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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024; 47:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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Cheng X, Zhao Y, Fu D, Zhou X, Gao Y, Yu Z. Posterior corneal stability after small incision lenticule extraction with different optical zones. Eye (Lond) 2024:10.1038/s41433-024-03224-9. [PMID: 38997503 DOI: 10.1038/s41433-024-03224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/16/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND To assess the changes in the posterior corneal surface following small incision lenticule extraction (SMILE) with different optical zones. METHODS In this retrospective study, 106 eyes of 106 patients who underwent SMILE were recruited 3 years after the procedure. Eyes were divided into two groups according to the size of the surgical optical zone: group A (52 eyes, ≤6.2 mm) and group B (54 eyes, ≥6.5 mm). Posterior central elevation (PCE) and 12 other points at 45°, 135°, 225° and 315° with distances of 1 mm, 2 mm and 3 mm from the centre were recorded from Pentacam. RESULTS No iatrogenic keratectasia was identified, and eyes in the two groups showed comparable visual results. The overall trend in posterior corneal elevation changes was consistent for both groups. PCE decreased significantly from 1.33 ± 2.32 to 0.75 ± 2.41 in group A (P = 0.024) and from 0.87 ± 2.61 to 0.06 ± 2.74 in group B (P = 0.003). All points in the central 2 mm region in both groups were reduced postoperatively. In the 4 mm and 6 mm corneal annulus, almost all points at 225°and 315° showed backward displacement, with the most prominent change occurring at 315° in the 6 mm annulus (P < 0.001), indicating no forward protrusion in the inferior area. CONCLUSIONS No forward protrusion in the posterior corneal surface was observed 3 years after SMILE with different optical zones. Comprehensive preoperative measurements are essential for ensuring corneal stability and avoiding iatrogenic keratectasia.
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Affiliation(s)
- Xueying Cheng
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Yu Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Dan Fu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Ying Gao
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
| | - Zhiqiang Yu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, NHC, Shanghai, China.
- Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China.
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Chen T, Li N, Ge T, Lin Y, Wu X, Gao H, Liu M. Regional analysis of posterior corneal elevation after laser refractive surgeries for correction of myopia of different degrees. Indian J Ophthalmol 2024; 72:824-830. [PMID: 38317325 PMCID: PMC11232844 DOI: 10.4103/ijo.ijo_2127_23] [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: 08/09/2023] [Accepted: 10/19/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE To evaluate regional changes in the posterior corneal elevation after three laser refractive surgeries for correction of myopia of different degrees. SETTINGS AND DESIGN Retrospective, comparative, and non-randomized study. METHODS Two hundred patients (200 eyes) who underwent laser epithelial keratoplasty (LASEK), femtosecond-assisted laser in-situ keratomileusis (FS-LASIK), and small-incision lenticule extraction (SMILE) were included in this study. According to preoperative spherical equivalent (SE), each surgical group was divided into two refractive subgroups: low-to-moderate myopia (LM group) and high myopia (H group). The posterior corneal elevation from Pentacam Scheimpflug tomography was analyzed preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. Three subregions of the posterior cornea were divided in this study as the central, paracentral, and peripheral regions. STATISTICAL ANALYSIS USED Generalized Estimating Equations (GEE). RESULTS For all three surgical groups, similar changing trends were seen in the two refractive subgroups. H group presented a larger changing magnitude than the LM group in FS-LASIK over time ( P < 0.05), whereas no significant difference was noted in the two refractive subgroups of LASEK or SMILE ( P > 0.05). At 12 months postoperatively, the central posterior corneal elevation returned to the preoperative level in LASEK ( P > 0.05) but shifted forward significantly in FS-LASIK and SMILE ( P < 0.05). CONCLUSION Different posterior corneal regions respond differently to corneal refractive surgeries. LASEK, FS-LASIK, and SMILE demonstrate different trends in the regional changes in posterior corneal elevation. The corneal shape seems more stable in LASEK than in FS-LASIK and SMILE.
