laboratory, Tianjin Eye Hospital & Eye Institute, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
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Kim BK, Mun SJ, Lee DG, Choi HT, Chung YT. Chung's swing technique: a new technique for small-incision lenticule extraction. BMC Ophthalmol 2016; 16:154. [PMID: 27580699 PMCID: PMC5007688 DOI: 10.1186/s12886-016-0321-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background To introduce the Chung’s swing technique for small-incision lenticule extraction (SMILE). Methods A total of 112 eyes of 56 patients were included in this study. Patients were divided into two groups: 52 eyes of 26 patients were treated with SMILE using a traditional method (traditional group) and 60 eyes of 30 patients were treated with SMILE using the Chung’s swing technique (swing group). Results At 1 month postoperatively, all eyes in both groups had an uncorrected distance visual acuity of 20/20 or better. The efficacy indices were 1.09 ± 0.17 and 1.02 ± 0.11 (p = 0.492), and the safety indices were 1.12 ± 0.14 and 1.09 ± 0.15 (p = 0.537), for the traditional and swing group, respectively. All eyes in both groups underwent successful lenticule extraction; all lenticules were intact and complete. The mean lenticule extraction times were 48.67 ± 4.9 and 39.8 ± 5.53 s, for the traditional and swing group, respectively (p < 0.001). Conclusions The Chung’s swing technique is efficient for lenticule separation and extraction. Our study results showed good clinical outcomes. Trial registration Trial registration number: KCT0001978. Registered 22 July 2016. Retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0321-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bu Ki Kim
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Korea
| | - Su Joung Mun
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Korea
| | - Dae Gyu Lee
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Korea
| | - Hyun Tae Choi
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Korea
| | - Young Taek Chung
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Korea.
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Han T, Zheng K, Chen Y, Gao Y, He L, Zhou X. Four-year observation of predictability and stability of small incision lenticule extraction. BMC Ophthalmol 2016; 16:149. [PMID: 27577086 PMCID: PMC5006606 DOI: 10.1186/s12886-016-0331-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate long-term refractive outcomes, wavefront aberrations and quality of life after small incision lenticule extraction (SMILE) for moderate to high myopia. METHODS A total of 26 patients (47 eyes) with preoperative mean spherical equivalent (SE) of -6.30 ± 1.47 diopters (D) who underwent SMILE were recruited. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, wavefront aberrations, and quality of life. RESULTS At 4 years postoperatively, UDVA was better than or equal to 20/20 in 92 % of eyes. The efficacy index was 1.07 ± 0.16. 89 % of eyes were within ± 0.5 D of the intended refractive target. No eye lost any Snellen lines. The safety index was 1.16 ± 0.14. No significant changes of SE occurred among postoperative follow-ups at months 1, 3, 6 and years 1, 2, 4 (P > 0.05, Scheffe test). Higher-order aberrations, coma, spherical aberration and higher-order astigmatism increased postoperatively, and no significant changes of aberrations were detected among the 1-month, 6-month or 4-year follow-ups postoperatively (37 eyes). Compared to the spectacles group, the surgery group showed a significantly higher total score on quality of life (45.71 ± 2.61 vs 39.96 ± 3.56, P < 0.001). CONCLUSIONS SMILE provides a predictable and stable correction of moderate to high myopia as documented by long-term follow-up.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Ke Zheng
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Yingjun Chen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China
| | - Yang Gao
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Li He
- Department of Ophthalmology, UruTmqi Eye and ENT Hospital, No.387 Zhongshan Road, Urumqi, Xinjiang, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, China.
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Kim BK, Mun SJ, Lee DG, Chung YT. Bilateral Small Incision Lenticule Extraction (SMILE) After Penetrating Keratoplasty. J Refract Surg 2016; 32:644-7. [PMID: 27598735 DOI: 10.3928/1081597x-20160526-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/11/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of successful bilateral small incision lenticule extraction (SMILE) performed on a patient who had penetrating keratoplasty and astigmatic keratotomy in the right eye and penetrating keratoplasty in the left eye. METHODS Case report. RESULTS Astigmatic keratotomy was used to reduce astigmatism of the right eye because astigmatism was higher than the maximum correction limitation of SMILE. Bilateral SMILE was performed afterward. Although there were no difficulties during lenticule separation and removal of the right eye, wound dehiscence occurred during lenticule separation of the left eye. Two sutures were used at both ends of the incision, and the remainder of the procedure was successfully completed. Visual acuity improved to 20/50 in both eyes without correction, and the corrected distance visual acuities were 20/50 and 20/30 in the right and left eyes, respectively, at the 6-month postoperative visit. CONCLUSIONS SMILE is a potentially effective alternative in correcting refractive errors in patients following penetrating keratoplasty. However, studies with a larger patient population with longer follow-up periods are needed to confirm these initial findings. [J Refract Surg. 2016;32(9):644-647.].
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Chan C, Lawless M, Sutton G, Versace P, Hodge C. Small incision lenticule extraction (SMILE) in 2015. Clin Exp Optom 2016; 99:204-12. [PMID: 27156103 DOI: 10.1111/cxo.12380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/11/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022] Open
Abstract
Small incision lenticule extraction (SMILE) represents a recent addition to the refractive surgeon's range of procedures. Although there remains a number of similarities to existing techniques in terms of patient selection and treatment parameters, consideration is required to optimise patient outcomes and satisfaction. Here, we review the selection criteria, contraindications, indications and existing published safety and efficacy outcomes.
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Affiliation(s)
- Colin Chan
- Vision Eye Institute, Chatswood, New South Wales, Australia
| | - Michael Lawless
- Vision Eye Institute, Chatswood, New South Wales, Australia.,Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gerard Sutton
- Vision Eye Institute, Chatswood, New South Wales, Australia.,Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Chris Hodge
- Vision Eye Institute, Chatswood, New South Wales, Australia.,University of New South Wales, Kensington, New South Wales, Australia
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