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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024; 35:278-283. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Kanclerz P, Bazylczyk N, Przewłócka K, Khoramnia R, Atchison DA, Tuuminen R. Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation. J Refract Surg 2024; 40:e420-e434. [PMID: 38848055 DOI: 10.3928/1081597x-20240416-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].
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Wei C, Liu J, Zhang C, Liu JY, Lu YM. Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis. J Fr Ophtalmol 2024; 47:104085. [PMID: 38377878 DOI: 10.1016/j.jfo.2024.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/18/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. METHODS A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta-analysis. RESULTS A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P=0.18), the proportion of eyes within±0.50 diopter of target refraction postoperatively (P=0.10), or the postoperative magnitude of cylinder (P=0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P=0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P=0.03) than SMILE. In terms of aberrations, higher order aberrations (P=0.46), spherical aberrations (P=0.22) and trefoil (P=0.56) were not statistically different, while WFG-LASIK induced less coma than SMILE surgery (P=0.02). CONCLUSION Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma.
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Affiliation(s)
- C Wei
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - C Zhang
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - J Y Liu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China
| | - Y M Lu
- Department of Ophthalmology, The Six Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Yinquan Road B24, Guangdong, Qingyuan, China.
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Du Y, Di Y, Yang S, Mo F, Cui G, Chen D, Li Y. Differences in ocular high order aberrations before and after small incision lenticule extraction for correction of myopia: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1274101. [PMID: 38601117 PMCID: PMC11004322 DOI: 10.3389/fmed.2024.1274101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Objective To examine the causes and factors that lead to high order aberration (HOA) during the treatment of myopia using small incision lenticule extraction (SMILE), as well as the differences between SMILE and other corneal refractive surgeries through a systematic review and meta-analysis. Methods A systematic search was conducted from January 2015 to February 2023 in Pubmed, Embase, Web of Science, and Google Scholar databases to gather relevant studies on SMILE and HOA. Studies meeting specific criteria were chosen, and clinical data was retrieved for analysis. Results This meta-analysis resulted in the inclusion of 19 studies involving 1,503 eyes. Pooled results showed significant induction of total HOA (tHOA, d = -0.21, p < 0.001), spherical aberration (SA, d = -0.11, p < 0.001) and coma aberration (CA, d = -0.18, p < 0.001) after SMILE compared to pre-SMILE, while no significant change in trefoil aberration (TA) was observed (d = -0.00, p = 0.91). There was a significantly lower induction of tHOA after SMILE compared to femtosecond laser-assisted in situ keratomileusis (FS-LASIK, d = 0.04, p < 0.001), and no significant difference was observed compared to wavefront aberration-guided (WFG) refractive surgery (d = 0.00, p = 0.75). There was also a significant association between different levels of myopia and astigmatism, duration of follow-up, lenticule thickness, and preoperative central corneal thickness (CCT) on the induction of tHOA after SMILE (p < 0.05), while the higher preoperative myopia group (sphere > -5D), lower preoperative astigmatism group (cylinder ≤ -1D), larger lenticule thickness group (lenticule thickness > 100 μm), shorter follow-up group (follow-up 1 month postoperatively) and the thicker CCT group (CCT > 550 μm) brought a significant induction of tHOA compared to the opposite comparison group (p < 0.001). Conclusion While SMILE can induce HOA significantly, it induces less HOA than FS-LASIK. Postoperative HOA following SMILE can be affected by factors such as myopia, astigmatism, lenticule thickness, CCT, and duration of follow-up. Future research should continue to explore techniques to decrease the induction of HOA by using this methodology. Systematic review registration https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | | | | | | | | | | | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Moshirfar M, Omidvarnia S, Christensen MT, Porter KB, Theis JS, Olson NM, Stoakes IM, Payne CJ, Hoopes PC. Comparative Analysis of Corneal Higher-Order Aberrations after Laser-Assisted In Situ Keratomileusis, Photorefractive Keratectomy, and Small Incision Lenticule Extraction with Correlations to Change in Myopic Q-Value and Spherical Equivalent with and without Astigmatism. J Clin Med 2024; 13:1906. [PMID: 38610671 PMCID: PMC11012266 DOI: 10.3390/jcm13071906] [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: 02/05/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This retrospective chart review compared the higher-order aberrations (HOAs) among photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) alongside changes in spherical equivalent (SEQ) and corneal shape (Q-value). Methods: Analyzing 371 myopic eyes, including 154 LASIK, 173 PRK, and 44 SMILE cases, Pentacam imaging was utilized pre-operatively and at one-year post-operative visits. Results: All procedures resulted in 100% of patients achieving an uncorrected distance visual acuity (UDVA) of 20/40 or better, with 87% of LASIK and PRK, and 91% of SMILE patients having 20/20 or better. Significant increases in HOAs were observed across all procedures (p < 0.05), correlating positively with SEQ and Q-value changes (LASIK (0.686, p < 0.05), followed by PRK (0.4503, p < 0.05), and SMILE (0.386, p < 0.05)). Vertical coma and spherical aberration (SA) were the primary factors for heightened aberration magnitude among the procedures (p < 0.05), with the largest contribution in SMILE, which is likely attributed to the centration at the corneal apex. Notably, PRK showed insignificant changes in vertical coma (-0.197 µm ± 0.0168 to -0.192 µm ± 0.0198, p = 0.78), with an increase in oblique trefoil (p < 0.05). Conclusions: These findings underscore differences in HOAs among PRK, LASIK, and SMILE, helping to guide clinicians.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (I.M.S.); (C.J.P.); (P.C.H.)
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
| | | | | | - Kaiden B. Porter
- School of Medicine, University of Arizona, Phoenix, AZ 85004, USA; (K.B.P.); (J.S.T.)
| | - Josh S. Theis
- School of Medicine, University of Arizona, Phoenix, AZ 85004, USA; (K.B.P.); (J.S.T.)
| | - Nathan M. Olson
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA;
| | - Isabella M. Stoakes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (I.M.S.); (C.J.P.); (P.C.H.)
- School of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA 98901, USA
| | - Carter J. Payne
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (I.M.S.); (C.J.P.); (P.C.H.)
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Phillip C. Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St., Ste. 200, Draper, UT 84020, USA; (I.M.S.); (C.J.P.); (P.C.H.)
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Mohr KM, Gyldenkerne AN, Hjortdal JØ. Impact of Small Incision Lenticule Extraction for High Myopia on Intraocular Pressure Measurements With Pneumotonometry. J Refract Surg 2023; 39:606-611. [PMID: 37675911 DOI: 10.3928/1081597x-20230728-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To evaluate the medium-term impact of small incision lenticule extraction (SMILE) on air-puff tonometry (APT) and how it may be corrected. METHODS In this controlled prospective study, 69 eyes from 69 patients treated with SMILE for high myopia (mean: -7.22 diopters) were included. Central corneal thickness (CCT), spherical equivalent refraction (SEQ), corneal power, and intraocular pressure (IOP) (assessed by APT) were measured before and 3 months after surgery. RESULTS The measured IOP decreased significantly after SMILE surgery (mean: -6.43 mm Hg), indicating a significant underestimation of the true IOP by APT. There was a significant correlation between change in SEQ, CCT, and apparent IOP. Correcting the apparent IOP measurement by applying a multiple regression correction did not provide significantly better estimates compared to adding 6.4 mm Hg to the measurement. CONCLUSIONS This study showed that previous SMILE surgery should be considered when interpreting APT measurements, because the measurements underestimate the true IOP. Multiple regressions cannot estimate the true IOP with certainty. For screening purposes, adding 6.4 mm Hg to the apparent IOP of a patient treated for high myopia may be sufficient. [J Refract Surg. 2023;39(9):606-611.].
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Du H, Zhang B, Wang Z, Xiong L. Quality of vision after myopic refractive surgeries: SMILE, FS-LASIK, and ICL. BMC Ophthalmol 2023; 23:291. [PMID: 37365492 DOI: 10.1186/s12886-023-03045-6] [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: 04/11/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND To characterize the quality of vision after SMILE, FS-LASIK, and ICL implantation and evaluate the related factors. METHODS 131 eyes of 131 myopic patients (90 female, 41 male) who underwent refractive surgeries including SMILE (35 patients), FS-LASIK (73 patients), and ICL implantation (23 patients) were analyzed. The Quality of Vision questionnaires were completed 3 months after surgery, and the results were characterized and analyzed with baseline characteristics, treatment parameters, and postoperative refractive outcomes using logistic regression analysis to find out predicted factors. RESULTS Mean age was 26.5 ± 4.6 years (range: 18 to 39 years) and mean preoperative spherical equivalent was - 4.95 ± 2.04 diopters (D) (range: -1.5 to -13.5). Safety and efficacy index was comparable between different techniques: the safety index was 1.21 ± 0.18, 1.22 ± 0.18, and 1.22 ± 0.16 and the efficacy index were 1.18 ± 0.20, 1.15 ± 0.17, 1.17 ± 0.15 for SMILE, FS-LASIK and ICL respectively. The mean overall QoV score was 13.40 ± 9.11, with mean frequency, severity, and bothersome score of 5.40 ± 3.29, 4.53 ± 3.04, and 3.48 ± 3.18 respectively, and there was no significant difference between different techniques. Overall, the symptom with the highest scores was glare, following fluctuation in vision and halos. Only the scores of halos were significantly different among different techniques (P < 0.000). Using ordinal regression analysis, mesopic pupil size was identified as a risk factor (OR = 1.63, P = 0.037), while postoperative UDVA was a protective factor (OR = 0.036, P = 0.037) for overall QoV scores. Using binary logistic regression analysis, we found that patients with larger mesopic pupil size had an increased risk to experience glare postoperatively; compared to ICL, patients who underwent SMILE or FS-LASIK tended to report fewer halos; patients with better postoperative UDVA were less likely to report blurred vision and focusing difficulty; with larger residual myopic sphere postoperatively, patients experienced focusing difficulties and difficulty judging distance or depth perception more frequently. CONCLUSIONS SMILE, FS-LASIK, and ICL had comparable visual outcomes. Overall, glare, fluctuation in vision, and halos were the most frequently experienced visual symptoms 3 months postoperatively. Patients with ICL implanted tended to report halos more frequently compared with SMILE and FS-LASIK. Mesopic pupil size, postoperative UDVA, and postoperative residual myopic sphere were predicted factors for reported visual symptoms.
