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Guo L, Cheng Z, Kong X, Huang Z, Xu X, Wu J, Lv H. The effect of different angle kappa on higher-order aberrations after small incision lenticule extraction. Lasers Med Sci 2023; 38:277. [PMID: 38012462 PMCID: PMC10682276 DOI: 10.1007/s10103-023-03934-8] [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: 02/20/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
This study aimed to compare higher-order aberrations (HOAs) after small incision lenticule extraction (SMILE) in patients with different angle kappa. This is a retrospective report in which 341 right eyes of 341 patients who were subjected to SMILE, which used coaxially sighted corneal light reflex (CSCLR) as the treatment zone centered, treated by the same experienced surgeon (LHB) for correction of myopia and myopic astigmatism, preoperative and postoperative spherical equivalent (SE), angle kappa, total higher-order aberrations (total HOA), spherical aberration (SA), vertical coma (VC), horizontal coma (HC), oblique trefoil (OT), and horizontal trefoil (HT), were compared. SMILE showed outstanding performance in terms of safety, efficacy, and predictability. In addition, a comparison of preoperative and postoperative HOAs exhibited the difference of total HOA (P < 0.01), SA (P < 0.01), VC (P < 0.01), and HC (P < 0.01), which was statistically significant; however, for OT and HT with the longer follow-up time, the statistical difference gradually decreased. For stratification of angle kappa into groups based on decantation, angle kappa was divided into three major groups: r < 0.1 mm, 0.1 ≤ r < 0.2 mm, and r ≥ 0.2 mm; the changes of SA (F = 4.127, P = 0.021) and OT (F = 3.687, P = 0.031) exhibited significant difference after 1 year of SMILE. We performed a correlation analysis of all preoperative and postoperative parameters, and the results indicated that the preoperative total HOA was negatively correlated with preoperative cylindrical diopter (DC), and postoperative total HOA, SA, and coma were affected by spherical diopter (DS) and SE. Moreover, we also found a significant difference of SA and VC in the early postoperative with preoperative. SA was positively correlated with Y values and r of 1 year after SMILE. All of the analyzed parameters in the three groups, except for the trefoil, gradually increased over time; however, the trefoil could gradually stabilize over time. We also divided angle kappa into four groups by quadrants; the result showed that the effects of higher-order aberrations were markedly different from the various quadrants. Patients with large angle kappa were able to increase VC and SA postoperatively, and higher HOAs were more significant in patients with high myopia. The differences in quadrants exhibited a diversity of HOAs; this could be attributed to the corneal surface reestablishment and the alteration of angle kappa, but the trend was not apparent. Although all patients displayed increased HOAs after SMILE, the potential application of CSCLR as the treatment zone centered still showed excellent safety, efficacy, and predictability.
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Affiliation(s)
- Lu Guo
- The First Affiliated Hospital of Jinan University, Guangzhou, 510000, Guangdong Province, China
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Zixuan Cheng
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Xiangmei Kong
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Zhaoxia Huang
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Xue Xu
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Jinchuan Wu
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China
| | - Hongbin Lv
- The First Affiliated Hospital of Jinan University, Guangzhou, 510000, Guangdong Province, China.
- The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan Province, China.
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Zhang R, Yuan Y, Zhang Y, Chen Y. Subjective patient-reported visual quality after small-incision lenticule extraction and its correlation to the objective one. Int Ophthalmol 2023; 43:3935-3942. [PMID: 37410299 DOI: 10.1007/s10792-023-02794-z] [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: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE The purpose of the study was to characterize the subjective visual quality and satisfaction following small-incision lenticule extraction (SMILE) and to identify its influential factors. SETTING Peking University Third Hospital, Beijing, China. DESIGN This was a retrospective observational study. METHODS Patients who had simultaneous binocular SMILE for myopia and myopic astigmatism were included 6 months postoperatively, and the patient-reported outcome questionnaire was employed for the assessment of visual quality in real-life situations. Examinations with SIRIUS combined corneal topography and tomography were performed including the parameters of Strehl ratio (SR), corneal higher-order aberrations (HOAs) within 6.0-mm area, kappa angel, and thinnest corneal thickness. Decentration and effective optical zone (EOZ) were measured based on a tangential pre-post-operation difference map. Binary logistic regression analysis was performed for predictors of patient-reported visual quality. RESULTS Clinical data from 97 cases were analyzed retrospectively. Overall satisfaction was 96.91% (94/97). Fluctuation in vision and glare is the most frequent and dominant visual symptoms. SR value increased non-significantly compared with preoperative (P> 0.05). A statistically significant (P < 0.05) increase in total HOAs, spherical aberration, and coma was noted. SR and HOAs were not correlated with the degree of visual symptoms (P > 0.05). No objective parameter was found to be associated with patient-reported visual quality after SMILE (P> 0.05). CONCLUSION The high patient-reported satisfaction confirmed the ideal effect on visual quality following SMILE in real-life situations, though some objective optical performances were not satisfying. It is very tolerant toward patients' conditions and mild deviations, and this study did not find factors affecting visual performances.
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Affiliation(s)
- Ruiyu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Institute of Laser Medicine, Beijing, China.
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Leccisotti A, Fields SV, De Bartolo G. Refractive Corneal Lenticule Extraction With the CLEAR Femtosecond Laser Application. Cornea 2023; 42:1247-1256. [PMID: 36156507 DOI: 10.1097/ico.0000000000003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate a new femtosecond laser application for refractive corneal lenticule extraction with suction control and computerized regulation of centration and alignment (Ziemer CLEAR). METHODS This was a retrospective, consecutive, noncomparative case series study. Patients undergoing CLEAR for spherical equivalent (SE) between -3 and -10 D, evaluating SE, defocus equivalent, refractive astigmatism, visual acuity, and centration at 10 months were evaluated in the study. RESULTS Fifty-three eyes of 42 patients (mean age 40.4 ± 8.6 years) were included, with preoperative SE -5.99 ± 1.49 D and mean corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR. With no suction losses, an intact lenticule was extracted in all eyes. In 6 eyes, peripheral adhesion was resolved by lenticulerrhexis, and in 1 eye, the incision was opened by a crescent blade. Moderate interface inflammation occurred in 3 eyes. At day 1, in the 42 eyes with uneventful surgery, the mean CDVA was 20/27, whereas in the 11 eyes with extra surgical manipulations, it was 20/36 ( P = 0.04). At 10 months, for the 53 eyes, the mean uncorrected distance visual acuity was 0.05 ± 0.09 logMAR; in 37 eyes (70%), it was 20/25 or better; and the mean CDVA was 0.04 ± 0.06 logMAR. Eight eyes (15%) lost 1 logMAR line. The mean SE was -0.13 ± 0.15 D. The mean defocus equivalent was 0.33 ± 0.32 D, with 46 eyes (87%) ≤0.50 D and 52 eyes (98%) ≤1 D. Refractive astigmatism was ≤0.50 D in 48 eyes (90%). The efficacy index was 1.00, and the safety index was 0.98. The mean decentration from the corneal vertex was 0.28 ± 0.07 mm. CONCLUSIONS The application yielded good predictability, efficacy, and safety. Slower visual recovery was observed after extra surgical manipulations.
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Affiliation(s)
- Antonio Leccisotti
- Siena Eye Laser, Poggibonsi, Siena, Italy
- Scuola di Specializzazione in Oftalmologia, Università di Siena, Siena, Italy; and
- School of Biomedical Sciences, Ulster University, Coleraine, UK
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Xie M, Deng Y, Sun C, Qiu L, Tang J. Higher-order aberrations and visual quality after incision lenticule extraction surgery with intraoperative angle kappa adjustments between small and large kappa patients: A 2-year follow-up. Indian J Ophthalmol 2023; 71:1849-1854. [PMID: 37203043 PMCID: PMC10391436 DOI: 10.4103/ijo.ijo_3017_22] [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: 05/20/2023] Open
Abstract
Purpose To evaluate the postoperative visual outcomes, that is, corneal higher-order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small-incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty-four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results At 24 months postoperatively, the mean spherical equivalent (SE) refraction was - 0.32 ± 0.40 and - 0.31 ± 0.35 in the S-kappa group (kappa <0.3 mm) and the L-kappa group (kappa ≥0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.
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Affiliation(s)
- Mengzhen Xie
- Department of Ophthalmology, West China Hospital, Sichuan University; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengshu Sun
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lemei Qiu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Liang C, Yan H. Methods of Corneal Vertex Centration and Evaluation of Effective Optical Zone in Small Incision Lenticule Extraction. Ophthalmic Res 2023; 66:717-726. [PMID: 36917962 DOI: 10.1159/000529922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
Inappropriate small incision lenticule extraction (SMILE) centration methods can affect the decentration of the effective optical zone (EOZ) after operation, which can subsequently lead to the decline of postoperative visual quality. We aimed to provide an overview of corneal vertex (CV) centration methods and an evaluation of the size and decentration of the EOZ in SMILE. We described the CV centration methods for patients with myopia, myopic astigmatism, hyperopia, and large kappa angle. The measurement methods of the EOZ were evaluated from the aspects of corneal morphology and corneal refractive power. Additionally, we summarized the advantages and disadvantages of measuring decentration based on topographic mapping and intraoperative video-captured images. Finally, we discussed the relationship between the EOZ and visual quality. Based on our review, clinicians should consider the following when choosing CV centration methods and evaluating EOZ postoperatively. First, the tear film mark center or topographic map comparison method is preferred for the correction of myopia, low myopic astigmatism, hyperopia, and large kappa angle (>0.2 mm). Triple marking centration is recommended for high myopic astigmatism (-3.5 diopters). Second, the total corneal power better reflects the change in refractive power than the topographic method. The measurement of the area rather than the diameter of the total corneal refractive power is more suitable for the evaluation of noncircular EOZs after high myopia astigmatism (<-2.0 diopters). Third, for the evaluation of decentration, the tangential curvature difference map method is preferred as it is not influenced by offset pupils. Finally, a large EOZ after SMILE may improve patient tolerance to decentration.