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Affiliation(s)
- Tong Chen
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Na Li
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Tian Ge
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Yue Lin
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Xiaohui Wu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Hua Gao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
| | - Mingna Liu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, China
- School of Ophthalmology, Shandong First Medical University, China
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Xia F, Chen Z, Miao H, Wei R, Li M, Zhao J, Zhou X. Ten-year outcomes following small incision lenticule extraction for up to -10Dioptres myopia. Clin Exp Optom 2024; 107:285-290. [PMID: 37194118 DOI: 10.1080/08164622.2023.2203313] [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: 06/10/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
CLINICAL RELEVANCE More than 6 million small-incision lenticule extraction (SMILE) procedures have been performed worldwide since 2011. Therefore, its long-term safety and efficacy should be investigated. BACKGROUND This study aimed to evaluate 10-year refractive outcomes, corneal stability, axial length, and wavefront aberrations in patients who underwent SMILE to correct myopia. METHODS Thirty two patients (32 eyes) who underwent SMILE-based myopic correction. Corrected distance visual acuity, uncorrected distance visual acuity, corneal stability, axial length, and wavefront aberrations were evaluated preoperatively and at 1 month and 1, 5, and 10 years postoperatively. RESULTS At 10 years postoperatively, the safety and efficacy indices for the patients included in this study were 1.19 ± 0.21 and 1.04 ± 0.27, respectively. For 26 (81%) and 30 eyes (94%), correction to within ±0.50 D and ±1.00 D of the target was achieved, respectively. Over the 10-year follow-up duration, a mean -0.32 ± 0.56 D regression was observed (-0.03 ± 0.06 D/year). Relative to baseline, horizontal and vertical comas significantly increased, as did the incidence of higher-order aberrations (all P < 0.001), whereas axial length and corneal elevation remained stable during follow-up. CONCLUSION These results indicate that the SMILE-based correction for myopia of up to -10 Dioptres is safe, effective, and stable, with relatively constant wavefront aberrations and corneal stability over time after treatment.
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Affiliation(s)
- Fei Xia
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huamao Miao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ruoyan Wei
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Ouyang BW, Ding H, Fan H, Wang H, Yang Z, Zhong T, Zhong X. Comparison of different corneal residual bed thickness after small incision lenticule extraction (SMILE). Eur J Ophthalmol 2024; 34:384-393. [PMID: 37438954 DOI: 10.1177/11206721231187669] [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] [Indexed: 07/14/2023]
Abstract
PURPOSE To evaluate the corneal biological parameters stability between the different corneal residual bed thickness (RBT) after Small Incision Lenticule Extraction (SMILE). METHODS In this prospective clinical trial, 127 eyes of 64 patients underwent SMILE. According to the corneal RBT, the patients were divided into the 250-270 µm, 270-290 µm and 290-310 µm groups. Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Scheimpflug camera (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany) measurements were performed preoperatively, 1 day, 1week, 1month and 3 months after surgery. RESULTS The keratometer values among the three groups were no significant differences in postoperative periods (each P > 0.05), except the corneal thickness values (each P < 0.05). In the 250-270 µm and 270-290 µm groups, the keratometer and corneal thickness values were decreased at postoperative 1 week and increased at 1 and 3 months. The 290-310 µm group significantly higher posterior maximum elevation (PME) than the 250-270 µm group at 1 and 3 months (P = 0.022, 0.022, respectively), and higher preoperative thinnest point (PTE) at 1 week and 1 month (P = 0.013, 0.035, respectively). The PME of the 290-310 µm group was higher than the 270-290 µm group at 3 months (P = 0.045), and higher PTE at 1 week and 3 months (P = 0.022, 0.02, respectively). In all three groups, the maximal deformation amplitude (DA) was significantly higher at 1 and 3 months compared to postoperative 1 day and 1 week, and the IOP was decreased at 1 month then recovered at 3 months (each P < 0.05).The DA of the 250-270 µm group was significantly higher than the 290-310 µm group at postoperative 1 week, 1 and 3 months (P = 0.001, 0.01, 0.02, respectively). The change of the posterior corneal elevation and biomechanical parameters values were no significant differences among the three groups in postoperative periods (each P > 0.05). CONCLUSIONS The range of 250-310 µm RBT was safe and stable at the early postoperative of SMILE. The RBT may be positively correlated with the posterior corneal elevation.