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Affiliation(s)
- Huiyi Du
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Bo Zhang
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Zheng Wang
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lu Xiong
- Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou, China.
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Reinstein DZ, Archer TJ, Potter JG, Gupta R, Wiltfang R. Refractive and Visual Outcomes of SMILE for Compound Myopic Astigmatism With the VISUMAX 800. J Refract Surg 2023; 39:294-301. [PMID: 37162399 DOI: 10.3928/1081597x-20230301-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To report the first refractive and visual outcomes of small incision lenticule extraction (SMILE) using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec AG). METHODS This was a retrospective analysis of consecutive eyes treated by SMILE using the VISUMAX 800 femtosecond laser at London Vision Clinic, EuroEyes Group, London, United Kingdom. Inclusion criteria were patients aged younger than 45 years, a corrected distance visual acuity (CDVA) of 20/20 or better, and the 3-month postoperative timepoint data being available for analysis. Standard outcomes analysis and vector analysis by the Alpins method were performed. RESULTS During the study period, 128 eyes of 66 consecutive patients were treated. Three-month data were available for 118 eyes (92%), and 10 eyes (8%) were lost to follow-up. The mean attempted spherical equivalent refraction (SEQ) was -4.65 ± 1.91 diopters (D) (range: -1.90 to -10.05 D) and the mean cylinder was -0.98 ± 0.78 D (range: 0.00 to -4.00 D). The mean age was 30 ± 5 years (range: 20 to 43 years), with 54% women and 46% men. Postoperative SEQ was within ±0.50 D in 86% and ±1.00 D in 100% of eyes. Uncorrected distance visual acuity was 20/20 or better in 91% of eyes. One line of CDVA was lost in 8% of eyes, and no eyes lost two or more lines. There was a small but statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. CONCLUSIONS Early outcomes data for SMILE with the second generation VISUMAX 800 femtosecond laser demonstrated an effective and safe option equivalent to published first generation VisuMax outcomes for the treatment myopia and astigmatism. [J Refract Surg. 2023;39(5):294-301.].
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Ma KK, Manche EE. Patient-reported quality of vision in a prospective randomized contralateral-eye trial comparing LASIK and small-incision lenticule extraction. J Cataract Refract Surg 2023; 49:348-353. [PMID: 36539217 DOI: 10.1097/j.jcrs.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare patient-reported quality of vision and visual symptoms in participants undergoing laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). SETTING Byers Eye Institute, Stanford University, Palo Alto, California. DESIGN Prospective randomized contralateral-eye clinical trial. METHODS Patients with myopia were randomized to receive wavefront-guided femtosecond LASIK in one eye and SMILE in the fellow eye. Participants reported the presence and severity of adverse visual symptoms through the Patient-Reported Outcomes With Laser In Situ Keratomileusis questionnaire and reported which eye had better vision at the preoperative and the postoperative 1-month, 3-month, 6-month, and 12-month visits. RESULTS 80 eyes of 40 participants were treated. There was no difference in the presence or severity of double vision, glare, halos, or starbursts between eyes that underwent LASIK or SMILE at each visit ( P ≥ .85 for each comparison). Scaled scores for the presence of visual symptoms improved from the preoperative visit to the postoperative month 12 visit for double vision (88 vs 97, P = .03), glare (77 vs 92, P = .02), halos (68 vs 87, P < .01), and starbursts (60 vs 86, P < .01). At the postoperative month 12 visit, 17 (46%) of 37 participants preferred the vision from the eye that underwent LASIK compared with 7 (19%) of 37 who underwent SMILE. The preferred eye was correlated with uncorrected distance visual acuity ( r = 0.52, P < .01). CONCLUSIONS Rates of visual symptoms were similar for LASIK and SMILE, and visual symptoms improved with time. More patients preferred vision from the eye that underwent LASIK compared with SMILE.
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Affiliation(s)
- Kevin K Ma
- From the Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
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Yao L, Zhang M, Wang D, Zhao Q, Wang S, Bai H. Small Incision Lenticule Extraction (SMILE) and Laser in Situ Keratomileusis (LASIK) Used to Treat Myopia and Myopic Astigmatism: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Semin Ophthalmol 2023; 38:283-293. [PMID: 35912896 DOI: 10.1080/08820538.2022.2107399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSES The purpose of this meta-analysis is to systematically compare the safety, efficacy, and predictability of small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). METHODS This study covered the data searched from the PubMed, the EMBASE and the Cochrane Library. The Cochrane Handbook was also referred to as evaluating the quality of the included studies. In addition, this meta-analysis was performed using Revman 5.4 software. RESULTS A total of 11 randomized controlled trails (RCTs) were included. The proportion of eyes with refraction within ±0.5D was higher in LASIK group compared with SMILE group (RR, 0.91; 95% CI, 0.83 to 0.99; p = .04). The spherical aberration (SA) was smaller in SMILE group compared with LASIK group (RR, -0.12; 95% CI, -0.23 to -0.01; p = .04). There were no significant differences between two groups with regard to final mean refractive spherical equivalent (SE) (MD, -0.04; 95% CI, -0.12 to 0.03; p = .22), proportion of eyes losing one or more lines of corrected distance visual acuity (CDVA) (RR, 1.14; 95% CI, 0.58 to 2.27; p = .70), proportion of eyes with uncorrected distance visual acuity (UCVA) of 20/20 or better (RR, 0.99; 95% CI, 0.94 to 1.05; p = .71), postoperative mean logMAR UCVA (MD, 0.01; 95% CI, -0.00 to 0.03; p = .13), postoperative refraction within ±1.0D (RR, 1.00; 95% CI, 0.98 to 1.02; p = .60), postoperative astigmatism within ±0.25, 0.5 and 1.0D (RR, 0.80, 0.99, 1.00; 95% CI, 0.35 to 1.83, 0.94 to 1.05, 0.98 to 1.02; p = .60, 0.86, 0.87), postoperative higher order aberrations (HOAs) (RR, 0.00; 95% CI, -0.16 to 0.16; p = .99). CONCLUSION For predictability, LASIK was superior to SMILE. There were comparably safety and efficacy for the correction of myopia and myopic astigmatism in SMILE and LASIK. SA was smaller after SMILE than after LASIK.
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Affiliation(s)
- Lin Yao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | | | - Qian Zhao
- Qingdao Aier Eye Hospital, Qingdao, SD, China
| | | | - Haiqing Bai
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, SD, China
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Cui G, Di Y, Yang S, Chen D, Li Y. Efficacy of small-incision lenticule extraction surgery in high astigmatism: A meta-analysis. Front Med (Lausanne) 2023; 9:1100241. [PMID: 36743675 PMCID: PMC9892059 DOI: 10.3389/fmed.2022.1100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy of small-incision lenticule extraction (SMILE) in improving vision and visual quality and correcting astigmatism for the treatment of high astigmatism. Methods Eligible studies and studies comparing the efficacy of SMILE with femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) or transepithelial photorefractive keratectomy (T-PRK) for high astigmatism (≥2.00 D) were identified in PubMed, Embase, and the Cochrane Central Register of Controlled Trials, searched from their inception to 29 May 2022. The references of all searched studies were checked as supplements. The risk of bias was evaluated for each eligible study. The literature was screened according to the inclusion and exclusion criteria, and relative data were extracted. Data were extracted and analyzed by ReviewManager 5.4. The primary outcome was post-operative uncorrected distance visual acuity (UDVA). The secondary outcomes included corneal aberrations and vector parameters. The weight mean difference (WMD) and their 95% confidence intervals (95% CI) were used to assess the strength of the association. Results A total of six studies including 380 astigmatism eyes were involved, with 211 high-astigmatism eyes and 31 low-astigmatism eyes undergoing SMILE surgery, 94 high-astigmatism eyes undergoing FS-LASIK surgery, and 44 high-astigmatism eyes undergoing T-PRK surgery. Compared with non-SMILE, SMILE induced more astigmatism (weighted mean difference [WMD] = -0.07, 95% CI [-0.12 to -0.02], P = 0.005) and fewer sphere aberrations (WMD = -0.12, 95% CI [-0.17 to -0.08], P < 0.00001). The post-operative UDVA, sphere, spherical equivalent (SE), and higher order aberrations in different surgeries were likewise equivalent. The difference vector and index of success were significantly higher, and the surgically induced astigmatism vector, correction index, and magnitude of error were significantly lower in SMILE. Conclusion This meta-analysis suggests that SMILE, FS-LASIK, and T-PRK show excellent efficacy, predictability, and safety for myopia. SMILE exhibited less astigmatism refraction predictability and less surgically induced spherical aberrations. There may be more under-correction in SMILE. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term.