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Affiliation(s)
- Chen Liang
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, China,
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,
| | - Hong Yan
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, China
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Zhang R, Zhang Y, Yuan Y, Chen Y. Comparison of objective and subjective visual quality after flapless laser vision correction for mild to moderate myopia: SMILE vs PRK. Graefes Arch Clin Exp Ophthalmol 2023; 261:1731-1741. [PMID: 36652015 DOI: 10.1007/s00417-022-05937-7] [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: 07/04/2022] [Revised: 11/06/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To investigate the differences in surgical results and the objective and subjective quality of vision (QoV) of patients after small incision lenticule extraction (SMILE) versus alcohol-assisted photorefractive keratectomy (PRK). METHODS Medical records of patients treated with SMILE and PRK were retrospectively examined. Visual quality, biometric parameters, Strehl ratio (SR), and corneal higher-order aberrations (HOAs) within a 6.0 mm area were recorded. The effective optical zone (EOZ) and decentration were measured using a tangential pre-post operation difference map. Subjective QoV and operation satisfaction were evaluated 6 months postoperatively using the Quality of Vision questionnaire. RESULTS The study comprised 100 eyes treated with SMILE (preoperative mean spherical equivalent (SE), - 4.52 ± 0.81 dioptres (D)) and 69 eyes with PRK (mean SE, - 4.21 ± 1.25 D). Six months postoperatively, the EOZ reduction was significantly larger in the PRK group (P < 0.001). Decentrations were comparable between the groups. Regarding visual symptoms, monocular diplopia was more common following PRK (P = 0.02), and 98 (98.00%) SMILE-treated and 67 (97.10%) PRK-treated patients were satisfied with the QoV. Both groups demonstrated significant increases in total HOAs, coma, and spherical aberration (SA) at 6 months postoperatively compared to preoperatively (P < 0.001); these values were significantly higher in the PRK (P < 0.05) compared to the SMILE group. SR increased significantly only in the PRK group (P < 0.05). CONCLUSION Although EOZ was more consistent with anticipated treatment and HOAs were fewer in SMILE, high patient-reported satisfaction and good corneal optical quality were achieved in both groups, indicating that both SMILE and alcohol-assisted PRK are excellent options for mild to moderate myopia correction.
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Affiliation(s)
- Ruiyu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Beijing, China.
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Kim BK, Chung YT. Comparison of Changes in Corneal Thickness and Curvature After Myopia Correction Between SMILE and FS-LASIK. J Refract Surg 2023; 39:15-22. [PMID: 36630439 DOI: 10.3928/1081597x-20221130-03] [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: 01/12/2023]
Abstract
PURPOSE To comparatively investigate the changes in corneal thickness and curvature between small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS Data were collected preoperatively and postoperatively at 1 week, 1 month, and 3 months, including central corneal thickness (CCT), midperipheral corneal thickness (MPCT), peripheral corneal thickness (PCT), central keratometry (CK), midperipheral keratometry (MPK), and peripheral keratometry (PK), using a dual rotating Scheimpflug analyzer. RESULTS At 1 week postoperatively, changes in CCT, MPCT, PCT, and PK were significantly greater in the SMILE group than in the FS-LASIK group (P = .003 for CCT and < .001 for MPCT, PCT, and PK), but no significant inter-group differences were found between changes in CK and MPK (P = .883 and .513, respectively). CCT, MPCT, and PK values showed a similar increase in both groups, but significantly more increase in PCT and significantly less increase in CK and MPK was observed in the SMILE group from 1 week to 3 months after surgery. At 3 months postoperatively, CCT and MPCT were significantly thinner in the SMILE group than in the FSLASIK group (P = .018 and .022, respectively), and there was no significant difference in PCT, CK, MPK, and PK between the two groups. CONCLUSIONS SMILE caused significantly more corneal thinning at the center, midperiphery, and periphery, and more corneal flattening at the periphery, compared to FS-LASIK. A different pattern of corneal remodeling was observed between the two surgeries during the 3-month follow-up period. [J Refract Surg. 2023;39(1):15-22.].
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Huang Y, Ding X, Han T, Fu D, Yu Z, Zhou X. Effective Optical Zone Following Small Incision Lenticule Extraction for Myopia Calculated With Two Novel Methods. J Refract Surg 2022; 38:414-421. [PMID: 35858198 DOI: 10.3928/1081597x-20220608-02] [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 effective optical zone (EOZ) following small incision lenticule extraction in myopic eyes using two novel methods and investigate factors influencing postoperative EOZ. METHODS In this prospective study, 45 patients (45 eyes) with a mean spherical equivalent of -5.82 ± 1.58 diopters underwent SMILE and were observed during a 6-month follow-up. Postoperative EOZ was calculated using custom software that automatically distinguishes EOZ on the tangential curvature difference map (EOZc) and total corneal refractive power map (EOZp) of the Pentacam HR (Oculus Optikgeräte GmbH). The agreement between the two methods, the difference between postoperative EOZ and programmed optical zone (POZ), and its relationship with parameters including corrected spheres, cylinders, ablation ratio (ablation depth/central cornea thickness), and Q-value change were investigated. RESULTS The EOZc area was 20.76 ± 2.43 mm2 (diameter: 5.04 ± 0.60 mm) and the EOZp area was 20.22 ± 4.70 mm2 (diameter: 5.13 ± 0.30 mm). Both were significantly smaller than POZ (P < .001). Bland-Altman plots showed 4.44% (2/45) points located outside the 95% limits of agreement. EOZc and EOZp reductions were negatively related to corrected cylinders (r = -0.631, P < .001 and r = -0.594, P < .001, respectively). EOZp reduction was positively correlated with corrected spheres (r = 0.336, P = .024). Subgroup analysis revealed significant differences in EOZc and EOZp reduction between low and high astigmatism groups despite myopia degree. CONCLUSIONS EOZ after incision lenticule extraction, measured using two novel methods, was smaller than POZ. The reduction of EOZ was negatively correlated with the corrected cylinders. [J Refract Surg. 2022;38(7):414-421.].
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Comparison of astigmatic correction with and without limbal marking during small incision lenticule extraction. J Cataract Refract Surg 2022; 48:924-928. [DOI: 10.1097/j.jcrs.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
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Comparison of effective corneal refractive centration to the visual axis: LASIK vs. SMILE, a contralateral eye digitized comparison of the postoperative result. J Cataract Refract Surg 2021; 47:1511-1518. [PMID: 34074993 DOI: 10.1097/j.jcrs.0000000000000687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To define and compare the centration of the ablation effect in LASIK to the corresponding effect in SMILE, in myopic laser vision correction in order to possibly explain the refractive performance differences noted between the two procedures in a contralateral eye study. SETTING Private Ambulatory Eye Surgery Unit. DESIGN Prospective randomized contralateral eye study. METHODS In 22 consecutive patients (44 eyes), one eye was prospectively randomized to have myopic topography-guided LASIK treatment and the contralateral eye to have SMILE; Digital image analysis of the achieved centration to the aimed corneal vertex was assessed for both procedures on the perioperative Scheimpflug tangential curvature maps, using a proprietary digitized methodology. RESULTS The radial displacement between the attempted centration on the corneal vertex versus the center of the effective anterior corneal curvature flattening was on average 130 ± 62 μm in the LASIK group and 313 ± 144μm in the SMILE group (P<0.001). CONCLUSIONS In this contralateral eye study, topography-guided myopic LASIK was found to achieve significantly better effective centration compared to myopic SMILE, in regards digitally measured decentration of the effective refractive change achieved in the anterior corneal curvature from the corneal vertex. This may explain the previously reported superior visual outcomes in the LASIK group eyes when compared to the contralateral SMILE group eyes.
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Zhao X, Zhang L, Ma J, Li M, Zhang J, Zhao X, Wang Y. Comparison of Wavefront-Guided Femtosecond LASIK and Optimized SMILE for Correction of Moderate-to-High Astigmatism. J Refract Surg 2021; 37:166-173. [PMID: 34038300 DOI: 10.3928/1081597x-20201230-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare refractive outcomes, higher order aberrations (HOAs), and the changes in contrast sensitivity after wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG LASIK) and optimized small incision lenticule extraction (SMILE) for moderate-to-high astigmatism correction. METHODS This prospective, randomized study included 87 eyes: 40 eyes in the WFG LASIK group and 47 eyes in the SMILE group. Manual cyclotorsion compensation by marking the horizontal axis before SMILE surgery was used for optimized SMILE. Refractive diopter, aberrations, and contrast sensitivity were assessed 3 months postoperatively. The Alpins vector analysis method was used to analyze the astigmatic changes after surgery. RESULTS There were no significant differences in the corrected distance visual acuity and refraction between the two groups after surgery. The fitted curve of surgically induced astigmatism versus target induced astigmatism was described as y = 0.9905 x + 0.0009 in the WFG LASIK group and y = 0.9672 x + 0.0026 in the SMILE group. The percentage of corneal astigmatism axis change within 5 degrees was statistically significant (chi-square test: 10.632, P = .001). HOAs increased in both the WFG LASIK and SMILE groups after surgery (t = -3.655, P = .001, t = -3.784, P = .001, respectively). However, comparison of the changes of HOAs between both groups was not significant (t = -0.565, P = .575). The improvement in contrast sensitivity in the WFG LASIK group was significantly higher than that in the SMILE group. CONCLUSIONS WFG LASIK and optimized SMILE can achieve similar outcomes for astigmatism correction. Optimized SMILE with marking could achieve good astigmatism correction, even without an eye tracking system. [J Refract Surg. 2021;37(3):166-173.].