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Affiliation(s)
- Bo-Wen Ouyang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Hui Ding
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Hongming Fan
- Yichang Maternal and Child Health Hospital, School of Clinical Medicine for Women and Children, China Three Gorges University, Hubei, China
| | - Han Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Zhenduo Yang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Tan Zhong
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Xingwu Zhong
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
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Zhao Y, Zhao W, Wang J, Zhang Z, Zhou X, Zhao J. Characteristics of disk halo size and its correlation with lenticule quality in small incision lenticule extraction for moderate to high myopia. Graefes Arch Clin Exp Ophthalmol 2024; 262:313-321. [PMID: 37405512 PMCID: PMC10805804 DOI: 10.1007/s00417-023-06133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE To investigate changes in disk halo size after small incision lenticule extraction (SMILE) and the correlation between halo size and lenticule quality in moderate to high myopia. METHODS Thirty eyes of 30 consecutive patients (mean age, 24.9 ± 4.5 years; mean spherical equivalent, -6.85 ± 1.18 D) undergoing SMILE were included in this prospective study. Lenticule surface quality was accessed with a scanning electron microscopy by a scoring system. Halo size was measured preoperatively and at 1, 3, and 6 months postoperatively. Multiple linear regression analysis was performed to explore associations between halo size and a range of factors, including lenticule quality. RESULTS Disk halo size increased slightly at 1 month and then recovered continually from 3 to 6 months postoperatively, with no difference between halo size during the preoperative period and at 6 months postoperatively (P > 0.05). One month after SMILE, halo size (1 cd/m2, 5 cd/m2) was associated only with uncorrected distance visual acuity (P ≤ 0.004). A halo size of 5 cd/m2 at 3 months postoperatively correlated with the anterior surface quality of the lenticule (P = 0.046). At 6 months postoperatively, a halo size of 1 cd/m2 was associated only with the baseline, accounting for 11.9% of the variability (P = 0.041); no correlations were found for the halo size of 5 cd/m2. CONCLUSIONS Disk halo size after SMILE was enlarged at an early stage postoperatively and subsequently declined to the baseline level during a 6-month follow-up. The quality of the lenticule surface influenced halo size changes in the early phase.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Wuxiao Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Center for Optometry and Visual Science, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jifang Wang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhe Zhang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Jing Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Li H, Zhang J, Shao T, Wang H, Liu S, Long K. Two-year stability of posterior corneal surface after transepithelial photorefractive keratectomy with a residual stromal thickness less than 350 μm. Graefes Arch Clin Exp Ophthalmol 2023; 261:857-865. [PMID: 36138148 DOI: 10.1007/s00417-022-05814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/16/2022] [Accepted: 08/19/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aimed to investigate the stability of posterior corneal surface 2 years after transepithelial photorefractive keratectomy (TPRK) in patients with a residual stromal thickness less than 350 μm. METHODS In total, 408 eyes of 212 patients (160 women, 52 men) who underwent TPRK were enrolled in this retrospective study. All surgeries were performed in the Amaris 750S excimer laser platform with smart pulse technology. The posterior corneal elevation, anterior chamber depth, Q value, and curvature were measured using Pentacam preoperatively and postoperatively. All patients were followed up for 2 years. The relationship between percent tissue altered (PTA), age, and changes in posterior corneal surface was analyzed. RESULTS The mean preoperative spherical equivalent was - 6.80 ± 1.18 D (range: - 9.00 to - 2.63 D). The mean residual stromal thickness was 336.46 ± 7.25 μm (range: 310-348 μm). The mean PTA was 30.93 ± 2.03% (range: 24.29-35.28%). At 2 years after surgery, the elevation of six points in the central area decreased by 1.91 ± 2.97 μm, 2.98 ± 3.23 μm, 1.17 ± 3.85 μm, 1.70 ± 2.88 μm, 1.36 ± 3.19 μm, and 1.65 ± 3.18 μm, compared with the preoperative value (P < 0.05). The elevation of three points in the peripheral area increased by 1.87 ± 6.34 μm, 0.68 ± 6.00 μm, and 0.95 ± 5.50 μm (P < 0.05). There was no significant linear relationship between PTA, age, and changes in posterior corneal surface, anterior chamber depth, and K2 (all P > 0.05). CONCLUSION Within 2 years after TPRK, the posterior corneal surface remained stable in patients with a residual stromal thickness between 310 and 350 μm. There was no sign of iatrogenic ectasia during the follow-up period.
