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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report provides an overview of the evidence for the treatment profile, safety, and efficacy of the range of corneal techniques currently available for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. Presbyopia correction by conductive keratoplasty involves application of radiofrequency energy to the mid-peripheral corneal stroma which leads to mid-peripheral corneal shrinkage, inducing central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Mäkinen P, Nättinen J, Aapola U, Pietilä J, Uusitalo H. Comparison of early changes in tear film protein profiles after small incision lenticule extraction (SMILE) and femtosecond LASIK (FS-LASIK) surgery. Clin Proteomics 2024; 21:11. [PMID: 38368345 PMCID: PMC10874072 DOI: 10.1186/s12014-024-09460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (LASIK) are widely used surgical methods to correct myopia with comparable efficacy, predictability, and safety. We examined and compared the early changes of tear protein profiles after SMILE and FS-LASIK surgery in order to find possible differences in the initial corneal healing process. METHODS SMILE operations for 26 eyes were made with Visumax femtosecond laser. In FS-LASIK surgery for 30 eyes, the flaps were made with Ziemer FEMTO LDV Z6 femtosecond laser and stromal ablation with Wavelight EX500 excimer laser. Tear samples were collected preoperatively, and 1.5 h and 1 month postoperatively using glass microcapillary tubes. Tear protein identification and quantification were performed with sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS). RESULTS Immediately (1.5 h) after we found differences in 89 proteins after SMILE and in 123 after FS-LASIK operation compared to preoperative protein levels. Of these differentially expressed proteins, 48 proteins were common for both surgery types. There were, however, quantitative differences between SMILE and FS-LASIK. Upregulated proteins were mostly connected to inflammatory response and migration of the cells connected to immune system. One month after the operation protein expressions levels were returned to baseline levels with both surgical methods. CONCLUSIONS Our study showed that immediate changes in protein profiles after SMILE and FS-LASIK surgeries and differences between the methods are connected to inflammatory process, and the protein levels quickly return to the baseline within 1 month. The differences in protein profiles between the methods are probably associated with the different size of the epithelial wound induced.
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Affiliation(s)
- Petri Mäkinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland.
| | - Janika Nättinen
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Aapola
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juhani Pietilä
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Silmäasema Eye Hospital, Hämeenkatu 6, Tampere, 33100, Finland
| | - Hannu Uusitalo
- SILK, Eye and Vision Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- TAUH Eye Center, Tampere University Hospital, Tampere, Finland
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Martínez-Hergueta MC, Cantó-Cerdán M, Amesty MA, García-Corral MJ, Casanova-Blanquer L, Plaza-Puche AB, Alió JL, Alió Del Barrio JL. Perioperative intense pulsed light to prevent and improve symptoms of post-laser corneal refractive surgery dry eye. A randomized clinical trial. Asia Pac J Ophthalmol (Phila) 2024; 13:100029. [PMID: 38383079 DOI: 10.1016/j.apjo.2023.100029] [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: 09/01/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To evaluate the efficacy of perioperative IPL therapy in preventing postoperative ocular surface disorders in patients undergoing corneal laser refractive surgery. DESIGN randomized, controlled, clinical trial with triple-blinding. METHODS Setting: Vissum Miranza - Alicante; Study population: 61 patients randomized in two groups: 31 study patients (perioperative IPL + laser refractive surgery) and 30 control patients (perioperative placebo + laser refractive surgery). Follow-up was conducted over a 6-month period; Intervention: Each participants underwent three IPL sessions with a two-week interval between each session (pre-surgery, post-surgery week-one, and post-surgery week-three). For controls, placebo was administered following the same protocol. MAIN OUTCOMES MEASURES visual outcomes and refraction, slit-lamp examination, corneal topography, visual analogue scale questionnaire and Oculus Keratograph 5 M including tear meniscus height, non-invasive tear break- up time, ocular redness, infrared meibography and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS 61 randomized eyes were included. No significant differences were observed in terms of uncorrected and corrected distance visual acuity (UDVA, CDVA), refractive error or corneal aberrations. A statistically significant improvement in OSDI score (change -8.47, p = 0.043), tear meniscus (change 0.05 mm, p = 0.004) and Meibography (change -0.42, p = 0.012) was observed at the third postoperative month in the study group. Additionally, at the sixth postoperative month, there were statistically significant improvements in tear meniscus (change 0.06 mm, p = 0.018), tear break-up-time (change 1.68 s, p = 0.039) and Meibography (change -0.37, p = 0.030). CONCLUSIONS Results suggest that perioperative IPL therapy applied to laser corneal refractive surgery improves objective and subjective ocular surface parameters over non-IPL-treated control patients and early postoperative dry eye symptoms.