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Liu S, Zhang X, You Z, Zhou X. Comparison of the Distribution of Lenticule Decentration Following SMILE by Pupil Center or Tear Film Mark Centration. J Refract Surg 2021; 36:239-246. [PMID: 32267954 DOI: 10.3928/1081597x-20200310-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/10/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate lenticule decentration following small incision lenticule extraction (SMILE) via the pupil center or tear film mark centration method and compare induction of corneal higher order aberrations (HOAs) between the two methods. METHODS This study analyzed decentration values obtained from tangential topography difference maps of 100 eyes (100 patients) undergoing SMILE with the pupil center (n = 50) or tear film mark (n = 50) centration method. Total HOAs and component aberrations were measured preoperatively and 6 months postoperatively. Relationships between the magnitudes of decentration and induced corneal HOAs were assessed. RESULTS Both vertical and total decentered displacement were significantly different (P < .001) between the two centration groups. A significant relationship between the preoperative pupillary offset and decentration was noted in the pupil center group (P < .001), but not in the tear film mark group (P = .530). Significantly greater induction of total HOAs, coma, and vertical coma (all P < .001), as well as horizontal coma (P = .001) and spherical aberration (P = .023), were observed in the pupil center group. Association between the total decentered displacement and induced total HOAs (P < .001), as well as all other significantly increased phenomena, was also significant in the pupil center group. Differences in decentered displacement and induced corneal HOAs were significant for preoperative pupillary offset (angle kappa) greater than 200 µm, but not for angle kappa less than 200 µm. CONCLUSIONS SMILE with tear film mark centration can yield improved treatment centration and less induction of total HOAs, coma, and spherical aberrations. [J Refract Surg. 2020;36(4):239-246.].
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Hou X, Du K, Wen D, Hu S, Hu T, Li C, Tang Y, Wu X. Early visual quality outcomes after small-incision lenticule extraction surgery for correcting high myopic astigmatism. BMC Ophthalmol 2021; 21:48. [PMID: 33468105 PMCID: PMC7816348 DOI: 10.1186/s12886-021-01807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate early optical quality outcomes after small-incision lenticule extraction (SMILE) surgery for correcting high myopic astigmatism. Methods This retrospective study enrolled 55 eyes from 37 patients who had preoperative myopic astigmatism of ≥2.00 diopters (D) who had been treated with SMILE surgery. Preoperatively, the mean cylinder was − 2.41 ± 0.54 D (range, − 2.00 D to − 4.50 D). The preoperative and postoperative visual outcomes, refraction, and higher-order aberration (HOA) at 1 and 3 months were compared. Refractive astigmatism changes were analyzed by the Alpins vector method. Results Three months after SMILE surgery, the average cylinder was − 0.14 ± 0.31 D, and the average astigmatism vector was − 0.09 D × 6.34°. The angle of error (AofE) was limited to within ±10°, and the magnitude of error was limited to within ±1.0 D in all patients. The correction index (CI) was 0.98 ± 0.07, the index of success (IOS) was 0.08 ± 0.13, and the flattening index (FI) was 0.97 ± 0.07. Significant positive correlations were found between IOS and |AofE| (P = 0.000); negative correlations were found between FI and |AofE| (P = 0.000). The postoperative total HOA, spherical aberration, vertical coma aberration, and trefoil 30° were increased significantly compared with preoperative measurements, and the increase in HOA was closely related to preoperative astigmatism (P < 0.05). Conclusions SMILE has preferable outcomes for correcting high myopic astigmatism. Axis rotation during the surgery might influence the undercorrection of astigmatism. The increase of HOA after surgery is related to preoperative astigmatism.
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Affiliation(s)
- Xiangtao Hou
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Kaixuan Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Dan Wen
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Shengfa Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Tu Hu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Chenling Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Yanhui Tang
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China
| | - Xiaoying Wu
- Eye Center of Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, 410008, Hunan, China.
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Kim BK, Chung YT. Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for high astigmatism. BMC Ophthalmol 2021; 21:23. [PMID: 33422053 PMCID: PMC7796618 DOI: 10.1186/s12886-020-01756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism. Methods This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method. Results Twenty-four months after the combined procedure, the average spherical equivalent was reduced from − 6.56 ± 2.38 D to − 0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to − 0.02 ± 0.09 and from − 0.03 ± 0.07 D to − 0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was − 5.48 ± 1.17 D, which was reduced to − 2.27 ± 0.97 D and − 0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p < 0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.
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Affiliation(s)
- Bu Ki Kim
- Onnuri Smile Eye Clinic, Hyobong building 9F 1, Gangnam-daero 65 gil, Seocho-gu, Seoul, Republic of Korea
| | - Young Taek Chung
- Onnuri Eye Hospital, 325, Baekje-daero, Wansan-gu, Jeonju-si, Jeollabuk-do, Republic of Korea.
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Asif MI, Bafna RK, Mehta JS, Reddy J, Titiyal JS, Maharana PK, Sharma N. Complications of small incision lenticule extraction. Indian J Ophthalmol 2020; 68:2711-2722. [PMID: 33229647 PMCID: PMC7856979 DOI: 10.4103/ijo.ijo_3258_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
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Affiliation(s)
- Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Kumar Bafna
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jodhbir Singh Mehta
- Singapore Eye Research Institute; Singapore National Eye Centre, 168751; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Jagadesh Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jeewan Singh Titiyal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Clinical outcomes of corneal refractive surgery comparing centration on the corneal vertex with the pupil center: a meta-analysis. Int Ophthalmol 2020; 40:3555-3563. [PMID: 32671600 DOI: 10.1007/s10792-020-01506-1] [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: 01/22/2018] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the visual and refractive outcomes between centration on the corneal vertex and the pupil center in corneal refractive surgery. METHODS A comprehensive literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library to identify relevant studies. The primary outcomes were the postoperative spherical equivalent (SE), effectiveness [uncorrected distance visual acuity (UDVA) ≥ 20/20, eyes within ± 0.50 diopter (D) of target refraction], and safety [loss ≥ 2 lines of corrected distance visual acuity (CDVA)]. Higher-order aberrations were considered secondary outcomes. RESULTS Seven studies describing a total of 1964 eyes were included in this meta-analysis. A statistical significance in postoperative SE was found between the two centration methods for the correction of myopia that favor the CV-centered method (p < 0.001). No significant differences were observed in the proportion of eyes with UDVA ≥ 20/20 or loss ≥ 2 lines of CDVA postoperatively. However, the proportion of eyes within ± 0.50 D was slightly higher (p = 0.02) and the coma aberration was much lower in the corneal vertex-centered method (p < 0.001). CONCLUSION Preferable visual and refractive outcomes could be achieved with either centering on the corneal vertex or pupil center in corneal refractive surgery; however, the corneal vertex-centered method has shown partial benefits in some clinical indices. In order to obtain higher quality of clinical evidences, more randomized controlled trials (RCTs) are required in further investigations.
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Li H, Peng Y, Chen M, Tian L, Li D, Zhang F. Six modes of corneal topography for evaluation of ablation zones after small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis. Graefes Arch Clin Exp Ophthalmol 2020; 258:1555-1563. [PMID: 32328759 DOI: 10.1007/s00417-020-04674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the ablation zone diameter (AZD) using six modes of corneal topography after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia and to compare the programmed and postoperative AZDs METHODS: This retrospective comparative study included 86 right eyes in 86 patients who underwent SMILE or FS-LASIK at the Shandong Eye Institute between June 2016 and August 2017. Data were collected preoperatively and at 1, 3, and 6 months postoperatively using the Pentacam system. The AZD was determined using six modes of corneal topography: postoperative axial curvature topography (PACT), postoperative tangential curvature topography (PTCT), difference-axial curvature topography (DACT), difference-tangential curvature topography (DTCT), postoperative front elevation topography (PFET), and difference-corneal thickness topography (DCTT). The difference between the programmed and postoperative AZDs was compared between the groups of two surgical procedures. RESULTS At 3 months, the AZDs measured by PTCT, DTCT, and PFET after SMILE showed a significant decrease, while the AZD by DACT revealed an increase (P < 0.001), and the AZDs measured by PACT, PTCT, DACT, DTCT, PFET, and DCTT after FS-LASIK were all significantly decreased (P < 0.001), as compared with the programmed ablation zone values. The AZDs measured by DACT and DTCT after 3 months were larger in the SMILE group (P < 0.001); likewise, the differences between the programmed and postoperative AZDs were lower in the SMILE group (P < 0.001). Furthermore, PACT, PTCT, DACT, DTCT, and PFET indicated acceptable inter-observer reliability (ICC > 0.75). CONCLUSIONS In the treatment of myopia, the achieved topographic ablation zones after FS-LASIK were smaller than the theoretically designed ones. The AZDs after SMILE were larger than those after FS-LASIK, with an equivalent programmed value. The DACT may be more suitable for measuring postoperative ablation zones in clinic with clearer borders and favorable repeatability. This method may be potential for the measurement of ablation zones and further research on the visual quality after refractive surgery.