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Affiliation(s)
- Hua Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
| | - Jiafan Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
| | - Ting Shao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
| | - Huifeng Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
| | - Sai Liu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China
| | - Keli Long
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao Eye Hospital of Shandong First Medical University, Eye Institute of Shandong First Medical University, Qingdao, 266071, Shandong Province, China.
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Yang L, Liu S, Zhou X, Zhao Y. Correlation between the ablation ratio and posterior corneal stability after small incision lenticule extraction for high myopia. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05979-5. [PMID: 36662234 DOI: 10.1007/s00417-023-05979-5] [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: 09/08/2022] [Revised: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of this study is to investigate changes in posterior corneal elevation and their correlations with the ablation ratio 3 years after small incision lenticule extraction (SMILE) for high myopia. METHODS Eighty eyes underwent SMILE were enrolled in this study. Eyes were classified into two groups based on the ablation ratio (AR, lenticule thickness from SMILE machine/thinnest corneal thickness): group A (< 25%, 40 eyes) and group B (≥ 25%, 40 eyes). Pentacam was used to measure the posterior corneal elevation at the central point, thinnest point, and posterior maximum elevation (PME) and the mean posterior elevation in the central 2-mm area (MPE-2 mm), 4-mm area, and 6-mm area at the 3-year follow-up. RESULTS More than 85% of the eyes had an AR of less than 27%, and no cases of iatrogenic keratectasia developed. In both groups, for central region, posterior elevation decreased implying backward displacement; for peripheral region, it increased indicating forward trend. There was no significant difference in changes in all determined parameters between the two groups (P ≥ 0.07). Moreover, no significant correlation was noted between AR and posterior elevation changes. In group A, decreasing changes in PME (r = - 0.42, P = 0.01) and MPE-2 mm (r = 0.40, P = 0.01) demonstrated negative correlations with residual bed thickness. CONCLUSION Region-dependent changes were demonstrated in the eyes that underwent SMILE. The central area showed a subtly declining posterior elevation, and the peripheral area showed a slightly increasing elevation. The limited ablation ratio had no impact on the changes in posterior corneal elevation.