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Affiliation(s)
- María C Martínez-Hergueta
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Ophthalmology Department, Hospital General de Elda, Alicante, Spain
| | - Mario Cantó-Cerdán
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Maria A Amesty
- Oculoplastic Unit, Vissum (Miranza Group), Alicante, Spain
| | - M Jose García-Corral
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | | | - Ana B Plaza-Puche
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L Alió Del Barrio
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain.
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [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: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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5
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Mao X, Ji S, Chen H, Dai J. Comparison of Postoperative Safety, Efficacy, and Visual Quality after SMILE for Myopic Patients with Different Corneal Thicknesses. Curr Eye Res 2023; 48:18-24. [PMID: 36285731 DOI: 10.1080/02713683.2022.2117382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the safety, efficacy, and visual quality of small incision lenticule extraction (SMILE) in different corneal thickness patients with myopia or myopic astigmatism. METHODS This prospective cohort study included 191 right eyes of 191 patients. Eyes were divided into three groups according to preoperative central corneal thickness (CCT) (Preoperative central corneal thickness (CCT) was the group indicator.) There were 31 eyes in the thin cornea group (CCT ≤500 um (μm), TC), 94 eyes in the moderate corneal thickness group (CCT ≥501 um (μm) and ≤550 um (μm), MD) and 66 eyes in the thick cornea group (CCT ≥550 um (μm), TK). Comparisons in uncorrected (UDVA) and best-corrected distance visual acuity (BDVA), manifest refractive spherical equivalent (SE), preoperative mesopic/photopic contrast sensitivity (CS), ocular higher-order aberrations (HOAs) at a 6mm analytical pupil diameter, and visual quality questionnaires were made (performed) among the three groups during the postoperative six months. Subgroup analyses were made based on preoperative SE. RESULTS The safety indices at six months were 1.15 ± 0.18, 1.14 ± 0.17, and 1.18 ± 0.17, respectively (p = 0.374), and the efficacy indices at six months were 1.07 ± 0.25, 1.12 ± 0.22, and 1.11 ± 0.21, respectively (p = 0.599). The postoperative SE was -0.07 ± 0.52D, -0.14 ± 0.38D, and -0.05 ± 0.46D after SMILE in the three groups, respectively (p = 0.376). No significant difference was found in mesopic/photopic CS, HOAs, and visual quality among different corneal thickness groups and SE groups. Postoperative SE and efficacy indices were the lowest in thin cornea eyes with ultra-high myopia (over -9.00 D). CONCLUSIONS SMILE provides comparable safety, efficacy, and visual quality results in different corneal thickness patients. Those with myopia higher than -9.00 D had less efficacy after surgery, especially in thin cornea patients.