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Affiliation(s)
- Hua Li
- Department of Ophthalmology, Qilu Medical College of Shandong University, Jinan, 250012, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Yusu Peng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Min Chen
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China.
| | - Le Tian
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Dewei Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
| | - Feifei Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, 266071, Shandong, China
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The Effect of Intraoperative Angle Kappa Adjustment on Higher-Order Aberrations Before and After Small Incision Lenticule Extraction. Cornea 2020; 39:609-614. [PMID: 32040010 DOI: 10.1097/ico.0000000000002274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare higher-order aberrations (HOAs) after small incision lenticule extraction (SMILE) in patients with and without intraoperative angle kappa adjustments. METHODS This is a retrospective case series. One hundred six eyes of 106 patients who underwent SMILE at Tianjin Eye Hospital (Tianjin Medical University, Tianjin, China) for correction of myopia and myopic astigmatism were divided into 2 groups. The first group consisted of eyes with intraoperative angle kappa adjustment and the second group consisted of eyes without adjustment. Preoperative and postoperative visual outcome, refraction, and HOA measurements at 1 and 3 months were compared. RESULTS At the pupil size of 6 mm, vertical coma at 1 and 3 months after SMILE for the angle kappa-adjusted group was 0.153 ± 0.107 and 0.157 ± 0.094 μm, which were significantly lower than those of the nonadjusted group (0.204 ± 0.117 and 0.203 ± 0.113 μm, respectively) (P = 0.026 at 1 mo, P = 0.047 at 3 mo). The change in vertical coma between preoperative and postoperative measurements was 0.011 ± 0.136 and 0.023 ± 0.129 μm at 1 and 3 months postoperatively for the angle kappa-adjusted group, which were lower than those of the nonadjusted group (0.082 ± 0.165 and 0.085 ± 0.150 μm, respectively) (P = 0.023 at 1 mo, P = 0.045 at 3 mo). Subgroup analysis for eyes with large angle kappa demonstrated that the vertical coma was significantly less in the angle kappa-adjusted group at both 1 and 3 months (P = 0.009, P = 0.043, respectively). No significant correlation was observed between angle kappa and HOAs in the angle kappa-adjusted group. CONCLUSIONS Adjustment of angle kappa during SMILE resulted in less HOAs. It would provide more insight on how to optimize treatment centration in SMILE.
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Ganesh S, Brar S, Sriprakash K. Post-small incision lenticule extraction phacoemulsification with multifocal IOL implantation: A case report. Indian J Ophthalmol 2019; 67:1353-1356. [PMID: 31332141 PMCID: PMC6677046 DOI: 10.4103/ijo.ijo_2069_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Superspecilaity Eye Hospital, Bangalore, India
| | - Sheetal Brar
- Nethradhama Superspecilaity Eye Hospital, Bangalore, India
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Damgaard IB, Ang M, Mahmoud AM, Farook M, Roberts CJ, Mehta JS. Functional Optical Zone and Centration Following SMILE and LASIK: A Prospective, Randomized, Contralateral Eye Study. J Refract Surg 2019; 35:230-237. [PMID: 30984980 DOI: 10.3928/1081597x-20190313-01] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/13/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare centration and functional optical zone (FOZ) after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (LASIK). METHODS In this prospective, randomized, single-masked, paired-eyed, clinical trial, 70 patients received SMILE in one eye and LASIK in the other eye for myopia and myopic astigmatism. FOZ was calculated using custom software on 3-month postoperative refractive power maps (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany). Programmed treatment area was defined as the total area of the programmed OZ plus the transition zone. Centration was evaluated by the linear distance between FOZ centroid and the pupil center and the corneal apex. RESULTS The average preoperative spherical equivalent (-5.38 ± 1.65 vs -5.45 ± 1.61 diopters [D]), postoperative spherical equivalent (0.05 ± 0.39 vs 0.06 ± 0.39 D), uncorrected distance visual acuity (0.01 ± 0.13 vs 0.00 ± 0.08 logMAR), and corrected distance visual acuity (-0.07 ± 0.10 vs -0.07 ± 0.10 logMAR) were comparable in SMILE- and LASIK-treated eyes of the 60 patients with complete datasets (P > .419). Postoperative increase in spherical aberration was lower in SMILE than in LASIK (0.08 ± 0.16 vs 0.17 ± 0.18 µm, P = .002). The FOZ area was significantly larger in SMILE than in LASIK (30.25 ± 3.60 vs 29.21 ± 3.72 mm2), despite the smaller programmed OZ diameter (6.48 ± 0.08 vs 6.52 ± 0.11 mm) and smaller programmed treatment area (33.87 ± 0.81 vs 46.30 ± 2.61 mm2, P < .037). Pupil centration (0.43 ± 0.21 vs 0.41 ± 0.22 mm) and apex centration (0.48 ± 0.24 vs 0.48 ± 0.22 mm) were comparable between SMILE and LASIK (P > .694). CONCLUSIONS SMILE created a larger FOZ than LASIK, despite the smaller programmed OZ. This may be due to a difference in the biomechanical response between the two procedures. Visual outcome and centration were comparable between SMILE and LASIK. [J Refract Surg. 2019;35(4):230-237.].
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Huang J, Zhou X, Qian Y. Decentration following femtosecond laser small incision lenticule extraction (SMILE) in eyes with high astigmatism and its impact on visual quality. BMC Ophthalmol 2019; 19:151. [PMID: 31315595 PMCID: PMC6637638 DOI: 10.1186/s12886-019-1153-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background To measure the decentration following SMILE in eyes with high myopic astigmatism and investigate its impact on visual quality. Methods The prospective study was conducted to analyze patients who underwent SMILE for correction of myopia and myopic astigmatism ≥2.5D (high astigmatism group, HA) at the ophthalmology department, Eye and ENT hospital, Shanghai, China.. Patients with myopic astigmatism < 1.5D served as controls (low astigmatism group, LA). Decentration was measured using a Scheimpflug camera with a difference map of the tangential curvature at 12 months postoperatively. Also the associations between decentration from the coaxial sighted corneal light reflex (CSCLR) and the visual outcomes, correction efficacy of astigmatism, wavefront aberrations and objective scatter index (OSI) were analyzed. Results No significant differences were observed in the decentered distance between HA and LA in either eyes (OD: HA: 0.18 ± 0.10 mm, LA: 0.20 ± 0.14 mm, P = 0.659; OS: HA: 0.22 ± 0.11 mm, LA: 0.20 ± 0.11 mm, P = 0.637). The analysis across the three levels of decentration (< 0.1 mm, 0.1–0.2 mm, and > 0.2 mm) showed no significant association between decentration and visual outcomes of predictability, efficiency, safety, MTF cutoff, OSI, SR and OVs in both groups. Also no significant association was observed between decentration and postoperative astigmatism in either group. A significant relationship between the magnitude of decentration and induced coma and spherical aberration was observed in HA. Conclusions The amount of decentration between HA and LA groups showed no differences. Decentration > 0.20 mm from CSCLR resulted in greater induction of coma and SA after SMILE in eyes with HA.
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Affiliation(s)
- Jia Huang
- Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
| | - Xingtao Zhou
- Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, People's Republic of China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, People's Republic of China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China
| | - Yishan Qian
- Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, People's Republic of China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, People's Republic of China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, People's Republic of China.
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Fourier Analysis of Corneal Irregular Astigmatism After Small Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted Laser In Situ Keratomileusis. Cornea 2019; 38:1536-1542. [DOI: 10.1097/ico.0000000000002029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Decentration measurements using Placido corneal tangential curvature topography and Scheimpflug tomography pachymetry difference maps after small-incision lenticule extraction. J Cataract Refract Surg 2019; 45:1067-1073. [PMID: 31133417 DOI: 10.1016/j.jcrs.2019.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/30/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the agreement of decentration measurements between tangential curvature topography and tomography pachymetry difference maps after a small-incision lenticule extraction (SMILE) procedure. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Retrospective case series. METHODS Decentrations and pupillary offset (angle κ) were analyzed and compared using two different methods. A difference map of the tangential curvature was generated with a Placido corneal topographer (Keratron Scout) and a pachymetry difference map was generated with a Scheimpflug tomographer (Pentacam) for each eye, using preoperative and 3-month postoperative scans. Decentrations were also compared using a vector difference plot for the two maps. RESULTS The study comprised 155 eyes (155 patients). The magnitude of decentration was 0.27 mm ± 0.17 (SD) (range 0.02 to 0.88 mm) with the tangential curvature difference maps and 0.26 ± 0.20 mm (range 0.00 to 0.91 mm) with the pachymetry difference maps, showing no significant difference in the arithmetic values of decentration (P = .124). However, the vector difference in pupillary offset between preoperative and postoperative measurements from the pachymetry difference map significantly correlated with the magnitude of vector differences of decentration between the two maps (P = .007). The vector difference plot also showed a wide distribution spread to all 4 quadrants, demonstrating a lack of agreement. CONCLUSIONS Although there was no significant difference between the scalar magnitude of decentration with the tangential topography difference maps and tomography pachymetry difference maps, the vector differences did not agree and increasing error was present with increasing differences in pupillary offset in the pachymetry difference maps.