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Affiliation(s)
- Liyuan Yang
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Shengtao Liu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
| | - Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
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Zhang Y, Che D, Cao Y, Yue Y, He T, Zhu Y, Zhou J. MicroRNA Profiling in the Aqueous Humor of Keratoconus Eyes. Transl Vis Sci Technol 2022; 11:5. [PMID: 36472881 PMCID: PMC9733654 DOI: 10.1167/tvst.11.12.5] [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] [Indexed: 12/12/2022] Open
Abstract
Purpose To identify differentially expressed (DE) microRNAs (miRNAs) in the aqueous humor (AH) of keratoconus (KC) eyes using next-generation sequencing and to explore whether DE miRNAs might play roles in KC pathophysiology. Methods The small RNAs in the AH of 15 KC eyes and 15 myopia eyes (the control group) were sequenced on an Illumina NovaSeq 6000 platform. Gene Oncology and Kyoto Encyclopedia of Genes and Genome enrichment analyses were performed. Receiver operating characteristic curves were used to identify potential KC biomarkers. Results We identified 204 miRNAs in the AH of the KC group and 200 in the AH of the control group. Fourteen miRNAs were differentially expressed between the two groups; four miRNAs were upregulated and 10 downregulated in KC AH. The possible pathways regulated by the DE miRNAs included antigen processing and presentation, endocytosis, mismatch repair, and Hippo signaling. The AH concentrations of miR-222-3p, miR-363-3p, and miR-423-5p exhibited areas under the curves of 1. Conclusions We profiled the DE miRNAs of the AH of KC eyes. These miRNAs may be associated with KC pathogenesis and could serve as KC biomarkers. Translational Relevance Data on aberrantly expressed miRNAs in KC combined with bioinformatics analyses suggest possible roles for specific miRNAs. The DE miRNAs may serve as diagnostic KC biomarkers.
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Affiliation(s)
- Yingjie Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Danyang Che
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yiting Cao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yu Yue
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Tianrui He
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi Zhu
- Aier Institute of Optometry and Vision Science, Changsha, China,Shanghai Aier Eye Hospital, Shanghai, China
| | - Jibo Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Wu J, Wu J, Wu S, Zhu D, Miao Y, Huang C, Akiti S, Vinciguerra R, Zhang X, Zhang P, Zheng X, Wang J, Wang Q, Chen S, Li Y, Ye Y, Bao F, Elsheikh A. Regional Changes in Posterior Corneal Surface During a 6-Month Follow-up Period After tPRK, FS-LASIK, and SMILE. J Refract Surg 2022; 38:708-715. [DOI: 10.3928/1081597x-20221005-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Zhao Y, Lin X, Chen Z, Zhou X. Five-year stability of posterior corneal surface after small incision lenticule extraction for high myopia. BMC Ophthalmol 2022; 22:239. [PMID: 35643458 PMCID: PMC9145076 DOI: 10.1186/s12886-022-02463-2] [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: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To study the 5-year changes in the posterior corneal surface after small incision lenticule extraction (SMILE) for high myopia.
Methods
Eighty eyes received SMILE was included in this prospective study. They were allocated into two groups based on the spherical equivalent: high myopia (40eyes, -7.49 ± 0.70D) and moderate myopia (40eyes, -4.43 ± 0.87D). Certain points of posterior corneal elevation (the central point (PCE), thinnest point (PTE), maximal point (PME), and in various corneal areas) were evaluated using a Scheimpflug camera (Pentacam; Oculus GmbH, Germany) preoperatively and at 6 months and 5 years after surgery.
Results
All surgeries were completed uneventfully and no ectasia was developed throng the observation. The safety index and efficacy index were 1.14 and 1.03 in the high myopia group, and 1.16 and 1.06 in the moderate myopia group, respectively. Most of the calculated values in the high myopia group showed a slight increase at 6 months but decreased at 5 years. At 5 years postoperatively, the value of the PTE was significantly lower than at baseline in both groups (P ≤ 0.047); a statistical difference was also revealed in the PME in the moderate group with slight changes (10.15 ± 3.01 μm vs. 11.60 ± 4.33 μm, P = 0.002); no statistical significance was observed in other calculated values (P ≥ 0.067). Similarly, no significant linear correlation was noted between changes in all values and the residual bed thickness either (P ≥ 0.057).
Conclusions
SMILE causes no protrusion in posterior corneal surface for correction of high myopia at the follow-up visit of 5 years.