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Affiliation(s)
- Xiuyu Mao
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Shunmei Ji
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
| | - Han Chen
- Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Fujian Provincial Hospital, Fujian, China
| | - Jinhui Dai
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences (Fudan University), Shanghai, China
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Jee KJ, Ling J, Bafna S, Chester T, Augustine J, Wiley WF. Prospective, Randomized, Fellow Eye-Controlled Study of Postoperative Pain and Inflammation Control with an Intracanalicular Dexamethasone 0.4 mg Ophthalmic Insert Following Small Incision Lenticule Extraction. Clin Ophthalmol 2022; 16:3895-3904. [PMID: 36444207 PMCID: PMC9700473 DOI: 10.2147/opth.s390815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/11/2022] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare postoperative anterior chamber inflammation, pain, and patient preference following small incision lenticule extraction (SMILE) in eyes treated with a dexamethasone 0.4 mg intracanalicular insert (DEX) or topical prednisolone acetate (PRED). PATIENTS AND METHODS In this prospective, randomized, fellow eye-controlled trial, 20 patients underwent same-day, bilateral SMILE. One randomly-selected eye of each patient received DEX placed immediately postoperatively, and the fellow eye received topical PRED tapered over 2 weeks. Postoperative evaluations were performed on day 1, week 1, month 1, and month 3. Primary outcomes included postoperative pain, incidence of anterior chamber cell and flare, and patient preference of steroid therapy. RESULTS No eyes in either group had any clinically evident cell or flare at any postoperative time point. Mean pain scores (0-10 by subjective report) and incidence of any pain were statistically similar at all postoperative visits. Uncorrected distance visual acuity improved in all eyes, 91% of which achieved 20/25 or better. No eyes lost any lines of corrected distance visual acuity. Three eyes developed a steroid-related rise in intraocular pressure, all of which resolved with 2 of the 3 eyes requiring topical therapy. At 1 week, 1 month, and 3 months, 70%, 65%, and 53% of patients preferred DEX over PRED therapy, respectively. CONCLUSION The DEX insert was preferred by more patients and controlled postoperative inflammation and pain comparably to topical PRED in eyes undergoing SMILE. There were no statistically significant differences in visual outcomes between the two groups.
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Jiang X, Wang Y, Yuan H, Li Y, Wang H, An Z, Li X. Influences of SMILE and FS-LASIK on Corneal Sub-basal Nerves: A Systematic Review and Network Meta-analysis. J Refract Surg 2022; 38:277-284. [PMID: 35412925 DOI: 10.3928/1081597x-20220127-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare postoperative corneal sub-basal nerve density and number between small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS A search was made in PubMed, EMBASE, and the Cochrane library for prospective comparative studies. The analysis was divided into two parts: network meta-analysis and traditional meta-analysis of the studies directly comparing two surgical groups. Stata 16 (Stata Corporation) and Rev-Man 5.4 (Cochrane) software were used to analyze the data. RESULTS Twelve studies (n = 775) were included. In the network meta-analysis, the SMILE group showed a significant increase compared with the FS-LASIK group in corneal nerve density at 1 month postoperatively (mean: 4.23; 95% CI: 0.06 to 8.39, P < .05), and in the number of corneal nerve trunks at 6 months postoperatively (mean: 13.25; 95% CI: 10.20 to 16.30, P < .05). In the traditional meta-analysis, the SMILE group showed significant improvement compared with the FS-LASIK group in corneal nerve density at 1 (weighted mean difference [WMD]: -2.05, 95% CI: -3.11 to -1.00, P < .05) and 3 (WMD: -0.90, 95% CI: -1.30 to -0.50, P < .05) months postoperatively, and in the number of corneal nerve trunks (WMD: -2.52, 95% CI: -4.91 to -0.14, P < .05) and corneal nerve branches (WMD: -2.80, 95% CI: -3.41 to -2.19, P < .05) at 1 month postoperatively. CONCLUSIONS The corneal nerve injury in the FS-LASIK group was worse than that in the SMILE group. The corneal nerve recovery in the SMILE group was better at 3 months postoperatively. However, there was no significant difference in corneal nerve density and number between the two groups at 6 months postoperatively. [J Refract Surg. 2022;38(4):277-284.].
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Chang JY, Lin PY, Hsu CC, Liu CJL. Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia. J Chin Med Assoc 2022; 85:145-151. [PMID: 34861667 DOI: 10.1097/jcma.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
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Affiliation(s)
- Jin-Yu Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Yu Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Mikalauskiene L, Grzybowski A, Zemaitiene R. Ocular Surface Changes Associated with Ophthalmic Surgery. J Clin Med 2021; 10:jcm10081642. [PMID: 33921534 PMCID: PMC8069708 DOI: 10.3390/jcm10081642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.