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Lee H, Roberts CJ, Arba-Mosquera S, Kang DSY, Reinstein DZ, Kim TI. Relationship Between Decentration and Induced Corneal Higher-Order Aberrations Following Small-Incision Lenticule Extraction Procedure. Invest Ophthalmol Vis Sci 2019; 59:2316-2324. [PMID: 29847636 DOI: 10.1167/iovs.17-23451] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the amount of lenticule decentration following small-incision lenticule extraction (SMILE) by using the Keratron Scout tangential topography difference map, and the relationship between the magnitudes of total decentration and induced corneal higher-order aberrations (HOAs). Methods This retrospective observational case series study analyzed decentration values obtained from the Keratron Scout tangential topography difference map of 360 eyes (360 patients) that underwent SMILE. Root mean square total HOAs, third order coma aberration, fourth order spherical aberration, as well as individual coefficients for vertical and horizontal coma were measured preoperatively and 3-months postoperatively. Simple linear regression analysis and piecewise regression models were used to determine the relationship between the magnitudes of total decentration and induced corneal HOAs. Results The mean total decentration distance from the corneal vertex was 0.36 ± 0.22 mm (range, 0.02-1.27 mm). There were significant differences in total HOAs, coma, vertical and horizontal comas, and spherical aberration between preoperative and 3-month postoperative assessments. Significant relationships between the magnitudes of total decentration and induced corneal HOAs were noted. Subgroup analysis according to the degree of total decentration (group I, total decentered displacement ≤0.335 mm; and group II, total decentered displacement >0.335 mm) revealed that induced changes in total HOAs, coma, vertical coma, and spherical aberration were significantly larger in group II than in group I. Conclusions A minimal degree of decentration was closely related to a smaller induction of corneal HOAs. Efforts to optimize centration are critical for achieving better surgical outcomes in SMILE.
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Affiliation(s)
- Hun Lee
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea.,The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Cynthia J Roberts
- Department of Ophthalmology & Visual Science and Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States
| | | | | | - Dan Z Reinstein
- London Vision Clinic, London, United Kingdom.,Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Centre Hospitalier National d'Ophtalmologie, Paris, France
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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Ganesh S, Brar S, K V M. CIRCLE Software for the Management of Retained Lenticule Tissue Following Complicated SMILE Surgery. J Refract Surg 2019; 35:60-65. [PMID: 30633789 DOI: 10.3928/1081597x-20181120-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/29/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the therapeutic use of CIRCLE software (Carl Zeiss Meditec, Jena, Germany) for the management of retained lenticule tissue after complicated small incision lenticule extraction (SMILE). METHODS Two patients were referred for consultation and treatment due to intraoperative complications during SMILE. In case 1, a black patch during laser delivery caused the lenticule to be torn irregularly from the undersurface during extraction and a sliver of it was retained in the pocket. Case 2 presented with false plane dissection and a completely retained lenticule on anterior segment optical coherence tomography. Both cases were managed using the CIRCLE software by converting the cap into a flap, thus making access to the interface possible. RESULTS In case 1, after lifting the flap a small sliver of tissue was found in the interface, which was dissected, following which a 20-µm phototherapeutic keratectomy was done to smooth the interface. In case 2, after lifting the flap the edge of the retained lenticule was identified by using an endoilluminator and the lenticule was separated and subsequently removed. Both cases showed significant improvement in uncorrected distance visual acuity, corrected distance visual acuity, and Objective Scatter Index score on day 1 after repair surgery. CONCLUSIONS CIRCLE software may be successfully used for managing retained lenticule tissue apart from performing enhancement after SMILE. [J Refract Surg. 2019;35(1):60-65.].
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Chan TCY, Wan KH, Kang DSY, Tso THK, Cheng GPM, Wang Y. Effect of corneal curvature on optical zone decentration and its impact on astigmatism and higher-order aberrations in SMILE and LASIK. Graefes Arch Clin Exp Ophthalmol 2018; 257:233-240. [DOI: 10.1007/s00417-018-4165-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/29/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
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Piñero DP, Teus MA. Clinical outcomes of small-incision lenticule extraction and femtosecond laser-assisted wavefront-guided laser in situ keratomileusis. J Cataract Refract Surg 2018; 42:1078-93. [PMID: 27492109 DOI: 10.1016/j.jcrs.2016.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Small-incision lenticule extraction and wavefront-guided femtosecond-assisted laser in situ keratomileusis (LASIK) provide good visual outcomes and an efficacious correction of myopia or myopic astigmatism with similar levels of safety. Some differences in predictability and the percentage of eyes gaining lines of corrected distance visual acuity are present. A higher level of coma is present after small-incision lenticule extraction, with no clear differences between techniques in spherical aberration. Better contrast sensitivity is achieved in the early postoperative period after wavefront-guided femtosecond laser-assisted LASIK, possibly because of less intrastromal light backscattering and Bowman layer microdistortions. Corneal sensitivity decreased less after small-incision lenticule extraction because of less severe decrease in subbasal nerve density, which has a significant effect on symptomatology and dry-eye tests (P < .05). Significant corneal biomechanical changes occurred after both techniques (P < .05), with no scientific evidence supporting the superiority of 1 technique over the other. FINANCIAL DISCLOSURE Dr. Piñero received an unrestricted educational grant from Abbott Medical Optics, Inc. Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David P Piñero
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain.
| | - Miguel A Teus
- From the Department of Optics, Pharmacology, and Anatomy, University of Alicante, the Department of Ophthalmology, Vithas Medimar International Hospital, and the Foundation for Visual Quality (Piñero), Alicante; the Hospital Universitario "Príncipe de Asturias," Alcalá de Henares, the Universidad de Alcalá, Alcalá de Henares, and the Novovision Clinic (Teus), Madrid, Spain
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Functional Optical Zone After Small-Incision Lenticule Extraction as Stratified by Attempted Correction and Optical Zone. Cornea 2018; 37:1110-1117. [PMID: 29927753 DOI: 10.1097/ico.0000000000001669] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the functional optical zone (OZ) with different levels of myopia and different OZ groups after small-incision lenticule extraction. METHODS This retrospective study included 249 patients (120 men) after small-incision lenticule extraction correction. We grouped participants according to attempted correction [low: spherical equivalent (SE) > -3.0 D; moderate: -6.0 D ≥ SE ≥ -3.0 D; high: SE ≥ -6.0 D] and planned functional optical zone (PFOZ) (OZ-1: PFOZ ≤ 6.3 mm; OZ-2: 6.3 mm < PFOZ ≤ 6.5; OZ-3: PFOZ > 6.5 mm), and we compared the achieved functional optical zone (AFOZ) and total corneal aberration, using Scheimpflug imaging, 1 month postoperatively. Correlations between corneal aberration and AFOZ were analyzed. RESULTS The AFOZ was smaller than the PFOZ in all 3 refraction groups (reduction: low, 0.78 ± 0.72 mm; moderate, 1.22 ± 0.60 mm; and high: 1.49 ± 0.58 mm, P < 0.001). There was no difference in the AFOZ among the 3 OZ groups. Total corneal aberration increased more in the high myopia group (total higher-order aberration, coma, and spherical aberration, P < 0.001), which also correlated with the AFOZ. CONCLUSIONS The discrepancy between the AFOZ and PFOZ increased with greater attempted correction. Attempted correction and AFOZ influence corneal aberration.
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Kang DSY, Lee H, Reinstein DZ, Roberts CJ, Arba-Mosquera S, Archer TJ, Kim EK, Seo KY, Kim TI. Comparison of the Distribution of Lenticule Decentration Following SMILE by Subjective Patient Fixation or Triple Marking Centration. J Refract Surg 2018; 34:446-452. [DOI: 10.3928/1081597x-20180517-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/07/2018] [Indexed: 11/20/2022]
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Steinwender G, Shajari M, Mayer WJ, Kook D, Ardjomand N, Vidic B, Kohnen T, Wedrich A. Impact of a Displaced Corneal Apex in Small Incision Lenticule Extraction. J Refract Surg 2018; 34:460-465. [PMID: 30001449 DOI: 10.3928/1081597x-20180514-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/20/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the possible impact of a displaced corneal apex (point of maximum curvature) on visual results and tomographic parameters after small incision lenticule extraction (SMILE). METHODS In this retrospective evaluation, eyes with uncomplicated SMILE for myopia correction were classified in two groups based on their preoperative distance between the corneal apex and corneal vertex (corneal intercept with the patient's line of sight) of 1 mm or greater (large A-V distance) or less than 1 mm (small A-V distance). All surgeries were performed during the early learning curve of two surgeons. Visual outcome parameters included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refractive spherical equivalent (MRSE), and refractive astigmatism 3 months postoperatively. Scheimpflug-derived tomographic outcome parameters included mean keratometry value, root mean square higher order aberrations (RMS HOAs), and optical zone decentration. RESULTS The study comprised 94 eyes of 48 patients: 44 eyes in the large A-V distance group and 50 eyes in the small A-V distance group. Preoperative and postoperative RMS HOAs were significantly higher in the large A-V distance group than in the small A-V distance group (P = .002 and .008, respectively). Postoperative CDVA was significantly better in the small A-V distance group (P = .014). There were no statistically significant differences in postoperative UDVA, MRSE, refractive astigmatism, mean keratometry value, and optical zone decentration. CONCLUSIONS After SMILE, CDVA was significantly worse in eyes with a preoperatively displaced corneal apex compared to eyes with a more central corneal apex. However, good visual results were achieved in both groups. [J Refract Surg. 2018;34(7):460-465.].