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Affiliation(s)
- Ge Cui
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Di Chen,
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Ying Li,
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12
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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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13
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Liu S, Zhang X, Niu L, Yu Z, Zhou X, Zhao J. Comparison of the Functional Optical Zone in Eyes With High Myopia With High Astigmatism After SMILE and FS-LASIK. J Refract Surg 2022; 38:595-601. [PMID: 36098388 DOI: 10.3928/1081597x-20220725-01] [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 the functional optical zone (FOZ) in eyes with high myopia with high astigmatism after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS In total, 45 eyes of 45 patients with high myopia with astigmatism greater than 2.00 diopters (D) who underwent SMILE or FS-LASIK were enrolled. The FOZ, optical zone decentration, and corneal aberrations were analyzed using Scheimpflug imaging. These values were then compared between the two groups 6 months postoperatively. RESULTS No postoperative complications were observed during follow-up. The mean FOZ diameter was 5.03 ± 0.31 mm for the FS-LASIK group and 5.24 ± 0.27 mm for the SMILE group (P = .007), corresponding to reductions of 1.18 ± 0.23 and 1.01 ± 0.21 mm, respectively, compared with the programmed optical zone (POZ) (P = .013). A significant difference was noted in the FOZ on the short axis between the two groups (P = .002), whereas no significant difference was observed on the long axis (P = .088). The FOZ area in the FS-LASIK and SMILE groups was 65.39 ± 6.14% and 70.09 ± 5.46% of the POZ area, respectively (P = .010). There was no significant difference in decentration between the two groups (0.29 ± 0.13 mm for the FS-LASIK group vs 0.30 ± 0.13 mm for the SMILE group, P = .798). A significant increase in spherical aberration was observed in the FS-LASIK group (P < .001). However, the induction of vertical coma was higher in the SMILE group than in the FS-LASIK group (P = .002). CONCLUSIONS Eyes with high myopia with high astigmatism following SMILE achieved a larger FOZ and less spherical aberration but a larger vertical coma introduction than following FS-LASIK. [J Refract Surg. 2022;38(9):595-601.].
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14
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Reinstein DZ, Carp GI, Archer TJ, Vida RS, Yammouni R. Large Population Outcomes of Small Incision Lenticule Extraction in Young Myopic Patients. J Refract Surg 2022; 38:488-496. [PMID: 35947004 DOI: 10.3928/1081597x-20220623-01] [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 evaluate the outcomes of small incision lenticule extraction (SMILE) for myopia in a large population of young adults. METHODS In this retrospective case series, the patient population consisted of the first 4,138 consecutive SMILE treatments using the VisuMax femtosecond laser (Carl Zeiss Meditec) between 2012 and 2018 at the London Vision Clinic. Inclusion criteria were myopic spherical equivalent up to -9.00 diopters (D), cylinder up to 6.00 D, corrected distance visual acuity of 20/20 or better, age younger than 40 years, and follow-up of 12 months. Outcomes analysis was performed using the Standard Graphs for Reporting Refractive Surgery. RESULTS Data were available at 12 months in 3,722 eyes (90%), and 416 eyes (10%) were lost to follow-up. Mean attempted spherical equivalent refraction (SEQ) was -4.61 ± 1.84 D (range: -1.12 to -9.00 D). Mean cylinder was -0.78 ± 0.66 D (range: 0.00 to -6.00 D). Postoperatively, the mean SEQ relative to target was -0.13 ± 0.30 D (range: -1.35 to +1.25 D) and was within ±0.50 D in 88.1% and ±1.00 D in 99.6% of eyes. Uncorrected distance visual acuity was 20/20 or better in 95.4% of eyes and 20/25 or better in 98.7% of eyes. One line of CDVA was lost in 3.0% of eyes, and 0.08% (n = 3) lost two or more lines of CDVA, for which CDVA was restored following phototherapeutic keratectomy treatment. There was a statistically significant improvement of 0.05, 0.06, 0.07, and 0.07 log units for contrast sensitivity at 3, 6, 12, and 18 cycles per degree, respectively (P < .001). CONCLUSIONS SMILE achieved excellent outcomes for myopia up to -9.00 D with cylinder up to -5.50 D for a large population in patients without presbyopia. [J Refract Surg. 2022;38(8):488-496.].
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15
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Reinstein DZ, Archer TJ, Vida RS, Carp GI, Reinstein JFR, McAlinden C. Objective and Subjective Quality of Vision After SMILE for High Myopia and Astigmatism. J Refract Surg 2022; 38:404-413. [PMID: 35858192 DOI: 10.3928/1081597x-20220516-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report subjective and objective quality of vision (QoV) results for high myopic small incision lenticule extraction (SMILE) between -9.00 and -13.00 diopters (D). METHODS This was a prospective study recruiting 114 patients undergoing SMILE with attempted spherical equivalent refraction (SEQ) correction from -9.00 to -13.00 D, and cylinder up to 5.00 D. Patients were informed before surgery of the increased risk of QoV symptoms. Patients completed the Rasch validated QoV questionnaire. Objective QoV was assessed by corneal and whole eye aberrations, HD Analyzer Objective Scatter Index (OSI) (Keeler), and contrast sensitivity. Patient satisfaction was assessed on a scale from 0 (very dissatisfied) to 10 (very satisfied). Individual item and total Rasch-scaled scores for the three subscales (frequency, severity, and bothersomeness) of the QoV questionnaire were calculated before and 12 months after surgery. RESULTS The mean patient satisfaction score was 9.27 ± 1.18 (range: 2 to 10), 8 or higher in 93%, and 7 or higher in 98% of patients. One patient with a satisfaction score of 2 had a simple refractive error re-treatment and then reported a satisfaction score of 10. The total mean ± standard deviation Rasch-scaled QoV score for the frequency, severity, and bothersomeness subscales before surgery was 24 ± 19, 20 ± 16, and 19 ± 18, respectively. Scores increased after surgery to 41 ± 18, 32 ± 16, and 30 ± 21, respectively (P < .001). Corneal aberrations (6 mm, OSI) increased on average by 0.39 µm for spherical aberration, 0.41 µm for coma, and 0.56 µm for higher order aberrations root mean square. OSI increased on average by 0.58. There was a small but statistically significant improvement in contrast sensitivity at 3, 6, 12, and 18 cycles per degree. There were no statistically significant correlations found between subjective scores for starbursts and objective measurements. CONCLUSIONS Satisfaction was high following SMILE for high myopia. As expected, there was an increase in QoV symptoms, mainly glare and starbursts. The acceptance of QoV symptoms for high myopic SMILE was high, indicating that residual refractive error and visual acuity are the major drivers for patient satisfaction with appropriate preoperative informed consent. [J Refract Surg. 2022;38(7):404-413.].
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16
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Reinstein DZ, Archer TJ, Vida RS, Carp GI, Reinstein JFR, McChesney T, Potter JG. Small Incision Lenticule Extraction (SMILE) for the Correction of High Myopia With Astigmatism. J Refract Surg 2022; 38:262-271. [PMID: 35536712 DOI: 10.3928/1081597x-20220314-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of small incision lenticule extraction (SMILE) for high myopia between -9.00 and -14.00 diopters (D). METHODS This was a prospective study of SMILE for high myopia using the VisuMax femtosecond laser (Carl Zeiss Meditec). Inclusion criteria were attempted spherical equivalent refraction (SEQ) between -9.00 and -14.00 D, cylinder up to 7.00 D, corrected distance visual acuity (CDVA) of 20/40 or better, age 21 years or older, and suitable for SMILE. The sub-lenticule thickness was 220 µm or greater, and the total uncut stromal thickness was 300 µm or greater. Patients were to be followed up for 1 year. Standard outcomes analysis was performed using 12-month data where available or 3-month data otherwise. RESULTS Of 187 eyes treated, data were available at 12 months for 181 eyes (96.8%) and 3 months for 4 eyes (2.1%), and 2 eyes (1.1%) were lost to follow-up. Mean attempted SEQ was -10.55 ± 1.00 D (range: -9.00 to -12.99 D). Mean cylinder was -1.19 ± 0.83 D (range: 0.00 to -4.00 D). Preoperative CDVA was 20/20 or better in 73% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 57% and 20/25 or better in 82% of eyes. Mean SEQ relative to target was -0.22 ± 0.48 D (range: -1.63 to +1.38 D), 66% ± 0.50 D and 93% ±1.00 D. Mean SEQ 12-month change was -0.08 ± 0.34 D (range: -1.75 to +0.88 D). There was loss of one line of CDVA in 4% of eyes, and no eyes lost two or more lines. Contrast sensitivity was unchanged. Patient satisfaction was 8 or more out of 10 in 94% and 6 or more in 99% of patients. CONCLUSIONS Outcomes of SMILE for myopia greater than -9.00 D at 3 to 12 months showed excellent efficacy, safety, stability, and predictability, with high patient satisfaction. [J Refract Surg. 2022;38(5):262-271.].
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17
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Wang C, Li X, Guo Y, He R, Guo H, Chen W. Effects of Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction on Corneal Biomechanical Behavior: A Finite Element Analysis. Front Bioeng Biotechnol 2022; 10:855367. [PMID: 35480973 PMCID: PMC9035518 DOI: 10.3389/fbioe.2022.855367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Myopia, which is the result of the uncoordinated development of the eyeball, has become a major public health focus worldwide. Laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE) have been successfully used in modern corneal refractive surgery. However, there are still controversies about postoperative results of LASIK and SMILE. In this study, a three-dimensional finite element model of the cornea was constructed based on the elevation and pachymetry data of a female volunteer. Surgical parameters, magnitudes of myopic correction, and intraocular pressure (IOP) were varied. Furthermore, an iterative algorithm was applied to retrieve the free-stress state of the intact corneal model, LASIK model, and SMILE model. To better evaluate the differences between LASIK and SMILE procedures, the displacement and Von Mises stress on the anterior and posterior corneal surface along the x- and y-axes were analyzed. Results for the zero-pressure model showed larger displacement compared to the image-based corneal model, suggesting that the initial corneal pre-stress stiffens the response of the cornea, both in the intact cornea and under refractive surgery. In addition, the displacement on the corneal surface in LASIK (both zero-pressure and image-based model) was obviously higher than that of the SMILE model. In contrast, SMILE increased Von Mises stress in the corneal cap and reduced Von Mises stress in the residual stromal bed compared with the LASIK model. However, the maximum Von Mises stress in the SMILE model was still smaller than that of the LASIK model. Moreover, the displacement and Von Mises stress on the residual stromal bed increased linearly with IOP. Overall, LASIK and SMILE refractive surgery could change biomechanical behaviors of the cornea. Compared to LASIK refractive surgery, SMILE may present a lower risk of ectasia. Creating a corneal cap rather than a corneal flap may have an advantage in improving corneal biomechanical stability.