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12
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Cao H, Zhang L, Liang S, Chen X, Jhanji V, Wang Y. Predictive factors of posterior corneal shift after small incision lenticule extraction: a 5-year follow-up study. Acta Ophthalmol 2022; 100:e1431-e1438. [PMID: 35488809 DOI: 10.1111/aos.15166] [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: 09/22/2021] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine risk factors affecting changes in posterior corneal elevation (PCE) and predict the 5-year stability after small incision lenticule extraction (SMILE). METHODS This retrospective, longitudinal study enrolled 161 patients post-SMILE. The PCE values were measured at the apex, thinnest, maximal and 24 other prespecified preoperative points and at 6 months, 1 year and 5 years postoperatively. RESULTS Posterior corneas exhibited time-dependent, region-dependent and angle-dependent changes. For every dioptre increase in the absolute preoperative spherical equivalent (SE), 10-μm decrease in the central corneal thickness (CCT), 10-μm increase in the maximum lenticule thickness (MLT), 10-μm decrease in the residual bed thickness (RBT), 10% increase in the percentage ablation depth (PAD, MLT divided by CCT) and 10% decrease in the percentage stromal bed thickness (PSBT, RBT divided by CCT), PCE exhibited average forward displacements of 0.2-0.4, 0.2-0.7, 0.1-0.2, 0.1-0.3, 0.6-1.0 and 0.5-1.1 μm, respectively (p < 0.05). PSBT was the variable with the highest accuracy in predicting 5-year stability of posterior corneas (area under curve = 0.75). The cut-off values of SE, CCT, MLT, RBT, PAD and PSBT for increased PCE were -8.00 to -8.31 D, 481.0-498.5 μm, 139.5-144.5 μm, 255.5-263.5 μm, 26.9-28.3% and 48.9-52.6%, respectively. CONCLUSION Eyes with thinner corneas, higher myopia requiring greater MLT and lower RBT exhibited greater predispositions towards posterior protrusion. The thresholds for preventing forward posterior corneal displacement were 26.9-28.3% for PAD and 48.9-52.6% for PSBT. Prediction of posterior corneal stability is useful for assessing surgical risks post-SMILE.
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Affiliation(s)
- Huazheng Cao
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
| | - Lin Zhang
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute Nankai University Affiliated Eye Hospital Tianjin China
| | - Shuang Liang
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
| | - Xuan Chen
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
| | - Vishal Jhanji
- Department of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh PA USA
| | - Yan Wang
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute Nankai University Affiliated Eye Hospital Tianjin China
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13
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Zhao Y, Fu D, Chen Z, Zhou X. Three-Year Follow-Up of Posterior Corneal Elevation in Thin Corneas After Small Incision Lenticule Extraction. Front Med (Lausanne) 2022; 9:758223. [PMID: 35186987 PMCID: PMC8854970 DOI: 10.3389/fmed.2022.758223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate the changes in posterior corneal elevation in thin corneas after small incision lenticule extraction (SMILE). Methods In this prospective study, 97 eyes of 97 patients undergoing SMILE were recruited. Eyes were categorized into the following groups based on the preoperative minimum central corneal thickness (CCT): group A (37 eyes, 480–499 μm), group B (30 eyes, 500–529 μm), and group C (30 eyes, 530–560 μm). The posterior corneal surface was measured with a Pentacam over a 3-year follow-up period. Changes in the posterior corneal elevation at the central point (PCE), thinnest point (PTE), and predetermined area were measured. Results No iatrogenic keratectasia was observed during the follow-up period. The mean changes in PCE, PTE, and the inferior area in group A were 1.14 ± 3.40 μm, −0.11 ± 3.20 μm, and −0.26 ± 1.23 μm, respectively (P ≥ 0.125). Although statistically significant change in the central-4 mm area was noted, the value was quite small (0.98 ± 1.67 μm) and was not higher than that in the other two groups (P = 0.003). For all three groups, the elevation remained stable or showed a backward change in the central annulus, while there was a small forward displacement in the 6-mm optical zone. In group A, changes in elevation values yielded negative statistical correlations with residual bed thickness and CCT (P ≤ 0.006) (except for the inferior area, the 4-mm and 6-mm optical zone). Conclusions With a strict preoperative assessment, SMILE achieved good safety and efficacy in correcting myopia in thin corneas and enabled a stable posterior corneal surface over a 3-year follow-up period. Synopsis Careful preoperative assessment and suitable surgical design should be taken to ensure posterior corneal stability after SMILE in thin corneas.