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Corneal Irregular Astigmatism and Curvature Changes After Small Incision Lenticule Extraction: Three-Year Follow-Up. Cornea 2018; 37:875-880. [DOI: 10.1097/ico.0000000000001532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun MS, Zhang L, Guo N, Song YZ, Zhang FJ. Consistent comparison of angle Kappa adjustment between Oculyzer and Topolyzer Vario topography guided LASIK for myopia by EX500 excimer laser. Int J Ophthalmol 2018; 11:662-667. [PMID: 29675388 DOI: 10.18240/ijo.2018.04.21] [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: 08/15/2017] [Accepted: 01/18/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate and compare the uniformity of angle Kappa adjustment between Oculyzer and Topolyzer Vario topography guided ablation of laser in situ keratomileusis (LASIK) by EX500 excimer laser for myopia. METHODS Totally 145 cases (290 consecutive eyes )with myopia received LASIK with a target of emmetropia. The ablation for 86 cases (172 eyes) was guided manually based on Oculyzer topography (study group), while the ablation for 59 cases (118 eyes) was guided automatically by Topolyzer Vario topography (control group). Measurement of adjustment values included data respectively in horizontal and vertical direction of cornea. RESULTS Horizontally, synclastic adjustment between manually actual values (dxmanu) and Oculyzer topography guided data (dxocu) accounts 35.5% in study group, with mean dxmanu/dxocu of 0.78±0.48; while in control group, synclastic adjustment between automatically actual values (dxauto) and Oculyzer topography data (dxocu) accounts 54.2%, with mean dxauto/dxocu of 0.79±0.66. Vertically, synclastic adjustment between dymanu and dyocu accounts 55.2% in study group, with mean dymanu/dyocu of 0.61±0.42; while in control group, synclastic adjustment between dyauto and dyocu accounts 66.1%, with mean dyauto/dyocu of 0.66±0.65. There was no statistically significant difference in ratio of actual values/Oculyzer topography guided data in horizontal and vertical direction between two groups (P=0.951, 0.621). CONCLUSION There is high consistency in angle Kappa adjustment guided manually by Oculyzer and guided automatically by Topolyzer Vario topography during corneal refractive surgery by WaveLight EX500 excimer laser.
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Affiliation(s)
- Ming-Shen Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
| | - Li Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
| | - Ning Guo
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
| | - Yan-Zheng Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
| | - Feng-Ju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing 100730, China
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Ganesh S, Brar S, Pawar A. Results of Intraoperative Manual Cyclotorsion Compensation for Myopic Astigmatism in Patients Undergoing Small Incision Lenticule Extraction (SMILE). J Refract Surg 2018; 33:506-512. [PMID: 28787514 DOI: 10.3928/1081597x-20170328-01] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/03/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the safety, efficacy, and outcomes of manual cyclotorsion compensation in small incision lenticule extraction (SMILE) for myopic astigmatism. METHODS Eligible patients with myopia from -1.00 to -10.00 diopters (D) spherical equivalent with a minimum astigmatism of 0.75 D undergoing SMILE were included. Intraoperative cyclotorsion compensation was performed by gently rotating the cone and aligning the 0° to 180° limbal marks with the horizontal axis of the reticule of the right eye piece of the microscope of the femtosecond laser after activating the suction. RESULTS In this study, 81 left eyes from 81 patients were analyzed for vector analysis of astigmatism. The mean cyclotorsion was 5.64° ± 2.55° (range: 2° to 12°). No significant differences were found for surgically induced astigmatism, difference vector, angle of error (AE), correction index, magnitude of error, index of success (IOS), and flattening index between 2 weeks and 3 months postoperatively (P > .05). The eyes were categorized into low (≤ 1.50 D, n = 37) and high (> 1.50 D, n = 44) cylinder groups. At 3 months, intergroup analysis showed a comparable correction index of 0.97 for the low and 0.93 for the high cylinder groups, suggesting a slight undercorrection of 3% and 7%, respectively (P = .14). However, the AE and IOS were significantly lower in the high compared to the low cylinder group (P = .032 and .024 for AE and IOS, respectively), suggesting better alignment of the treatment in the high cylinder group. However, the mean uncorrected distance visual acuity of both groups was comparable (P = .21), suggesting good visual outcomes in the low cylinder group despite a less favorable IOS. CONCLUSIONS Manual compensation may be a safe, feasible, and effective approach to refine the results of astigmatism with SMILE, especially in higher degrees of cylinders. [J Refract Surg. 2017;33(8):506-512.].
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Fu D, Wang L, Zhou XT, Yu ZQ. Cap morphology after small-incision lenticule extraction and its effects on intraocular scattering. Int J Ophthalmol 2018; 11:456-461. [PMID: 29600180 DOI: 10.18240/ijo.2018.03.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate cap morphology after small-incision lenticule extraction (SMILE) and its effects on intraocular scattering. METHODS Sixty-five eyes of 33 patients undergoing SMILE were enrolled. In addition to regular evaluation, Fourier-domain optical coherence tomography was used to investigate cap thickness at 1d, 1wk, 1 and 3mo postoperatively. The optical quality including modulation transfer function cutoff frequency, Strehl ratio, Optical Quality Analysis System (OQAS) values, and objective scattering index (OSI), were evaluated using OQAS™. RESULTS Cap thickness decreased from 1d to 1wk (P<0.001), but remained higher than intended thickness of 120 µm after 3mo (P<0.001). Cap thickness in central area was thinner than that of in the paracentral and peripheral areas (P<0.0001). Total number of microdistortions decreased from 1d to 3mo (P<0.0001). Pearson analysis revealed a weak correlation between OSI and standard deviation of cap thickness at 1d and 1mo, as well as between range of cap thickness and OSI at 1mo. No correlation was found between microdistortion and OSI, but a negative correlation existed between microdistortion and range at 1d and 1moafter surgery. CONCLUSION The corneal cap tends to be more accurate and regular with time lapse. Better cap morphology tends to contribute less intraocular scattering in the eyes undergoing SMILE.
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Affiliation(s)
- Dan Fu
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Lin Wang
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Xing-Tao Zhou
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Myopia Key Laboratory of the Health Ministry, Shanghai 200031, China
| | - Zhi-Qiang Yu
- Eye and ENT Hospital of Fudan University, Shanghai 200031, China.,Myopia Key Laboratory of the Health Ministry, Shanghai 200031, China
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Ganesh S, Brar S, Pandey R, Pawar A. Interface healing and its correlation with visual recovery and quality of vision following small incision lenticule extraction. Indian J Ophthalmol 2018; 66:212-218. [PMID: 29380760 PMCID: PMC5819097 DOI: 10.4103/ijo.ijo_775_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: To study the time course of interface healing and its correlation with visual acuity, modulation transfer function (MTF), and aberrations after myopic small-incision lenticule extraction (SMILE) correction. Methods: Seventy-eight eyes of 78 patients (1 eye per patient) with a mean age of 25.7 years and mean spherical equivalent (SE) of −3.74D, undergoing bilateral SMILE procedure, were included in this study. On postoperative day 1, 2 weeks, and 3 months, dilated retroillumination photographs were taken and morphology of corneal interface was graded by comparing them with 5 standard templates representing 5 grades of interface roughness (IRG): IRG – 0 (clear), IRG – 1 (mild), IRG – 2 (moderate), IRG – 3 (severe), and IRG – 4 (severe IRG with Bowman's folds in visual axis). Pearson's correlations were computed to study correlation associations, and Wilcoxon signed-rank test was used for intragroup comparison of means. P ≤ 0.05 was considered statistically significant. Results: At 3 months, 90.70% eyes were Grade 0 while 9.30% eyes still had Grade 2 interface granularity. Mean IRG significantly improved from 2.47 ± 0.57 at day 1 to 0.62 ± 0.53 at 3 months (P = 0.00). At day 1, pre-SE showed a significant positive correlation with IRG; however, mean postoperative corrected distant visual acuity (CDVA, in decimal), corneal Strehl ratio (SR), and MTF showed weak but significant negative correlation with IRG (r2 = 0.28 for SE, −0.052 for CDVA, −0.017 for SR, and −0.39 for MTF, respectively, P < 0.05 for all correlations). At 2 weeks and 3 months, corneal MTF continued to show a significant negative correlation, whereas other parameters did not show any correlation with IRG. Conclusion: Visual quality and corneal MTF may be significantly affected by the IRG in the immediate postoperative period after SMILE and may take 3 months or more for complete recovery.