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Affiliation(s)
- Chenyan Wang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Xiaona Li
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
- *Correspondence: Xiaona Li, ; Weiyi Chen,
| | - Yuan Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Rui He
- Department of Excimer Laser, Shanxi Eye Hospital, Taiyuan, China
| | - Hongmei Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
- *Correspondence: Xiaona Li, ; Weiyi Chen,
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18
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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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19
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Jabbarvand M, Khodaparast M, Moravvej Z, Shahraki K, Ahmadi H, Shahraki K, Jamali A, Narooie-Noori F. Vector analysis of moderate to high myopic astigmatism after small-incision lenticule extraction (SMILE): 12-month follow-up. Eur J Ophthalmol 2022; 32:3312-3320. [PMID: 35175136 DOI: 10.1177/11206721221080821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism. STUDY DESIGN Prospective interventional case series. METHODS This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of - 0.5 D or more and astigmatism between - 1.0 D and -5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. RESULTS The preoperative mean spherical equivalent was -5.48 ± 2.17 D (range - 1.75 to - 10.00 D) and the mean cylinder was -2.02 ± 1.09 D (range - 1.00 to - 5.00 D). The mean postoperative cylinder value was -0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. CONCLUSION SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Mehdi Khodaparast
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Zahra Moravvej
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Eye Research Center, Eye Department, Amiralmomenin Hospital, School of Medicine, 37554Guilan University of Medical Sciences, Rasht, Iran
| | - Kianoush Shahraki
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran
| | - Hanie Ahmadi
- Eye Research Center, 48438Farabi Eye Hospital, Tehran University of Medical Sciences, Iran.,Department of Ophthalmology, 92948Mazandaran University of Medical sciences, Sari, Iran
| | - Kourosh Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
| | - Foroozan Narooie-Noori
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, 440827Iran University Of medical Sciences, Tehran, Iran
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20
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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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21
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He S, Luo Y, Chen P, Ye Y, Zheng H, Lan M, Zhuang J, Yu K. Prospective, Randomized, Contralateral Eye Comparison of Functional Optical Zone, and Visual Quality After SMILE and FS-LASIK for High Myopia. Transl Vis Sci Technol 2022; 11:13. [PMID: 35133403 PMCID: PMC8842633 DOI: 10.1167/tvst.11.2.13] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the functional optical zone (FOZ) and visual quality after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in correcting high myopia. Methods Ninety-two eyes of 46 high myopic patients with the same programmed optical zone (POZ) received SMILE in one eye and FS-LASIK in the contralateral eye. FOZ was calculated using a refractive power method. The decentration, visual outcomes, wavefront aberrations, contrast sensitivity, and quality of vision (QoV) questionnaire were analyzed at 6 months postoperatively. Results The postoperative visual and refractive outcomes were comparable between SMILE and FS-LASIK. The FOZ for SMILE (5.62 ± 0.31 mm) was larger than for FS-LASIK (5.35 ± 0.28 mm; P < 0.001). Moreover, the total decentration for SMILE (0.29 ± 0.14 mm) was greater than in FS-LASIK (0.22 ± 0.11 mm; P < 0.001). The induced change in spherical aberration was less for SMILE than for FS-LASIK (P < 0.001). There was better contrast sensitivity under the mesopic condition with glare for SMILE than for FS-LASIK (P = 0.024). However, no significant difference was found in QoV scores between the two groups. Conclusions SMILE created a larger FOZ and greater decentration than FS-LASIK when the same POZ was designed in high myopia. Objective and subjective visual symptoms were comparable between SMILE and FS-LASIK. Translational Relevance The differences in FOZ and decentration between SMILE and FS-LASIK have little effect on vision outcomes. Surgeons should consider the FOZ and decentration in surgical options in high myopia.
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Affiliation(s)
- Shengyu He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yiqi Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Pei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yiming Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hua Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Min Lan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou, People's Republic of China
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22
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Ramirez-Miranda A, Mangwani-Mordani S, Hernandez-Bogantes E, Abdala-Figuerola A, Olivo-Payne A, Larrea J, Navas A, Graue-Hernandez EO. Visual and Refractive Outcomes Following SMILE to Correct Myopia Performed by Surgeons in Training. J Refract Surg 2022; 38:28-34. [PMID: 35020540 DOI: 10.3928/1081597x-20211209-01] [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 assess visual outcomes and complications following small incision lenticule extraction (SMILE) performed by cornea fellows under the supervision of experienced surgeons. METHODS This retrospective, noncomparative case series was designed to assess outcomes following SMILE procedures performed at a large surgical center by cornea fellows between May 1, 2012 and March 30, 2015. Preoperative and postoperative uncorrected distance visual acuity (UDVA), preoperative and postoperative corrected distance visual acuity (CDVA), spherical equivalent (SE) up to -10.00 diopters (D), and complications were recorded. RESULTS A total of 114 patients (228 eyes) met the inclusion criteria. The mean preoperative SE was -5.79 ± 1.95 D (range: -1.75 to -10.00 D) and the mean cylinder was -2.21 ± 1.43 D (range: 0.00 to -5.50 D). At the last follow-up visit (average: 6.4 months), 94% of the patients achieved a UDVA of 20/30 or better and 96% of the patients achieved stability in their vision. Adverse events were encountered in 40 eyes (17.5%), with epithelial defect being the most common. Two patients required a second intervention to improve visual outcomes. CONCLUSIONS SMILE performed by cornea fellows under the supervision of an experienced surgeon is an effective and safe refractive procedure with a short learning curve and excellent visual outcomes. [J Refract Surg. 2022;38(1):28-34.].
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Reversal of Myopic Correction for Patients Intolerant to LASIK. J Ophthalmol 2021; 2021:7113676. [PMID: 34956671 PMCID: PMC8694978 DOI: 10.1155/2021/7113676] [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: 09/09/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the outcome of the reversal of myopia correction in patients intolerant to LASIK. Methods This study is a retrospective and case series of patients who decided to reverse their previous myopic LASIK correction between July 2012 and July 2020. It was conducted at a private refractive surgery centre, Ismailia, Egypt. The patients were followed up after reversal treatment for one year. Primary LASIK and reversal treatment were performed by a 500 kHz Amaris excimer laser platform. The main outcomes included refractive predictability, stability, efficacy, and safety and any reported complications. Results This study included 48 eyes of 24 patients (6 male and 18 female patients). The average duration between the primary LASIK surgery and reversal treatment was 3.20 ± 0.30 months (range 3 to 4 months). Reversal treatment was bilateral in all patients. The mean age of the patients was 38 ± 1.9 years (range 37 to 45 yrs). After reversal, the mean postreversal cycloplegic refraction spherical equivalent was −1.82 ± 0.34 D (range −1.50 to −3.00 D). The mean ablation depth was 34.10 ± 7.36 μm (range 20 to 46 μm), and the mean of the central corneal thickness 12 months after reversal treatment was 510.2 ± 14.4 μm (range 515 to 487 μm). The mean keratometric reading was 42.6 ± 1.6 (range 42.5 to 44.8). The mean of CDVA was 0.2 ± 0.03 log MAR (range −0.10 to 0.4 log MAR). The mean optical zone of reversal treatment was 6.1 ± 0.3 mm (range 5.9 to 6.2 mm). UDVA was 0.4 log MAR in 87.5% of the patients, 0.5 log MAR in 8.3% of the patients, and 0.6 log MAR in 4.2% of the patients. CDVA remained unchanged in 83.3% of patients; 2.1% of the patients gained one line of CDVA (Snellen); 8.3% of the patients lost one line of CDVA; 6.3% of the patients lost two lines of CDVA. No cases of corneal ectasia were recorded. The only postoperative complications were flap microfolds in 3 eyes (6.25%). Conclusion In conclusion, this study demonstrates that reversal of myopic LASIK treatment is a safe, stable, and effective option for intolerant patients.
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Yin H, Chen X, Hong X, Ma J, Wu F, Wan T, Sang Y, Fu Q, Qin Z, Lyu D, Wu W, Yin J, Yang Y. Effect of SMILE-derived decellularized lenticules as an adhesion barrier in a rabbit model of glaucoma filtration surgery. BMC Ophthalmol 2021; 21:329. [PMID: 34503472 PMCID: PMC8431885 DOI: 10.1186/s12886-021-02090-3] [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: 05/03/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background To investigate the effects of small incision lenticule extraction (SMILE)-derived decellularized lenticules on intraocular pressure (IOP) and conjunctival scarring in a rabbit model of glaucoma filtration surgery. Methods Trabeculectomy was performed on both eyes of New Zealand rabbits. A decellularized lenticule was placed in the subconjunctival space in one eye of the rabbits (the decellularized lenticule group), and no adjunctive treatment was performed in the fellow eye (the control group). The filtering bleb features and IOP were evaluated 0, 3, 7, 14, 21, and 28 days after surgery, and histopathologic examination was performed 28 days after surgery. Results Decellularized lenticules significantly increased bleb survival and decreased IOP postoperatively in the rabbit model with no adverse side effects. The histopathologic results showed a larger subconjunctival space and less subconjunctival fibrosis in the decellularized lenticule group. Conclusions Decellularized lenticules can prevent postoperative conjunctiva-sclera adhesion and fibrosis, and they may represent a novel antifibrotic agent for trabeculectomy.