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Affiliation(s)
- Lina Mikalauskiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania;
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland;
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania;
- Correspondence:
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Sharma B, Soni D, Saxena H, Stevenson LJ, Karkhur S, Takkar B, Vajpayee RB. Impact of corneal refractive surgery on the precorneal tear film. Indian J Ophthalmol 2020; 68:2804-2812. [PMID: 33229655 PMCID: PMC7856956 DOI: 10.4103/ijo.ijo_2296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/28/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
Corneal refractive surgeries are one of the commonly performed procedures for correction of refractive errors. Tear film abnormality is the most common postoperative complication of corneal refractive surgeries. Consequently, these procedures represent a clinically significant cause of dry eye disease. The mechanisms which lead to dry eye disease include corneal sensory nerve dysfunction, ocular surface desiccation, glandular apoptosis and ocular surface inflammation. Although transient tear film abnormalities occur in almost all patients following surgery, patients with pre-existing dry eye symptoms or dry eye disease are at significant risk of developing more severe or long-term ocular surface disease. As such, careful patient selection and preoperative evaluation is essential to ensuring successful surgical outcomes. This is particularly important with LASIK which has the strongest association with dry eye disease. Appropriate surface lubrication and anti-inflammatory therapy remains the cornerstone treatment. Timely and effective management is important to facilitate visual rehabilitation and reduce the risk of secondary complications. In this review we describe the causes, pathophysiology, risk factors, manifestations, and management of tear film dysfunction and dry eye disease following corneal refractive surgery.
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Affiliation(s)
- Bhavana Sharma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Harsha Saxena
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Louis J Stevenson
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rasik B Vajpayee
- Cornea Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, Victoria, Australia
- Cornea Unit, Vision Eye Institute, Melbourne, Victoria, Australia
- Cornea and Cataract Surgery Unit, University of Melbourne, Melbourne, Victoria, Australia
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11
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Asif MI, Bafna RK, Mehta JS, Reddy J, Titiyal JS, Maharana PK, Sharma N. Complications of small incision lenticule extraction. Indian J Ophthalmol 2020; 68:2711-2722. [PMID: 33229647 PMCID: PMC7856979 DOI: 10.4103/ijo.ijo_3258_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
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Affiliation(s)
- Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jodhbir Singh Mehta
- Singapore Eye Research Institute; Singapore National Eye Centre, 168751; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Jagadesh Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Luft N, Siedlecki J, Schworm B, Dirisamer M, Priglinger SG. „Small incision lenticule extraction“ (SMILE): eine Standortbestimmung. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-00444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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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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Wong AH, Cheung RK, Kua WN, Shih KC, Chan TC, Wan KH. Dry Eyes After SMILE. Asia Pac J Ophthalmol (Phila) 2019; 8:397-405. [PMID: 31490199 PMCID: PMC6784859 DOI: 10.1097/01.apo.0000580136.80338.d0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/15/2019] [Indexed: 11/26/2022] Open
Abstract
Dry eyes is one of the most common complications after laser vision correction. Small incision lenticule extraction (SMILE) is a flapless procedure with a smaller corneal incision, less corneal nerves are transected during, making it theoretically less prone to dry eyes. Both SMILE and femtosecond-laser-assisted in situ keratomileusis (FS-LASIK) induce a transient worsening in dry eye parameters, but there is evidence showing that SMILE holds promises to have fewer negative impacts on the ocular surface parameters and allow an earlier recovery. SMILE-treated eyes may also have shown less corneal denervation and better corneal sensitivity compared with FS-LASIK eyes. This review summarizes the mechanisms of dry eyes after laser vision correction, the short-term (≤6 months) and long-term (>6 months) results in changes to dry eyes signs and symptoms, and corneal sensitivity of SMILE, as compared with FS-LASIK. Limitation of the studies and reasons accounting for their discrepancies will be discussed. Future randomized controlled trials with standardized postoperative regime are needed for better evaluation of dry eyes after SMILE.