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Affiliation(s)
- Yu Zhao
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dan Fu
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Zhuoyi Chen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Xingtao Zhou
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Tian M, Zhang X, Jian W, Sun L, Shen Y, Zhou X. Long-Term Follow-Up of Accelerated Transepithelial Corneal Crosslinking for Post-LASIK Ectasia: A Pilot Prospective Observational Study. Front Bioeng Biotechnol 2022; 9:809262. [PMID: 35004659 PMCID: PMC8727765 DOI: 10.3389/fbioe.2021.809262] [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: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Keratectasia after corneal refractive surgery is a rare but serious postoperative complication, and reports on accelerated transepithelial corneal crosslinking (ATE-CXL)-based treatment of patients with post-laser-assisted in situ keratomileusis (LASIK) ectasia are limited. Therefore, this study evaluated the long-term efficacy and safety of ATE-CXL for progressive post-LASIK ectasia. Methods: This prospective observational study was conducted at the Eye and ENT Hospital, Fudan University, Shanghai, China, and 25 eyes from 25 patients with post-LASIK ectasia undergoing ATE-CXL were examined. Clinical examinations were conducted preoperatively and postoperatively to assess parameters such as manifest refraction, corrected distance visual acuity (CDVA), endothelial cell density; keratometry, corneal thickness, posterior elevation and topometric indices were measured using Pentacam; sectoral pachymetry and epithelial thickness were evaluated using optical coherence tomography. A paired t-test, Wilcoxon rank-sum test, Kruskal-Wallis test, and repeated measures analysis of variance were used for statistical analysis. Results: Participants were examined for an average of 46 months. No severe complications occurred during or after ATE-CXL. CDVA improved from 0.25 ± 0.31 preoperatively to 0.15 ± 0.17 postoperatively (p = 0.011). Maximum keratometry decreased from 55.20 ± 8.33 D to 54.40 ± 7.98 D, with no statistical significance (p = 0.074), and the central corneal thickness increased from 414.92 ± 40.96 μm to 420.28 ± 44.78 μm (p = 0.047) at the final follow-up. Posterior elevation, pachymetry, and epithelial thickness remained stable (p > 0.05) throughout the follow-up. No significant differences were noted in topometric indices, except the central keratoconus index, which decreased significantly (p < 0.001) at the final follow-up. Conclusion: Improvements in CDVA and stabilization in corneal keratometry and posterior elevation after ATE-CXL were noted at the 46-months follow-up, demonstrating that ATE-CXL is a safe and effective treatment for progressive post-LASIK ectasia.
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Affiliation(s)
- Mi Tian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xiaoyu Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Weijun Jian
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Ling Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
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15
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Wang J, Lopes BT, Li H, Vinciguerra R, Cao S, Wu S, Zhu R, Wang Q, Zheng X, Bao F, Elsheikh A. Unintended changes in ocular biometric parameters during a 6-month follow-up period after FS-LASIK and SMILE. EYE AND VISION 2021; 8:9. [PMID: 33741072 PMCID: PMC7977186 DOI: 10.1186/s40662-021-00232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022]
Abstract
Background Corneal refractive surgery has become reliable for correcting refractive errors, but it can induce unintended ocular changes that alter refractive outcomes. This study is to evaluate the unintended changes in ocular biometric parameters over a 6-month follow-up period after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE). Methods 156 consecutive myopic patients scheduled for FS-LASIK and SMILE were included in this study. Central corneal thickness (CCT), mean curvature of the corneal posterior surface (Kpm), internal anterior chamber depth (IACD) and the length from corneal endothelium to retina (ER) were evaluated before and after surgery over a 6-month period. Results Both the FS-LASIK and SMILE groups (closely matched at the pre-surgery stage) experienced flatter Kpm, shallower IACD and decreased ER 1 week post-surgery (P < 0.01), and these changes were larger in FS-LASIK than in SMILE group. During the 1 week to 6 months follow up period, Kpm, IACD and ER remained stable unlike CCT which increased significantly (P < 0.05), more in the FS-LASIK group. Conclusions During the follow up, the posterior corneal surface became flatter and shifted posteriorly, the anterior chamber depth and the length from the corneal endothelium to retina decreased significantly compared with the pre-surgery stage. These unintended changes in ocular biometric parameters were greater in patients undergoing FS-LASIK than SMILE. The changes present clear challenges for IOL power calculations and should be considered to avoid affecting the outcome of cataract surgery.