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Affiliation(s)
- Sri Ganesh
- Department of Phacorefractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Department of Phacorefractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Rahul Pandey
- Department of Phacorefractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Archana Pawar
- Department of Phacorefractive, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Sekundo W, Messerschmidt-Roth A, Reinstein DZ, Archer TJ, Blum M. Femtosecond Lenticule Extraction (FLEx) for Spherocylindrical Hyperopia Using New Profiles. J Refract Surg 2018; 34:6-10. [DOI: 10.3928/1081597x-20171031-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/25/2017] [Indexed: 11/20/2022]
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Ganesh S, Brar S, Lazaridis A. Management and Outcomes of Retained Lenticules and Lenticule Fragments Removal After Failed Primary SMILE: A Case Series. J Refract Surg 2017; 33:848-853. [PMID: 29227514 DOI: 10.3928/1081597x-20171004-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/18/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the management of and report the outcomes following the removal of retained lenticules or lenticule fragments after a complicated small incision lenticule extraction (SMILE). METHODS Three patients were referred for consultation due to intraoperative complications during SMILE. In case 1, the lenticule was torn during extraction and a central fragment was retained in the pocket. In case 2, the inferior part of the lenticule remained attached at the anterior plane and its detached, superior part was dislocated and folded at the inferior part of the pocket. In case 3, the lenticule was completely attached at the anterior plane. All cases underwent secondary surgery. The lenticule fragment was detached using the dissector's body and tip and was extracted using the advanced lenticule forceps. The retained lenticules were extracted after dissection of tissue bridges at the anterior plane and periphery. RESULTS Postoperatively, all eyes showed improvement of visual acuity and topographic regularization of the anterior corneal curvature. Complete removal of lenticule remnants was accomplished in cases 1 and 2. In case 3, the photodisruption during primary SMILE was incomplete at a peripheral area next to the incision. A small peripheral fragment, corresponding to the described peripheral area, remained attached after the lenticule removal and was left in situ but did not have any impact on visual acuity and quality. CONCLUSIONS Retained lenticules or lenticule fragments may induce irregular astigmatism and loss of visual acuity. Prompt removal restores visual acuity and induces the desired effect of the primary SMILE procedure. [J Refract Surg. 2017;33(12):848-853.].
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Abstract
Refractive lenticule extraction (ReLEx/SMILE) is a refractive surgical method developed by the authors in stages primarily for correction of myopia and myopic astigmatism, in which a femtosecond laser is exclusively used. In the (ReLEx/SMILE) method a refractive lenticule is generated by the femtosecond laser, which is subsequently extracted through a small incision. Opening of the corneal surface with a flap and use of an excimer laser is no longer necessary. In 2013 the method was newly assessed and classified by the Joint Commisssion for Refractive Surgery (KRC) of the Professional Association of Ophthalmologists (BVA) and the German Ophthalmological Society (DOG). This article presents the individual stages of the technique in a video and possible errors and their avoidance are explained.
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Affiliation(s)
- M Blum
- Augenklinik HELIOS Klinikum Erfurt GmbH, Nordhäuser Str. 74, 99089, Erfurt, Deutschland.
| | - W Sekundo
- Augenklinik, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstr., 35043, Marburg, Deutschland
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Ganesh S, Brar S, Pawar A. Matched population comparison of visual outcomes and patient satisfaction between 3 modalities for the correction of low to moderate myopic astigmatism. Clin Ophthalmol 2017; 11:1253-1263. [PMID: 28740361 PMCID: PMC5505606 DOI: 10.2147/opth.s127101] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose To compare toric implantable collamer lens (T-ICL), femto-LASIK, and ReLEx SMILE for the treatment of low to moderate myopic astigmatism in terms of long-term visual and refractive outcomes and predictability of astigmatic correction. Materials and methods The study included 30 eyes from 30 patients between the age groups of 21 and 40 years, undergoing bilateral surgery with any of the three procedures – T-ICL, femto-LASIK, or ReLEx SMILE – for correction of myopic astigmatism within the range of −3 to −8 D spherical equivalent (SE), with a minimum astigmatism of −0.75 D. Patients were followed up at day 1, 1 month, 6 months, and 1 year. Results At 1 year, the mean cylinder reduced to −0.21±0.28, −0.17±0.36, and −0.22±0.28 D in the T-ICL, femto-LASIK, and ReLEx SMILE group, respectively. The predictability of astigmatism correction was comparable, with no statistically significant difference between the 3 groups (P>0.05). A total of 97% of eyes in ReLEx SMILE achieved a uncorrected distance visual acuity of 20/20 or better, compared to T-ICL (93%) and FS-LASIK (90%). However, gain in lines of corrected distant visual acuity (CDVA) was maximum in T-ICL group (60%). Four eyes in the femto-LASIK group had loss of CDVA by one line. Three eyes required exchange due to high vault and rotation of the T-ICL, which did not affect the final outcome. Conclusion All 3 modalities were effective for myopic astigmatism at the end of 1 year. Quality of vision and patient satisfaction with T-ICL and ReLEx SMILE were similar and better than FS-LASIK. However, slight chances of postoperative rotation and exchange exist with T-ICL, which warrant thorough preoperative planning.
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Affiliation(s)
- Sri Ganesh
- Phacorefractive Department, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Phacorefractive Department, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Archana Pawar
- Phacorefractive Department, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Luft N, Priglinger SG, Ring MH, Mayer WJ, Mursch-Edlmayr AS, Kreutzer TC, Bolz M, Dirisamer M. Stromal remodeling and lenticule thickness accuracy in small-incision lenticule extraction: One-year results. J Cataract Refract Surg 2017; 43:812-818. [DOI: 10.1016/j.jcrs.2017.03.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/29/2016] [Accepted: 03/26/2017] [Indexed: 11/24/2022]
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Comparison of ReLEx SMILE and PRK in terms of visual and refractive outcomes for the correction of low myopia. Int Ophthalmol 2017; 38:1147-1154. [PMID: 28551832 DOI: 10.1007/s10792-017-0575-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the objective and subjective quality of vision after femtosecond laser-assisted small incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK) for low myopia. METHODS One hundred and twenty eyes from 60 patients (34 females, 26 males) undergoing bilateral correction of low myopia (≤-4 D SE) with either ReLEx SMILE or PRK were included. Visual acuity, contrast sensitivity and higher-order aberrations were recorded preoperatively and compared postoperatively. A quality of vision questionnaire was scored and analyzed 3 months postoperatively. RESULTS At 3 months, the SMILE group had significantly better uncorrected and corrected distant visual acuity (CDVA), compared to PRK group (p = 0.01). Post-op spherical equivalent (SE) was comparable in both groups (SMILE = -0.15 ± 0.19 D, PRK = -0.14 ± 0.23 D, p = 0.72). However, SE predictability was better in SMILE group with 97% eyes within ±0.05 D compared to 93% eyes in the PRK group. Total higher-order aberrations (HOAs) were significantly higher in PRK compared to the SMILE group (p = 0.022). The SMILE group demonstrated slightly better contrast sensitivity, which was significant at spatial frequency of 12 cpd (p = 0.03). Four eyes in the PRK group had loss of CDVA by one line due to mild haze. CONCLUSIONS Both SMILE and PRK were effective procedures for correction of low myopia. However, SMILE offered superior quality of vision and patient satisfaction due to better postoperative comfort and lower induction of aberrations at 3 months.
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Corneal Higher-Order Aberrations of the Anterior Surface, Posterior Surface, and Total Cornea After SMILE, FS-LASIK, and FLEx Surgeries. Eye Contact Lens 2017; 42:358-365. [PMID: 27028185 DOI: 10.1097/icl.0000000000000225] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the corneal higher-order aberrations (HOAs) of the anterior surface, posterior surface, and total cornea after small incision lenticule extraction (SMILE) and compare the results using femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and femtosecond laser lenticule extraction (FLEx). METHODS This study included 160 eyes in total; 73 eyes underwent SMILE, 52 eyes underwent FS-LASIK, and 35 eyes underwent FLEx surgery. Corneal HOAs of the anterior surface, posterior surface, and total cornea were evaluated using a Scheimpflug camera over 6-mm diameter preoperatively and 3 months postoperatively. RESULTS The anterior and total corneal HOAs significantly increased after SMILE, FS-LASIK, and FLEx surgeries, especially the spherical aberration and coma, whereas most posterior corneal HOAs remained unchanged. The SMILE procedure induced significantly lower anterior corneal and total corneal spherical aberration and third to eighth HOAs compared with FLEx surgery (P<0.01). FLEx surgery induced higher posterior corneal coma than SMILE (P=0.013) and FS-LASIK (P<0.001) surgeries. CONCLUSIONS SMILE, FS-LASIK, and FLEx surgeries mainly induced coma and spherical aberrations in the anterior surface and total cornea. The SMILE procedure induced less spherical aberration of the anterior cornea and total cornea than FLEx surgery. The posterior corneal spherical aberration significantly increased after FS-LASIK surgery. The SMILE procedure seems to have fewer effects on posterior corneal coma compared with the FLEx procedure.
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Abstract
To evaluate intraoperative decentration from pupil center and kappa intercept during small incision lenticule extraction (SMILE) and its impact on visual outcomes.This was a retrospective noncomparative case series. A total of 164 eyes that underwent SMILE at the Singapore National Eye Center were included. Screen captures of intraoperative videos were analyzed. Preoperative and 3 month postoperative vision and refractive data were analyzed against decentration.The mean preoperative spherical equivalent (SE) was -5.84 ± 1.77. The mean decentration from the pupil center and from kappa intercept were 0.13 ± 0.06 mm and 0.47mm ± 0.25 mm, respectively. For efficacy and predictability, 69.6% and 95.0% of eyes achieved a visual acuity (VA) of 20/20 and 20/30, respectively, while 83.8% and 97.2% of eyes were within ±0.5D and ±1.0D of the targeted SE. When analyzed across 3 groups of decentration from the pupil center (<0.1 mm, 0.1-0.2 mm, and >0.2 mm), there was no statistically significant association between decentration, safety, efficacy, and predictability. When analyzed across 4 groups of decentration from kappa intercept (<0.2 mm, 0.2-<0.4 mm, 0.4-<0.6 mm, and ≥0.6 mm), there was a trend toward higher efficacy for eyes with decentration of kappa intercept between 0.4 and <0.6 mm (P = .097). A total of 85.4% of eyes in the 0.4 to <0.6 mm group had unaided distance VA of 20/20 or better, as compared to only 57.8% of eyes in ≥0.6 mm group.Decentration of 0.13 mm from the pupil center does not result in compromised visual outcomes. Decentration of greater than 0.6 mm from the kappa intercept may result in compromised visual outcomes. There was a trend toward better efficacy in eyes which had decentered treatment from 0.4 to <0.6 mm from the kappa intercept. Patients with a large kappa intercept (>0.6 mm) should have their lenticule created 0.4 to 0.6 mm from the kappa intercept and not close to the pupil.