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Affiliation(s)
- Houfa Yin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Chen
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Hong
- Department of Ophthalmology, People's Hospital of Kaihua, Kaihua, China
| | - Jian Ma
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Wu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Wan
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiwen Sang
- Department of Laboratory Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiuli Fu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenwei Qin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danni Lyu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wu
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinfu Yin
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yabo Yang
- Eye Center, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Soleimani M, Haydar AA. Fungal keratitis after small incision lenticule extraction (SMILE): a case report and review of the literature. J Ophthalmic Inflamm Infect 2021; 11:25. [PMID: 34476600 PMCID: PMC8413420 DOI: 10.1186/s12348-021-00256-0] [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: 04/19/2021] [Accepted: 08/01/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To report a case of perforated fungal keratitis after small incision lenticule extraction (SMILE) treated with penetrating keratoplasty (PKP). Methods Case report and literature review. Results A 41-year-old woman presented with culture-proven unilateral fungal keratitis 4 days after uneventful SMILE. Her visual acuity was hand motion. The patient was treated with voriconazole irrigation (50 μm/0.1 ml) of the pocket and intrastromal voriconazole injection, in addition to systemic and topical antifungals. Despite aggressive management and decreased infiltration, the cornea was perforated and subsequently treated with PKP. Conclusions Infectious keratitis after SMILE is unusual. To our knowledge, this is the first report of perforated fungal keratitis post-SMILE. PKP eradicated the infection.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Ali A Haydar
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran.
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Comparison of the optical quality after SMILE and FS-LASIK for high myopia by OQAS and iTrace analyzer: a one-year retrospective study. BMC Ophthalmol 2021; 21:292. [PMID: 34340669 PMCID: PMC8330115 DOI: 10.1186/s12886-021-02048-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/09/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To compare the correction effect and optical quality after small-incision lenticule extraction (SMILE) and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia. METHODS 51 high myopia eyes after SMILE and 49 high myopia eyes after FS-LASIK were enrolled and divided into two groups retrospectively. The OQAS and iTrace analyzer were used for optical quality inspection. Between the two groups the spherical equivalent (SE), astigmatism, uncorrected distant visual acuity (UDVA), strehl ratio (SR), modulation transfer function cutoff frequency (MTF cutoff), objective scatter index (OSI) and wavefront aberrations were analyzed and compared before surgery and at 1, 6 and 12 months after surgery. RESULTS After the operation: (1) SE and astigmatism declined and UDVA increased significantly in both groups, and UDVA was better after SMILE than FS-LASIK. (2) SR and MTF cutoff reduced and OSI increased significantly after SMILE and FS-LASIK. SR and MTF cutoff were significantly higher after SMILE than FS-LASIK. OSI was significantly lower after SMILE than FS-LASIK. (3) The total wavefront aberration, total low-order wavefront aberration, defocus and astigmatism aberration as well as trefoil aberration reduced significantly in both groups. The total high-order wavefront aberration increased significantly after FS-LASIK. The spherical and coma aberration increased significantly in both groups. The total high-order wavefront aberration and coma aberration at 1 month were higher after FS-LASIK than SMILE. CONCLUSION The optical quality descended after SMILE and FS-LASIK. SMILE was superior to FS-LASIK at the correction effect and optical quality for high myopia. The combination of OQAS and iTrace analyzer is a valuable complementary measurement in evaluating the optical quality after the refractive surgery. TRIAL REGISTRATION This is a retrospective study. This research was approved by the ethics committee of Xiangya Hospital and the IRB approval number is 201612074.
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Samir A, Lotfy A, Heikal MA, Abdelrahman Elsayed AM. Small Incision Lenticule Extraction for Correction of Pediatric Unilateral Anisometropic Myopia. J Refract Surg 2021; 37:510-515. [PMID: 34388076 DOI: 10.3928/1081597x-20210506-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of femtosecond laser small incision lenticule extraction (SMILE) on treating unilateral myopic anisometropia in children with spectacles or contact lens intolerance. METHODS This was a retrospective study that included children with unilateral myopic anisometropic amblyopia who underwent a SMILE procedure at Alpha Vision Center, Zagazig, Egypt, from January 2014 to December 2016. RESULTS One hundred twenty-four eyes of 124 patients were included in this study. The postoperative corrected distance visual acuity (CDVA) at the 3-month and 1-, 2-, 3-, and 4-year follow-up visits improved significantly (P < .05) compared to the preoperative CDVA, indicating the safety of the procedure. At the 3-month postoperative visit, 23% of cases showed improvement of one or more lines of CDVA, whereas only 2% of cases showed a decline of only one line. Moreover, the postoperative uncorrected distance visual acuity compared favorably to the preoperative CDVA, denoting the efficacy of the refractive correction. The spherical equivalent was within ±0.50 diopters of the intended correction in 75% of the cases and within ±1.00 diopters in 89% of the cases. The intraoperative complications were scarce and relatively innocuous. CONCLUSIONS SMILE is a safe and effective alternative method for correcting myopic anisometropic amblyopia in children with spectacles or contact lens intolerance with good refractive results. A larger study with longer follow-up periods is necessary to determine the long-term effects of SMILE. [J Refract Surg. 2021;37(8):510-515.].
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Abstract
A lenticule of intrastromal corneal tissue was cut together with 2 small incisions of 3.0 mm using a low-energy femtosecond laser system, FEMTO LDV Z8; 1 incision led to the posterior plane and 1 to the anterior, allowing dissection of the lenticule. When needed, recentering of the treatment area was possible without repeating the docking stage. Five eyes were operated, and a complete dissection and removal of the lenticule was achieved in all cases without any intraoperative complications. In addition, at postoperative day 1, all patients had a clear cornea. In conclusion, guided lenticule extraction using a low-energy femtosecond laser was a promising and easy procedure.
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Pradhan KR, Arba-Mosquera S. Three-Month Outcomes of Myopic Astigmatism Correction With Small Incision Guided Human Cornea Treatment. J Refract Surg 2021; 37:304-311. [PMID: 34044692 DOI: 10.3928/1081597x-20210210-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate refractive and visual outcomes of small incision guided human cornea treatment (SmartSight; SCHWIND eye-tech-solutions) in the treatment of myopic astigmatism with the use of a new femtosecond laser system. METHODS This retrospective, observational case series study included 104 eyes of 56 patients who underwent SmartSight to correct myopic astigmatism and completed the 3-month follow-up. Procedures were performed with a SCHWIND ATOS femtosecond laser. RESULTS Preoperatively, mean manifest spherical equivalent refraction was -6.12 ± 1.99 diopters (D) (range: -3.00 to -11.50 D) and astigmatism was 1.02 ± 0.56 D (range: 0.25 to 2.75 D). Three months postoperatively, it was +0.47 ± 0.32 D (range: -0.75 to +1.00 D) and 0.27± 0.22 D (range: 0.00 to 0.75 D), respectively (both P < .05). Spherical equivalent correction within ±0.50 D was achieved in 62 eyes (60%), and cylindrical correction in 90 eyes (87%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 94 eyes (90%) and postoperative uncorrected distance visual acuity was 20/20 or better in 96 eyes (92%). No eye lost two or more Snellen lines of CDVA. CONCLUSIONS Myopic astigmatism correction with Smart-Sight provided good results for efficacy, safety, predictability, and visual outcomes in the first 3 months of follow-up. [J Refract Surg. 2021;37(5):304-311.].
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Kwak JJ, Jun I, Kim EK, Seo KY, Kim TI. Clinical Outcomes of Small Incision Lenticule Extraction in Myopia: Study of Vector Parameters and Corneal Aberrations. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 34:76-84. [PMID: 32037752 PMCID: PMC7010474 DOI: 10.3341/kjo.2019.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/05/2019] [Accepted: 10/17/2019] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To investigate clinical outcomes of small incision lenticule extraction (SMILE) including vector parameters and corneal aberrations in myopic patients. METHODS This retrospective, observational case series included 57 eyes (29 patients) that received treatment for myopia using SMILE. Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1 and 3 months after surgery. We analyzed the safety, efficacy, vector parameters, and corneal aberrations at 3 months after surgery. RESULTS Preoperatively, mean manifest refraction spherical equivalent refraction was -4.94 ± 1.94 D (range, -8.25 to 0 diopters [D]), and the cylinder was -1.14 ± 0.82 D (range, -3 to 0 D). Mean manifest refraction spherical equivalent improved to -0.10 ± 0.23 D at 3 months postoperatively, when uncorrected distance visual acuity was 20 / 20 or better in 55 (96%) eyes. The linear regression model of target induced astigmatism vector versus surgically induced astigmatism vector exhibited slopes and coefficients (R²) of 0.9618 and 0.9748, respectively (y = 0.9618x + 0.0006, R² = 0.9748). While total corneal root mean square higher order aberrations, coma and trefoil showed statistically significant increase, spherical aberration did not show statistically significant change after SMILE. CONCLUSIONS SMILE has proven to be effective and safe for correcting myopia and astigmatism. We showed that SMILE did not induce spherical aberrations. A small increase in postoperative corneal higher order aberration may be associated with increase in coma and trefoil.