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Affiliation(s)
- Angela H.Y. Wong
- Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China
| | | | - Wee Nie Kua
- Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China
| | - Kendrick C. Shih
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - Tommy C.Y. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Kelvin H. Wan
- Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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15
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Liu Q, Yang X, Lin L, Liu M, Lin H, Liu F, Xie Y, Lam DS. Review on Centration, Astigmatic Axis Alignment, Pupil Size and Optical Zone in SMILE. Asia Pac J Ophthalmol (Phila) 2019; 8:385-390. [PMID: 31567265 PMCID: PMC6784779 DOI: 10.1097/01.apo.0000580144.22353.46] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
The advent of "flapless" small-incision lenticule extraction (SMILE), employing all-in-one technology, has resulted in a revolutionary breakthrough in refractive surgeries. SMILE has been gaining popularity due to fewer potential complications, such as postoperative dry eyes and greater biomechanical stability, etc. However, attention must be given to 1) the centration on the corneal vertex, 2) the proper alignment of the astigmatic axis, and 3) the relationship between pupil size and treatment diameter, to achieve good SMILE results. There is no pupil-tracking system to ascertain the accuracy of centration during the SMILE surgery. To improve the centration accuracy, our center uses two corneal topographers (Pentacam and Sirius) to measure and determine corneal vertex. Proper predicted optical zone diameter is not clearly defined yet in SMILE. Some scholars insist that mesopic pupil size should be taken into consideration when setting the predicted optical zone. Meanwhile, the issue of "functional optical zone" still has many unresolved issues and warrants further studies.
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Affiliation(s)
- Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaonan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Manli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haiqin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dennis S.C. Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Futian, Shenzhen, China
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Bandeira F, Yusoff NZ, Yam GHF, Mehta JS. Corneal re-innervation following refractive surgery treatments. Neural Regen Res 2019; 14:557-565. [PMID: 30632489 PMCID: PMC6352585 DOI: 10.4103/1673-5374.247421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Laser refractive surgery is one of the most performed surgical procedures in the world. Although regarded safe and efficient, it has side effects. All of the laser based refractive surgical procedures invoke corneal nerve injury to some degree. The impact of this denervation can range from mild discomfort to neurotrophic corneas. Currently, three techniques are widely used for laser vision correction: small incision lenticule extraction, laser-assisted keratomileusis in situ and photorefractive keratotomy. Each of these techniques affects corneal innervation differently and has a different pattern of nerve regeneration. The purpose of this review is to summarize the different underlying mechanisms for corneal nerve injury and compare the different patterns of corneal reinnervation.
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Affiliation(s)
- Francisco Bandeira
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore; Federal University of São Paulo, Sao Paulo; São Gonçalo Eye Hospital, São Gonçalo, Brazil
| | - Nur Zahira Yusoff
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Gary Hin-Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute; Eye-ACP, Duke-NUS Graduate Medical School, Singapore
| | - Jodhbir Singh Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute; Eye-ACP, Duke-NUS Graduate Medical School; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore; Singapore National Eye Centre; School of Material Science and Engineering, Nanyang Technological University, Singapore
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17
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Influence of Incision Size on Dry Eye Symptoms in the Small Incision Lenticule Extraction Procedure. Cornea 2018; 38:18-23. [PMID: 30308580 DOI: 10.1097/ico.0000000000001782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the influence of incision size on dry eye symptoms in the small incision lenticule extraction (SMILE) procedure. METHODS Ninety-four eyes of 47 patients with myopia and/or myopic astigmatism who had undergone the SMILE procedure were enrolled in this study. The patients were divided into 3 groups according to the incision size (2, 3, and 4 mm) applied during the SMILE procedure. RESULTS There were no significant differences among the groups in respect to age and sex (P values 0.251 and 0.974, respectively) and in respect to preoperative, postoperative first day, first week, first month, third month, and sixth month values of the Ocular Surface Disease Index score, tear break-up time, ST1, and staining grades. CONCLUSIONS There was no difference in dry eye symptoms with 2-, 3-, and 4-mm incisions. In the learning period of SMILE surgery, larger incision sites can be used to make the procedure easier.
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18
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Chiche A, Trinh L, Baudouin C, Denoyer A. [SMILE (Small Incision Lenticule Extraction) among the corneal refractive surgeries in 2018 (French translation of the article)]. J Fr Ophtalmol 2018; 41:650-658. [PMID: 30170707 DOI: 10.1016/j.jfo.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 11/24/2022]
Abstract
Refractive surgery is a field in constant evolution. In recent years, a new procedure has appeared under the name SMILE (Small Incision Lenticule Extraction). This technique, carried out solely with a femtosecond laser, should make it possible to better preserve corneal innervation and biomechanics. After a detailed review of the technique itself, we then focus on the scientific evidence for the safety and efficacy of SMILE and its current indications. Advantages of SMILE will be discussed in comparison to disadvantages of the conventional techniques, particularly concerning dry eye and the risk of corneal ectasia with LASIK. Lastly, the current limitations of SMILE (indications, retreatment) are discussed, and future applications are considered regarding improvements in the technique.