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Affiliation(s)
- John X. Wong
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
| | - Elizabeth P. Wong
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute
| | | | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute
- Singapore National Eye Centre, Singapore
- Department of Clinical Sciences, Duke-NUS Graduate Medical School
- School of Material Science and Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University
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Impact of Treatment Decentration on Higher-Order Aberrations after SMILE. J Ophthalmol 2017; 2017:9575723. [PMID: 28396804 PMCID: PMC5370520 DOI: 10.1155/2017/9575723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/31/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate decentration following femtosecond laser small incision lenticule extraction (SMILE) and sub-Bowman keratomileusis (SBK) and its impact on higher-order aberrations (HOAs). Methods. Prospective, nonrandom, and comparison study. There were 96 eyes of 52 patients who received SMILE and 96 eyes of 49 patients who received SBK in this study. Decentration was calculated 6 months after surgery with Pentacam. HOAs and visual acuity after the surgery were examined for patients in both groups before and 6 months after surgery. Results. The mean decentration displacement in SMILE group was significantly less than SBK group (P = 0.020). 89 eyes were decentered within 0.50 mm after SMILE and SBK. The association between vertical decentration and the induced spherical aberration was insignificant in SMILE group (P = 0.035). There was an association between decentration and safety index, efficacy index, vertical coma, spherical aberration, and HOAs in root mean square (RMS, μm) after SBK (all P < 0.05). No difference was found in uncorrected and corrected distance visual acuity, safety index, efficacy index, and wavefront aberrations between the two subgroups at any delimited value after SMILE (all P > 0.05). Decentration exceeding 0.37 mm affected vertical coma and RMSh of SBK eyes (P = 0.002, 0.005). Conclusion. SMILE surgery achieved more accurate centration than SBK surgery. Vertical decentration is associated with the induced spherical aberration in SMILE.
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Corneal Clarity and Visual Outcomes after Small-Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted In Situ Keratomileusis. J Ophthalmol 2017; 2017:5646390. [PMID: 28396803 PMCID: PMC5370519 DOI: 10.1155/2017/5646390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 01/27/2023] Open
Abstract
Purpose. To evaluate corneal clarity and visual outcomes after small-incision lenticule extraction (SMILE) and compare them to femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Materials and Methods. Fifty-eight myopic eyes of 33 patients who underwent SMILE were compared to 58 eyes of 33 patients treated with FS-LASIK. All procedures were performed using VisuMax® femtosecond laser and MEL 80® excimer laser (Carl Zeiss Meditec AG, Germany). Pentacam™ (Oculus, Germany) was used for pre- and 3-month postoperative corneal densitometry (CD) analysis. CD was evaluated at 3 optically relevant, concentric radial zones (0–2 mm, 2–6 mm, and 0–6 mm annulus) around the corneal apex and at 3 different anatomical corneal layers (anterior, central, and posterior). Associations of postoperative CD values with the lenticule thickness and ablation depth were examined. Preoperative and postoperative corrected distance visual acuity (CDVA) values were also compared. Results. After SMILE, the total CD (all corneal layers) at 0–6 mm annulus showed no significant change compared to preoperative values (P = 0.259). After FS-LASIK, the total CD was significantly reduced (P = 0.033). Three-month postoperative CD showed no significant differences between the 2 groups for all examined annuli (0–2 mm: P = 0.569; 2–6 mm: P = 0.055; and 0–6 mm: P = 0.686). Total CD after SMILE at 0–6 mm annulus displayed a weak negative association with the lenticule thickness (P = 0.079, R2 = 0.0532) and after FS-LASIK displayed a weak negative association with the ablation depth (P = 0.731, R2 = 0.0015). Postoperative CDVA was similar for both groups (P = 0.517). Conclusion. Quantification of corneal clarity using the Scheimpflug CD showed similar results before and 3 months after SMILE. Compared to FS-LASIK, no significant differences of corneal clarity and CDVA were found 3 months postoperatively.
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Reinstein DZ, Pradhan KR, Carp GI, Archer TJ, Gobbe M, Sekundo W, Khan R, Citron K, Dhungana P. Small Incision Lenticule Extraction (SMILE) for Hyperopia: Optical Zone Centration. J Refract Surg 2017; 33:150-156. [PMID: 28264128 DOI: 10.3928/1081597x-20161220-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate optical zone centration of hyperopic small incision lenticule extraction (SMILE). METHODS This prospective study of 60 consecutive hyperopic SMILE procedures used the VisuMax femtosecond laser and matched LASIK procedures with the VisuMax and MEL 80 excimer lasers (Carl Zeiss Meditec AG, Jena, Germany). Inclusion criteria were maximum attempted hyperopic meridian of between +1.00 and +7.00 diopters (D) and astigmatism up to 6.00 D. For SMILE, the optical zone was between 6.3 and 6.7 mm, with a 2-mm transition zone. Two LASIK control groups (6.5- and 7-mm optical zone) were generated matched for spherical equivalent treated. In SMILE, the corneal vertex of the coaxially fixating eye was aligned with the vertex of the curved contact glass. In LASIK, the treatment was centered on the coaxially sighted corneal light reflex (first Purkinje image) with the contralateral eye (Seiler method). A tangential (instantaneous) curvature preoperative to 3 months postoperative difference map was generated for each eye. A fixed grid and set of concentric circles were superimposed on the difference map to measure the offset between the optical zone center and corneal vertex (0,0), and vector analysis was used for comparative analysis. RESULTS Mean attempted spherical equivalent was +5.61 ± 0.96 D (range: +3.20 to +6.50 D) and mean cylinder was -0.96 ± 0.62 D (range: 0.00 to -2.75 D) in the SMILE group. Mean age was 29 ± 7 years (range: 19 to 52 years) in the SMILE group. Mean centration offset was 0.23 ± 0.15 mm (range: 0 to 0.61 mm) for the SMILE group, 0.33 ± 0.14 mm (range: 0.14 to 0.85 mm) for the 6.5-mm LASIK group, and 0.31 ± 0.19 mm (range: 0.05 to 0.85 mm) for the 7-mm LASIK group. The mean centration offset for SMILE was less than that of both LASIK groups (P < .05). CONCLUSIONS Optical zone centration of hyperopic SMILE was found to be similar to eye-tracker-centered hyperopic LASIK with the MEL 80 laser. [J Refract Surg. 2017;33(3):150-156.].
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Lazaridis A, Reinstein DZ, Archer TJ, Schulze S, Sekundo W. Refractive Lenticule Transplantation for Correction of Iatrogenic Hyperopia and High Astigmatism After LASIK. J Refract Surg 2016; 32:780-786. [DOI: 10.3928/1081597x-20160726-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022]
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Early outcomes after small incision lenticule extraction and photorefractive keratectomy for correction of high myopia. Sci Rep 2016; 6:32820. [PMID: 27601090 PMCID: PMC5013393 DOI: 10.1038/srep32820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/03/2016] [Indexed: 11/21/2022] Open
Abstract
We prospectively compared visual and refractive outcomes in patients with high myopia and myopic astigmatism after small-incision lenticule extraction (SMILE) and photorefractive keratetctomy (PRK) with mitomycin C. Sixty-six eyes of 33 patients (mean age, 29.7 ± 5.6 years) were included (SMILE: 34 eyes, PRK 32 eyes). Preoperatively, no significant difference was noted in manifest spherical equivalent (p = 0.326), manifest sphere (p = 0.277), and manifest cylinder (p = 0.625) between both groups. At 1 month, there were significant differences in logMAR uncorrected distance visual acuity, efficacy index and manifest refraction spherical equivalent between SMILE and PRK (p ≤ 0.029). At 6 months, the logMAR corrected distance visual acuity (p = 0.594), logMAR uncorrected visual acuity (p = 0.452), efficacy index (p = 0.215) and safety index was (p = 0.537) was comparable between SMILE and PRK. Significant differences were observed in postoperative manifest spherical equivalent (p = 0.044) and manifest cylinder (p = 0.014) between both groups. At the end of 6 months, 100% of the eyes in SMILE group and 69% of the eyes in PRK group were within ±0.50 D of the attempted cylindrical correction. The postoperative difference vector, magnitude of error and absolute angle of error were significantly smaller after SMILE compared to PRK (p ≤ 0.040) implying a trend towards overcorrection of cylindrical correction following PRK.
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Zhang Y, Shen Q, Jia Y, Zhou D, Zhou J. Clinical Outcomes of SMILE and FS-LASIK Used to Treat Myopia: A Meta-analysis. J Refract Surg 2016; 32:256-65. [DOI: 10.3928/1081597x-20151111-06] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/28/2015] [Indexed: 11/20/2022]
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Comparison of Moderate- to High-Astigmatism Corrections Using WaveFront–Guided Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction. Cornea 2016; 35:523-30. [DOI: 10.1097/ico.0000000000000782] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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