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Affiliation(s)
- Jay Jiyong Kwak
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, and Brain Korea 21 Project for Medical Science, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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Miraftab M, Hashemi H, Aghamirsalim M, Fayyaz S, Asgari S. Matched comparison of corneal higher order aberrations induced by SMILE to femtosecond assisted LASIK and to PRK in correcting moderate and high myopia: 3.00mm vs. 6.00mm. BMC Ophthalmol 2021; 21:216. [PMID: 33992084 PMCID: PMC8122548 DOI: 10.1186/s12886-021-01987-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background The refractive surgeries induce corneal higher order aberrations (C-HOAs). In this study, change of C-HOAs after small-incision lenticule extraction (SMILE) compared to femtosecond assisted laser in situ keratomileusis (femto-LASIK), and to photorefractive keratectomy with mitomycin-C (PRK) under photopic and mesopic conditions. Methods In this prospective study, age, gender, and apical corneal thickness (ACT) matched cases with moderate myopia [spherical equivalent (SE) 3.00 to 6.00D) to high myopia (SE > 6.00D)] were enrolled. In addition to visual acuity and refraction, total C-HOA, coma, spherical aberration (SA), and trefoil in the 3- and 6-mm zones were measured before and 3 and 6 months after surgery. Results Overall, 372 moderate myopia cases (124 eyes of 124 individuals in each surgical group) and 171 high myopia cases (57 eyes of 57 individuals in each surgical group) were enrolled. At baseline, the differences in age, gender, ACT, uncorrected and corrected visual acuity, and SE were not statistically significant between subgroups of surgical methods within each myopia group (all P > 0.05). At 12 months, in the moderate myopia group, there was less increase in 6-mm zone total C-HOA, coma, and SA with SMILE compared to the other groups (all P < 0.05). In the high myopia group, there was greater increase in photopic total C-HOA and trefoil and less increase in mesopic SA with SMILE (all P < 0.05). Conclusions In correction of moderate myopia, SMILE has better results in mesopic condition. In high myopia correction, femto-LASIK and PRK have better results in photopic and SMILE in mesopic condition.
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Affiliation(s)
- Mohammad Miraftab
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave, Tehran, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave, Tehran, Iran.
| | | | - Shiva Fayyaz
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave, Tehran, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave, Tehran, Iran
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Ramirez-Miranda A, Mangwani-Mordani S, Quiroz-Casian N, Oliva-Bienzobas V, Cabral-Macias J, Navas A, Graue-Hernandez EO. Combined Bacterial and Herpes Simplex Virus Keratitis following Small-Incision Lenticule Extraction for the Correction of Myopia. Case Rep Ophthalmol 2021; 12:227-231. [PMID: 33976687 PMCID: PMC8077540 DOI: 10.1159/000511374] [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: 08/19/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022] Open
Abstract
A 28-year-old male presented unilateral visual loss, intense ocular pain, redness and intraocular hypertension in his right eye 2 days after undergoing small-incision lenticule extraction (SMILE) in both eyes. Initial examination of the affected eye revealed the presence of white infiltrates within the corneal interface, as well as a central epithelial defect. The patient was diagnosed with infectious keratitis, posteriorly the eye was irrigated with balanced saline solution and treatment was initiated with hourly moxifloxacin 0.5%. Since this approach failed to resolve symptoms, a sample from the interface was obtained for PCR assay, which revealed the presence of herpes simplex virus DNA, confirming the cause of the infection. The patient was prescribed a regimen of oral acyclovir, topical ganciclovir and prednisolone. Clinical improvement following resolution of the epithelial defect was observed. Although rare, herpetic keratitis following SMILE is best managed via early diagnosis and initiation of appropriate anti-herpetic treatment.
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Affiliation(s)
- Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Simran Mangwani-Mordani
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Natalia Quiroz-Casian
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Valeria Oliva-Bienzobas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Jesus Cabral-Macias
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología, Conde de Valenciana, Mexico City, Mexico
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Zhang R, Wei H, Jhanji V, Sun L, Li J, Jiang J, Zhuang S, Zhang M. Comparison of corneal aberrations and refractive outcomes after small-incision lenticule extraction and femtosecond-assisted laser-assisted in situ keratomileusis. Int Ophthalmol 2021; 41:2521-2531. [PMID: 33783676 DOI: 10.1007/s10792-021-01810-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSES To retrospectively compare the short-term refractive outcomes and corneal aberrations after small-incision lenticule extraction (SMILE) and femtosecond-assisted laser-assisted in situ keratomileusis (FS-LASIK) combined with smart pulse technology (SPT) in patients with compound myopic astigmatism. METHODS A total of 91 eyes (91 patients) were included, 43eyes in FS-LASIK group and 48 eyes in the SMILE group. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive results and corneal topography were evaluated 1 and 3 months postoperatively. Corneal aberrations of anterior corneal surface were calculated from the topography data over 6 mm-diameter. RESULTS There was no significant difference in UCVA, BCVA, and refractive results between the two groups. There were no statistical difference in TIA (target induced astigmatism), SIA (surgery induced astigmatism), DV (difference vector), ME (magnitude of error), AE (angle of error), AE (absolute value) and CI (correction index) between both groups at 1 and 3 months. Coma and spherical aberration improved in all the patients in both groups at 1 and 3 months postoperatively. The amount of induced spherical aberrations was higher in FS-LASIK group compared to SMILE group. CONCLUSIONS Both FS-LASIK and SMILE achieved similar refractive outcomes in patients with myopia and compound myopic astigmatism. FS-LASIK combined with SPT resulted in higher spherical aberration than SMILE in early postoperative period.
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Affiliation(s)
- Riping Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.
| | - Heng Wei
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Vishal Jhanji
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lixia Sun
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jinyu Li
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Jingjing Jiang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Suoqing Zhuang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, 515041, China
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Fu Y, Yin Y, Wu X, Li Y, Xiang A, Lu Y, Fu Q, Hu T, Du K, Wen D. Clinical outcomes after small-incision lenticule extraction versus femtosecond laser-assisted LASIK for high myopia: A meta-analysis. PLoS One 2021; 16:e0242059. [PMID: 33556075 PMCID: PMC7870077 DOI: 10.1371/journal.pone.0242059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To compare postoperative clinical outcomes of high myopia after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS From March 2018 to July 2020, PubMed, MEDLINE, Embase, the Cochrane Library, and several Chinese databases were comprehensively searched. The studies meeting the criteria were selected and included; the data were extracted by 2 independent authors. The clinical outcome parameters were analyzed with RevMan 5.3. RESULTS This meta-analysis included twelve studies involving 766 patients (1400 eyes: 748 receiving SMILE and 652 receiving FS-LASIK). Pooled results revealed no significant differences in the following outcomes: the logarithm of the mean angle of resolution (logMAR) of postoperative uncorrected distance visual acuity (weighted mean difference (WMD) = -0.01, 95% confidence interval (CI): -0.02 to 0.00, I2 = 0%, P = 0.07 at 1 mo; WMD = -0.00, 95% CI: -0.01 to 0.01, I2 = 0%, P = 0.83 at 3 mo; WMD = -0.00, 95% CI: -0.01 to 0.00, I2 = 32%, P = 0.33 in the long term), and the postoperative mean refractive spherical equivalent (WMD = -0.03, 95% CI: -0.09 to 0.03, I2 = 13%, P = 0.30). However, the SMILE group had significantly better postoperative corrected distance visual acuity (CDVA) than the FS-LASIK group (WMD = -0.04, 95% CI, -0.05 to -0.02, I2 = 0%, P<0.00001). In the long term, postoperative total higher-order aberration (WMD = -0.09, 95% CI: -0.10 to -0.07, I2 = 7%, P<0.00001) and postoperative spherical aberration (WMD = -0.15, 95% CI: -0.19 to -0.11, I2 = 29%, P<0.00001) were lower in the SMILE group than in the FS-LASIK group; a significant difference was also found in postoperative coma (WMD = -0.05, 95% CI: -0.06 to -0.03, I2 = 30%, P<0.00001). CONCLUSION For patients with high myopia, both SMILE and FS-LASIK are safe, efficacious and predictable. However, the SMILE group demonstrated advantages over the FS-LASIK group in terms of postoperative CDVA, while SMILE induced less aberration than FS-LASIK. It remains to be seen whether SMILE can provide better visual quality than FS-LASIK; further comparative studies focused on high myopia are necessary.
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Affiliation(s)
- Yanyan Fu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yewei Yin
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Xiaoying Wu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Yuanjun Li
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Aiqun Xiang
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Ying Lu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Qiuman Fu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Tu Hu
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Kaixuan Du
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Dan Wen
- Department of Ophthalmology, XiangYa Hospital, Central South University, Changsha, Hunan, China
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- * E-mail:
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Hamilton DR, Chen AC, Khorrami R, Nutkiewicz M, Nejad M. Comparison of early visual outcomes after low-energy SMILE, high-energy SMILE, and LASIK for myopia and myopic astigmatism in the United States. J Cataract Refract Surg 2021; 47:18-26. [PMID: 32769749 DOI: 10.1097/j.jcrs.0000000000000368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare uncorrected distance visual acuities (UDVAs) and induced higher-order aberrations (HOAs) in the early postoperative period between low-energy (LE) small-incision lenticule extraction (SMILE), high-energy (HE) SMILE, and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) procedures. SETTING University based refractive surgery center. STUDY DESIGN Retrospective cohort study. METHODS Records of patients who underwent SMILE or FS-LASIK were retrospectively reviewed. SMILE patients were separated into 2 groups: HE settings (125 nJ, 3.0 μm spot spacing) and LE settings (125-130 nJ, 4.5 μm spot spacing). UDVA was measured at postoperative day (POD) 1. Corneal HOAs and UDVA were measured at postoperative month (POM) 1. Induced spherical aberration, vertical coma, horizontal coma, total coma, and total HOAs were calculated. RESULTS The study included 147 eyes of 106 patients, 49 in each group. For SMILE patients, the difference in mean UDVA at POD1 was highly statistically significant in favor of the LE group (-0.003 vs 0.141, P < .0001). No significant difference in mean UDVA at POD1 was noted between the LE group and FS-LASIK group (-0.003 vs -0.011, P = .498). Induced change in spherical aberration was less in LE SMILE than that in FS-LASIK (0.136 vs 0.186 μm, P = .02) at POM1. No significant differences in POM1 mean UDVA (-0.033 vs -0.036) or induced change in all other HOAs were noted between LE SMILE and FS-LASIK. CONCLUSIONS LE settings were associated with significantly improved POD1 UDVA. POD1 and POM1 UDVA were comparable with those of FS-LASIK. Spherical aberration induction was less with LE SMILE than that with FS-LASIK, whereas all other induced HOAs were comparable with FS-LASIK.