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Affiliation(s)
- A Chiche
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, université de Versailles-Saint-Quentin-en-Yvelines, 28, rue de Charenton, 75012 Paris, France
| | - L Trinh
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, université de Versailles-Saint-Quentin-en-Yvelines, 28, rue de Charenton, 75012 Paris, France; Espace Nouvelle Vision, 6, rue de la Grande Chaumière, 75006 Paris, France
| | - C Baudouin
- Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, université de Versailles-Saint-Quentin-en-Yvelines, 28, rue de Charenton, 75012 Paris, France; Inserm U968, université UPMC Paris VI, UMR S 968, CNRS, UMR 7210, 75012 Paris, France
| | - A Denoyer
- Inserm U968, université UPMC Paris VI, UMR S 968, CNRS, UMR 7210, 75012 Paris, France; Hôpital Robert-Debré, CHU de Reims, rue du Général Koenig, 51100 Reims, France; URCA, université de Reims-Champagne-Ardenne, Reims, France.
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Chiche A, Trinh L, Baudouin C, Denoyer A. SMILE (Small Incision Lenticule Extraction) among the corneal refractive surgeries in 2018. J Fr Ophtalmol 2018; 41:e245-e252. [PMID: 29914764 DOI: 10.1016/j.jfo.2018.05.001] [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: 01/08/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Abstract
Refractive surgery is a field in constant evolution. In recent years, a new procedure has appeared under the name SMILE (SMall Incision Lenticule Extraction). This technique, carried out solely with a femtosecond laser, should make it possible to better preserve corneal innervation and biomechanics. After a detailed review of the technique itself, we then focus on the scientific evidence for the safety and efficacy of SMILE and its current indications. Advantages of SMILE will be discussed in comparison to the conventional techniques, particularly concerning dry eye and the risk of corneal ectasia related to LASIK. Lastly, the current limitations of SMILE (indications, retreatment) are discussed, and future applications are considered regarding new improvements in the technique.
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Affiliation(s)
- A Chiche
- Ophthalmology Service 3, Quinze-Vingts National Ophthalmology Hospital, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - L Trinh
- Ophthalmology Service 3, Quinze-Vingts National Ophthalmology Hospital, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; Espace Nouvelle Vision, 75012 Paris, France
| | - C Baudouin
- Ophthalmology Service 3, Quinze-Vingts National Ophthalmology Hospital, University of Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France; INSERM, U968, 75012 Paris, France; UMR S 968, Institut de la Vision, University UPMC Paris VI, 75012 Paris, France; CNRS, UMR 7210, 75012 Paris, France
| | - A Denoyer
- INSERM, U968, 75012 Paris, France; UMR S 968, Institut de la Vision, University UPMC Paris VI, 75012 Paris, France; CNRS, UMR 7210, 75012 Paris, France; University Hospital Robert-Debré, rue du Général-Koenig, 51100 Reims, France; URCA, University of Reims Champagne-Ardenne, 51100 Reims, France.
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20
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Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm. Indian J Ophthalmol 2018; 66:10-19. [PMID: 29283117 PMCID: PMC5778540 DOI: 10.4103/ijo.ijo_761_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.
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Affiliation(s)
- Sri Ganesh
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Raghavender Reddy Arra
- Department of Phaco-Refractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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21
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Rodriguez JD, Lane KJ, Ousler GW, Angjeli E, Smith LM, Abelson MB. Blink: Characteristics, Controls, and Relation to Dry Eyes. Curr Eye Res 2017; 43:52-66. [PMID: 29043838 DOI: 10.1080/02713683.2017.1381270] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Blink is a complex phenomenon that is profoundly affected by diverse endogenous and exogenous stimuli. It has been studied in the context of cognition, emotional, and psychological states, as an indicator of fatigue and sleepiness, particularly in the automobile and transportation industry, in visual tasking, and finally, as it relates to tear film stability and ocular surface health. The fact that it is highly variable and has input from so many sources makes it very difficult to study. In the present review, the behavior of blink in many of these systems is discussed, ultimately returning in each instance to a discussion of how these factors affect blink in the context of dry eyes. Blink is important to ocular surface health and to an individual's optimal functioning and quality of life. Disturbances in blink, as cause or effect, result in a breakdown of tear film stability, optical clarity, and visual function.