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Affiliation(s)
- D Rex Hamilton
- From the Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles (Chen, Khorrami, Nejad), Los Angeles, and Hamilton Eye Institute (Hamilton, Nutkiewicz), Los Angeles, California, USA
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Xia F, Qin B, Shang J, Chen Z, Zhou X, Zhao J, Wang X, Zhou X. Four-Year Outcomes of Small Incision Lenticule Extraction for Extreme High Myopia and Myopic Astigmatism. Front Med (Lausanne) 2020; 7:575779. [PMID: 33313044 PMCID: PMC7703695 DOI: 10.3389/fmed.2020.575779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the long-term safety, efficacy, predictability, and stability of small incision lenticule extraction (SMILE) for the treatment of high myopia and myopic astigmatism >−10.0 D. Methods: This was a prospective study that incorporated 35 consecutive patients (35 eyes) undergoing SMILE from September 2015 to March 2016. These patients had a mean preoperative spherical equivalent refraction of −10.06 ± 0.64 D. Patients were followed over a 4-year period and assessed for outcomes including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and corneal topography. Results: At 4 years post-SMILE, respective efficacy and safety indices were 1.01 ± 0.19 and 1.07 ± 0.15. In total, 97% of operated eyes achieved an UDVA of 20/25 or better. ≥1 line was gained for 9 eyes (26%), with 25 eyes (71%) remaining stable. Twenty-four (69%) and 33 (94%) eyes, respectively, were within ±0.50 D and ±1.0 D of target refraction. From 3 months to 4 years postoperatively, a mean refractive regression of −0.22 D (−0.06 D per year) was detected, whereas no significant changes in mean corneal back curvature or posterior central elevation were detected (P = 0.617 and 0.754, respectively). We detected significant increases in higher-order aberrations (HOAs) of the anterior and total cornea (all P < 0.001), with spherical aberrations and vertical coma being particularly common, whereas posterior corneal HOA remained fairly stable (all P < 0.05). Conclusion: SMILE is a safe, effective, predictable, and stable means of correcting high myopia and myopic astigmatism over a 4-year postoperative period.
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Affiliation(s)
- Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Bing Qin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jianmin Shang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Fu D, Zhao J, Zeng L, Zhou X. One Year Outcome and Satisfaction of Presbyopia Correction Using the PresbyMAX® Monocular Ablation Profile. Front Med (Lausanne) 2020; 7:589275. [PMID: 33330548 PMCID: PMC7732614 DOI: 10.3389/fmed.2020.589275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To explore the safety, efficacy, and satisfaction of the PresbyMAX monocular mode for the correction of presbyopia. Methods: Prospective study. Twenty-two patients (mean age 50.6 ± 6.2 years, 11 myopia patients and 11 hyperopia patients) were enrolled. The dominant eye was fully corrected for distance vision; the non-dominant eye was corrected using central PresbyMAX monocular mode. Binocular uncorrected distance visual acuity (BUDVA), near visual acuity (BUNVA), intermediate visual acuity (BUIVA), corrected distance visual acuity (CDVA), and mean spherical equivalent (SE) were tested at 1 day, 1 week, 1 month, 3 months, and 1 year postoperatively. Questionnaire was performed preoperatively, 1 month, 3 months, and 1 year after surgery. Results: At the final visit, the mean safety index was 1.03 ± 0.14. There were 85.7% eyes with the same or better CDVA than the preoperative value, and 17.1% and 2.9% eyes gained 1 line and 2 lines of CDVA, respectively. All treated eyes achieved 20/25 or better BUDVA, and 95.5% achieved 20/32 or better BUNVA, which improved significantly compared with preoperative values (P < 0.001). BUDVA maintained stability from 1 month postoperatively, BUNVA and BUIVA kept stable since 1 week after surgery. Overall satisfaction was 95.5% (21/22) at 3 months visit, and 100% at the last visit. No differences in terms of visual acuity and satisfaction were found between the myopia and hyperopia groups. Conclusion: The PresbyMAX monocular ablation profile was safe and effective in treating presbyopia, with great satisfaction achieved at postoperative 1 year.
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Affiliation(s)
- Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Li Zeng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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38
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Ahmed AA, Hatch KM. Advantages of Small Incision Lenticule Extraction (SMILE) for Mass Eye and Ear Special Issue. Semin Ophthalmol 2020; 35:224-231. [PMID: 32892680 DOI: 10.1080/08820538.2020.1807028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review summarizes the advantages of Small-incision lenticule extraction (SMILE), including improved patient intraoperative experience, improved postoperative ocular surface, low incidence of regression, low re-treatment rates, and advantageous biomechanical corneal stability. Visual and refractive outcomes are similar to those achieved with LASIK, notably in large population studies. Since the inception of SMILE almost 10 years ago, the procedure has been rapidly growing in popularity. With the implementation of the novel SMILE technology in their practice, refractive surgeons generate excitement and potential for expanding the refractive market. Other parts of the world, including Asia, Europe, and Russia, SMILE has become the most popular refractive procedure performed. It is speculated that as SMILE continues to grow in popularity in the US since FDA approval in 2016 and more refractive surgeons implement this technology into their practice, it will drive an increase in the refractive market similar to what is seen in other countries.
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Affiliation(s)
- Amani A Ahmed
- Anterior Segment - Cornea and Refractive Surgery, Mass Eye and Ear Main Campus , Boston, MA, USA.,Anterior Segment - Cornea and Refractive Surgery, Harvard University , Boston, MA, USA
| | - Kathryn M Hatch
- Anterior Segment - Cornea and Refractive Surgery, Mass Eye and Ear Main Campus , Boston, MA, USA.,Anterior Segment - Cornea and Refractive Surgery, Harvard University , Boston, MA, USA
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Park SY, Kwag JY, Hyun J, Pak KH, Chung SK, Choi JS. Comparison of Perioperative Contrast Sensitivity between Laser in situ Keratomileusis and Small-incision Lenticule Extraction. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.8.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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40
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Gulmez M, Tekce A, Kamıs U. Comparison of refractive outcomes and high-order aberrations after small incision lenticule extraction and wavefront-guided femtosecond-assisted laser in situ keratomileusis for correcting high myopia and myopic astigmatism. Int Ophthalmol 2020; 40:3481-3489. [PMID: 32737727 DOI: 10.1007/s10792-020-01534-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the results of using small incision lenticule extraction (SMILE) and wavefront-guided femtosecond-assisted laser in situ keratomileusis (WFG FS-LASIK) to correct high myopia and myopic astigmatism. MATERIAL AND METHODS The 94 eyes of 47 patients with high myopia or myopic astigmatism, if not both, who had undergone SMILE were compared with the 94 eyes of 47 patients with high myopia or myopic astigmatism, also if not both, who had undergone WFG FS-LASIK. Only eyes with high myopic or myopic astigmatism errors greater than - 6.0 diopter (D) spherical refraction and 0-3 D cylindrical refraction were included. Values of uncorrected distance visual acuity, corrected distance visual acuity, efficacy index, safety index, predictability, and high-order aberration between the patient groups were compared. RESULTS The SMILE and WFG FS-LASIK groups did not significantly differ according to sex or age. Values of preoperative and postoperative spherical refraction, cylindrical refraction, spherical equivalent, uncorrected distance visual acuity, and corrected distance visual acuity between the groups also did not significantly differ nor did values of predictability, the efficacy index, or the safety index. SMILE induced more coma and trefoil (p < 0.001), whereas WFG FS-LASIK induced more spherical aberration (p < 0.001). CONCLUSION Both SMILE and WFG FS-LASIK are efficient, safe, predictable procedures for correcting high myopia and myopic astigmatism. SMILE may induce more coma and trefoil, whereas WFG FS-LASIK may induce more spherical aberration.
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Affiliation(s)
- Mehmet Gulmez
- Department of Ophthalmology, The Dunya Goz Eye Hospital, Konya, Turkey.
| | - Abdulhakim Tekce
- Department of Ophthalmology, The Dunya Goz Eye Hospital, Baku, Azerbaijan
| | - Umit Kamıs
- Department of Ophthalmology, The Dunya Goz Eye Hospital, Konya, Turkey
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41
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Application of Femtosecond Laser in Anterior Segment Surgery. J Ophthalmol 2020; 2020:8263408. [PMID: 32351726 PMCID: PMC7171667 DOI: 10.1155/2020/8263408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
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Qian Y, Chen X, Naidu RK, Zhou X. Comparison of efficacy and visual outcomes after SMILE and FS-LASIK for the correction of high myopia with the sum of myopia and astigmatism from -10.00 to -14.00 dioptres. Acta Ophthalmol 2020; 98:e161-e172. [PMID: 31912660 DOI: 10.1111/aos.14078] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 02/02/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the efficacy and visual outcomes after femtosecond laser small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in correcting high myopia. METHODS This prospective, randomized study included patients who underwent SMILE or FS-LASIK for the correction of high myopia [the sum of spherical and cylindrical error from -10.00 to -14.00 dioptres (D)]. Preoperative, 1-month (P1m), 3-months (P3m) and 6-months (P6m) postoperative outcomes were analysed and compared between the two procedures. RESULTS Ninety-six right eyes of 96 patients (SMILE: n = 51, FS-LASIK: n = 45) were included. Both the (Attempted - achieved) sphere and the (attempted - achieved) spherical equivalent (SEQ) were greater in the FS-LASIK group at all three postoperative time-points (p < 0.001). The postoperative vector means of astigmatism were smaller in the SMILE group than in the FS-LASIK group. The differences between the optical zone of tissue removal (ROZ) during surgery and the postoperative functional optical zone (FOZ; ROZ-FOZ) were smaller in the SMILE group than in the FS-LASIK group. No significant difference was found between the two procedures in the delta-root mean square (RMS) of aberrations, except for delta-spherical aberration (SA) at P3m. CONCLUSIONS Both SMILE and FS-LASIK are effective in correcting high myopia. SMILE resulted in less under-correction, less regression, a smaller decrease in the FOZ and a smaller increase in SA when compared to FS-LASIK, resulting in better visual outcomes with SMILE.
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Affiliation(s)
- Yishan Qian
- Department of Ophthalmology Eye and ENT Hospital of Fudan University Shanghai China
- Department of Ophthalmology NHC Key Laboratory of Myopia (Fudan University) Shanghai China
| | - Xun Chen
- Department of Ophthalmology Eye and ENT Hospital of Fudan University Shanghai China
- Department of Ophthalmology NHC Key Laboratory of Myopia (Fudan University) Shanghai China
| | | | - Xingtao Zhou
- Department of Ophthalmology Eye and ENT Hospital of Fudan University Shanghai China
- Department of Ophthalmology NHC Key Laboratory of Myopia (Fudan University) Shanghai China
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43
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Five-year outcomes of small-incision lenticule extraction vs femtosecond laser–assisted laser in situ keratomileusis: a contralateral eye study. J Cataract Refract Surg 2020; 46:403-409. [DOI: 10.1097/j.jcrs.0000000000000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Hiep NX, Khanh PTM, Quyet D, Thai TV, Nga VT, Dinh TC, Bac ND. Outcomes of Small Incision Lenticule Extraction for Myopic Astigmatic Treatment. Open Access Maced J Med Sci 2019; 7:4272-4277. [PMID: 32215076 PMCID: PMC7084039 DOI: 10.3889/oamjms.2019.373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND: Some studies have shown that there is a certain rotation of the eye in the sitting and lying position of the patient. The Visumax system used for the Refractive Lenticule Extraction-Small Incision Lenticule Extraction (ReLEx SMILE) surgery lacks the rotation of eye control function. So, is the ReLEx SMILE surgery for patients with astigmatism safe and effective? AIM: To evaluate the outcomes of the ReLEx SMILE surgery in cases with myopic astigmatism. METHODS: The case series included 120 eyes with myopic astigmatism undergoing ReLEx SMILE surgery from January 2018 to November 2018. The distribution of patients for two subgroups based on the power of astigmatism, low astigmatic group (≤ 1.50D) and high astigmatic group (> 1.50D). All patients were measured UDVA, CDVA, refractive sphere, astigmatism and sphere equivalent before and after surgery one week, one month and three months carefully. The astigmatic correction was evaluated by the vectorial analysis Alpins. RESULTS: The mean efficacy index of the low and high astigmatic group was 1.035 and 1.082 (respectively); the mean safety index was 1.113 and 1.215 (respectively). 93% of eyes in the low astigmatic group had an angle of error (AE) within ± 15 degrees and 100% in high astigmatic group. There was an undercorrection in astigmatic treatment. No complications during and after surgery were recorded. CONCLUSION: ReLEx SMILE surgery for the myopic astigmatic treatment was safe and effective.
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Affiliation(s)
| | | | - Do Quyet
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Than Van Thai
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
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Yang W, Liu S, Li M, Shen Y, Zhou X. Visual Outcomes after Small Incision Lenticule Extraction and Femtosecond Laser-Assisted LASIK for High Myopia. Ophthalmic Res 2019; 63:427-433. [PMID: 31805561 DOI: 10.1159/000504304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to compare visual outcomes after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for high myopia. METHODS In this prospective, comparative study, a total of 52 eyes of 34 consecutive highly myopic patients with spherical equivalent within the range of -8.00 to -10.00 diopters were recruited. Twenty-three eyes of 16 patients were in the FS-LASIK group and 29 eyes of 18 patients were in the SMILE group. Visual outcomes and wavefront aberrations were analyzed preoperatively and 6 months postoperatively. RESULTS At the postoperative 6-month visit, 96.6% in the SMILE group and 91.3% in the FS-LASIK group achieved unchanged or better corrected distance visual acuity (CDVA). As for uncorrected distance visual acuity (UDVA), 96.6% in the SMILE group and 95.7% in the FS-LASIK group achieved UDVA of 20/20 or better. As for wavefront aberrations, high-order aberrations (HOAs) and spherical aberrations increased significantly after surgery in both groups relative to corresponding preoperative values (p < 0.001), and vertical coma increased after SMILE (p < 0.001). No statistically significant differences in changes of HOAs (p =0.90), spherical aberrations (p = 0.07), horizontal coma (p = 0.56), coma (p =0.08), horizontal trefoil (p =0.19), vertical trefoil (p = 0.90), and trefoil (p = 0.45) were detected between the 2 groups, except for vertical coma (p < 0.01). CONCLUSIONS SMILE is as effective as FS-LASIK in correcting high myopia, but attention should be paid to the induction of vertical coma in highly myopic patients following a SMILE procedure.
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Affiliation(s)
- Weiming Yang
- Department of Ophthalmology and Optometry, Children's Hospital of Fudan University, Shanghai, China
| | - Shengtao Liu
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Meiyan Li
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China, .,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China, .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China,
| | - Yang Shen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
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Phakic Posterior Chamber Intraocular Lens with a Central Hole in Treating Patients with Moderate to High Myopia: A Meta-Analysis. J Ophthalmol 2019; 2019:9496326. [PMID: 31781381 PMCID: PMC6875278 DOI: 10.1155/2019/9496326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/01/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate the efficacy of phakic posterior chamber intraocular lens with a central hole (ICL V4c) in treating patients with moderate to high myopia. Methods PubMed, Embase, Cochrane Library, Clinical Trial, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and China Science Periodical Database (CSPD) were searched online. The search included publications from the building of the library until December 2018. All randomized controlled trials containing moderate to high myopia treated by phakic posterior chamber intraocular lens with a central hole were collected. Literature search, screening literature, data extraction, and quality evaluation were independently performed by two reviewers. Meta-analysis was performed using RevMan 5.3 software. Results Meta-analysis results based on five randomized controlled trials showed that ICL V4c and ICL without a central hole had similar UCVA results (SMD = 0.08, 95% CI (−0.71, 0.88), P=0.84), SE (SMD = −0.18, 95% CI (−0.52, 0.15), P=0.29), BCVA (SMD = −0.27, 95% CI (−0.93, 0.40), P=0.43), and IOP (SMD = 0.03, 95% CI (−0.24, 0.30), P=0.84), and the difference was not statistically significant. In addition, no complications that could jeopardize vision occurred. Conclusions Implanting ICL V4c in patients with moderate to high myopia is safe and effective.
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Unwanted Astigmatism and High-order Aberrations One Year after Excimer and Femtosecond Corneal Surgery. Optom Vis Sci 2019; 95:1064-1076. [PMID: 30339639 DOI: 10.1097/opx.0000000000001298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
SIGNIFICANCE Small incision lenticule extraction (SMILE) is advanced as the most minimally invasive and least traumatic corneal procedure for correcting refractive errors using a single laser. Although SMILE obtains similar results to femtosecond laser in situ keratomileusis (LASIK) with spherical myopia, it has deficiencies in astigmatism correction. PURPOSE The purpose of this study was to compare refractive outcomes and high-order aberrations (HOAs) between SMILE and femtosecond LASIK corneal procedures at 1 year post-operative. METHODS Ninety-two patients (181 eyes) with myopia/myopic astigmatism underwent either SMILE (group 1) or femtosecond LASIK (group 2). The refractive target was to achieve emmetropia in all cases. Data were analyzed to determine significance of change in refraction and HOAs. Furthermore, astigmatism was subjected to vector analysis using the Thibos (calculation of change, Δ, in J0 and J45 values) and Alpins (calculation of difference, ΔC, between target-induced astigmatism [TIA] and surgically induced astigmatism) methods. RESULTS Forty-five patients (89 eyes) from group 1 and 47 patients (92 eyes) from group 2 completed the study. The main significant (P ≤ .001) findings were as follows: (a) residual astigmatism was greater in group 1; (b) group 1, ΔJ0 = 1.015J0 + 0.040 (R = 0.861), ΔJ45 = 1.082J45 + 0.019 (R = 0.792), ΔC = 0.401TIA + 0.323 (R = 0.489), and mean spherical aberration increased from -0.003 (SD, ±0.059; 95% confidence interval [CI], -0.015 to 0.009) to 0.028 μm (SD, ±0.041; 95% CI, -0.037 to -0.020); and (c) group 2, ΔJ0 = 0.952J0 - 0.005 (R = 0.921), ΔJ45 = 0.962J45 - 0.002 (R = 0.923), ΔC = 0.187TIA + 0.101 (R = 0.272), mean coma reduced from 0.114 (SD, ±0.087; 95% CI, 0.096 to 0.132) to 0.077 μm (SD, ±0.059; 95% CI, 0.065 to 0.089), and trefoil from 0.089 (SD, ±0.049; 95% CI, 0.079 to 0.0990) to 0.056 μm (SD, ±0.047; 95% CI, 0.046 to 0.066). CONCLUSIONS In comparison with SMILE, femtosecond LASIK offered better precision in the overall control of astigmatism and HOAs.
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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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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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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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