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Affiliation(s)
| | | | | | | | | | - Mark B Abelson
- a Ora, Inc , Andover , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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Cai WT, Liu QY, Ren CD, Wei QQ, Liu JL, Wang QY, Du YR, He MM, Yu J. Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis: a Meta-analysis. Int J Ophthalmol 2017; 10:632-638. [PMID: 28503439 DOI: 10.18240/ijo.2017.04.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the corneal sensitivity and the incidences of dry eye after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS The Meta-analysis was performed using RevMan 5.3. We searched on PubMed from inception to March 2016. Summary weighted mean difference (WMD) and 95% confidence intervals (CIs) were used to analyze the datum. Random-effects or fixed-effects models were chosen up to between-study heterogeneity. The main outcomes were composed of the Ocular Surface Disease Index (OSDI) scores, tear film break-up time (TBUT), Schirmer Test and corneal sensitivity. RESULTS Eight eligible studies including 772 eyes (386 in SMILE group and 386 in FS-LASIK group) were identified. The parameters have no significiant difference heterogeneity between SMILE and FS-LASIK group preoperatively. There were significant differences between the two groups in OSDI scores at one and three months postoperatively, in TBUT at one and three months postoperatively, in corneal sensitivity at one week, about one month and three months postoperatively. However, there was no significant difference observed in Schirmer Test at the follow-up periods. CONCLUSION Compare to FS-LASIK, dry eye and the corneal sensitivity recover better in the SMILE group, in first three months after the surgery.
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Affiliation(s)
- Wen-Ting Cai
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qing-Yu Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Cheng-Da Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qing-Quan Wei
- Nanchang University, Nanchang 330031, Jiangxi Province, China
| | - Jun-Ling Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Qian-Yi Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Ya-Ru Du
- Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Meng-Mei He
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
| | - Jing Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai 200072, China
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A review and meta-analysis of corneal cross-linking for post-laser vision correction ectasia. J Curr Ophthalmol 2017; 29:145-153. [PMID: 28913504 PMCID: PMC5587251 DOI: 10.1016/j.joco.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/06/2017] [Accepted: 02/19/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study was to review the safety and stability of cornea cross-linking (CXL) for the treatment of keratectasia after Excimer Laser Refractive Surgery. METHODS Eligible studies were identified by systematically searching PubMed, Embase, Web of Science and reference lists. Meta-analysis was performed using Stata 12.1 software. The primary outcome parameters included the changes of corrected distant visual acuity (CDVA), uncorrected visual acuity (UCVA), the maximum keratometry value (Kmax) and minimum keratometry value (Kmin), the surface regularity index (SRI), the surface asymmetry index (SAI), the keratoconus prediction index (KPI), corneal thickness, and endothelial cell count. Efficacy estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the interested outcomes. RESULTS Seven studies involving 118 patients treated with CXL for progressive ectasia after laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) (140 eyes; the follow-up time range from 12 to 62 months) were included in the meta-analysis. The pooled results showed that there were no significant differences in Kmax and Kmin values after CXL (WMD = 0.584; 95% CI: -0.289 to 1.458; P = 0.19; WMD = 0.466; 95% CI: -0.625 to 1.556; P = 0.403, respectively). The CDVA improved significantly after CXL (WMD = 0.045; 95% CI: 0.010 to 0.079; P = 0.011), whereas UCVA did not differ statistically (WMD = 0.011; 95% CI: -0.055 to 0.077; P = 0.746). The changes were not statistically significant in SRI, SAI, and KPI (WMD = 0.116; 95% CI: -0.090 to 0.322; P = 0.269; WMD = 0.240; 95% CI: -0.200 to 0.681; P = 0.285; WMD = 0.045; 95% CI: -0.001 to 0.090; P = 0.056, respectively). Endothelial cell count and corneal thickness did not deteriorate (WMD = 12.634; 95% CI: -29.460 to 54.729; P = 0.556; WMD = 0.657; 95% CI: -9.402 to 10.717; P = 0.898, respectively). CONCLUSION The study showed that CXL is a promising treatment to stabilize the keratectasia after Excimer Laser Refractive Surgery. Further long-term follow-up studies are necessary to assess the persistence of the effect of the CXL.
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Shen Z, Zhu Y, Song X, Yan J, Yao K. Dry Eye after Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis. PLoS One 2016; 11:e0168081. [PMID: 27992482 PMCID: PMC5161410 DOI: 10.1371/journal.pone.0168081] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/26/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose To compare dry eye after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK) for correcting myopia. Methods CENTRAL, Embase and PubMed were searched in November 2016. All randomized controlled trials (RCTs) and prospective cohorts that compared dry eye after SMILE with FS-LASIK were selected. Results Five cohorts and one RCT were identified for comparing dry eye after SMILE (291 eyes) and FS-LASIK (277 eyes). The pooled results revealed that the SMILE and FS-LASIK groups did not differ significantly in terms of Schirmer’s I test (SIT) and tear film osmolarity (TFO) at any postoperative visits. By contrast, tear break up time (TBUT; p = 0.04 for one month, p < 0.001 for three months, and p = 0.02 for six months) and ocular surface disease index (OSDI; p < 0.001 for one month and three months, and p = 0.006 for six months) were significantly worse in the FS-LASIK group than in the SMILE group at follow-up. At six months postoperatively, TBUT and TFO values in both the SMILE and FS-LASIK groups and OSDI scores in the SMILE group returned to preoperative levels, but SIT values in both groups (p = 0.02 for the SMILE group and p < 0.001 for the FS-LASIK group) and OSDI in the FS-LASIK group (p < 0.001) were still statistically impaired. Conclusion Dry eye after both SMILE and FS-LASIK usually occurs transiently. SMILE does not show obvious superiority over FS-LASIK by exhibiting similar and acceptable objective parameters, and SMILE may have milder subjective symptoms.
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Affiliation(s)
- Zeren Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yanan Zhu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Song
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Yan
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- * E-mail:
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Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK) for Myopia: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0158176. [PMID: 27367803 PMCID: PMC4930219 DOI: 10.1371/journal.pone.0158176] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/11/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose The goal of this study was to compare small incision lenticule extraction (SMILE) with femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for treating myopia. Methods The CENTRAL, EMBASE, PubMed databases and a Chinese database (SinoMed) were searched in May of 2016. Twelve studies with 1,076 eyes, which included three randomized controlled trials (RCTs) and nine cohorts, met our inclusion criteria. The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group framework. Data were extracted and analysed at three to six months postoperatively. Primary outcome measures included a loss of one or more lines of best spectacle corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA) of 20/20 or better, mean logMAR UCVA, postoperative mean spherical equivalent (SE) and postoperative refraction within ±1.0 D of the target refraction. Secondary outcome measures included ocular surface disease index (OSDI), tear breakup time (TBUT) and Schirmer’s 1 test (S1T) as dry eye parameters, along with corneal sensitivity. Results The overall quality of evidence was considered to be low to very low. Pooled results revealed no significant differences between the two groups with regard to a loss of one or more lines in the BSCVA (OR 1.71; 95% CI: 0.81, 3.63; P = 0.16), UCVA of 20/20 or better (OR 0.71; 95% CI: 0.44, 1.15; P = 0.16), logMAR UCVA (MD 0.00; 95% CI: -0.03, 0.04; P = 0.87), postoperative refractive SE (MD -0.00; 95% CI: -0.05, 0.05; P = 0.97) or postoperative refraction within ±1.0 D of the target refraction (OR 0.78; 95% CI: 0.22, 2.77; P = 0.70) within six months postoperatively. The pooled analysis also indicated that the FS-LASIK group suffered more severely from dry eye symptoms (OSDI; MD -6.68; 95% CI: -11.76, -2.00; P = 0.006) and lower corneal sensitivity (MD 12.40; 95% CI: 10.23, 14.56; P < 0.00001) at six months postoperatively. Conclusions In conclusion, both FS-LASIK and SMILE are safe, effective and predictable surgical options for treating myopia. However, dry eye symptoms and loss of corneal sensitivity may occur less frequently after SMILE than after FS-LASIK.
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