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Affiliation(s)
- Junjie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Bernardo T Lopes
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK
| | - Hechen Li
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | | | - Si Cao
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Songan Wu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Rong Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Qinmei Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Xiaobo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China. .,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
| | - Fangjun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China. .,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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16
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Seven-year observation of posterior corneal elevation after small incision lenticule extraction (SMILE) in patients with moderate and high myopia. J Cataract Refract Surg 2021; 47:1398-1402. [PMID: 33770391 DOI: 10.1097/j.jcrs.0000000000000639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
Purpose To investigate the long-term changes in posterior corneal elevation in moderate and high myopia after small incision lenticule extraction (SMILE). Setting Eye & ENT Hospital, Fudan University. Design Prospective case series. Methods Thirty-three eyes of 20 patients (30.1+/-9.5 years, 7 male and 13 female, spherical equivalent [SE] range -4.00 to -8.75 D, average SE -6.25+/-1.29 D) who underwent SMILE were included. Changes in the posterior corneal elevation at central points (PCE), the thinnest point (PTE), the maximal point (PME), and an additional 20 points within the 4-mm area of the best-fit sphere were evaluated with a Pentacam (Oculus Optikgerate GmbH, Wetzlar, Germany) during a 7-year follow-up period. Mixed linear models were used to evaluate changes with P-values <0.05. Correlations of elevation changes and residual bed thickness (RBT) were also evaluated. Results No ectasia was observed among the 33 eyes. The safety index was 1.08, and the efficacy index was 1.03. The mean change in PCE at 1, 3, 5, and 7 years was -1.42+/-0.95, -2.67+/-0.98, -2.44+/-1.06, and -1.91+/-0.92 [micro]m, respectively. Significant differences were found at 3, 5, and 7 years (P=0.007, 0.023, and 0.040, respectively). PTE was significantly reduced at each time point compared to baseline. The mean change was -2.82+/-1.19, -3.55+/-1.22, -3.47+/-1.32, and -2.39+/-1.15 [micro]m, respectively (P=0.019, 0.004, 0.010, and 0.039, respectively). PME changed 2.45+/-1.02 [micro]m at 7 years compared to baseline (P=0.017). The changes in PCE and PME negatively correlated with the RBT. Conclusions Long-term posterior corneal elevation was stable in moderate and high myopia after SMILE.
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Li M, Yang D, Zhao Y, Yang W, Shang J, Zhou X, Yao P, Yang D, Lin X, Zhou X. Impact of ablation ratio on 5-year postoperative posterior corneal stability after refractive surgery: SMILE and FS-LASIK. EYE AND VISION 2020; 7:53. [PMID: 33292814 PMCID: PMC7654178 DOI: 10.1186/s40662-020-00218-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate the impact of the ablation ratio on 5-year postoperative posterior corneal stability in myopic eyes after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. METHODS A prospective, nonrandomized, cohort study: 80 eyes of 43 patients underwent SMILE surgery and 63 eyes of 32 patients underwent FS-LASIK surgery at the EYE & ENT Hospital, Fudan University. Ablation ratio was defined as lenticule thickness (SMILE cases) or ablation depth (FS-LASIK cases) divided by central corneal thickness (CCT). Posterior corneal elevation changes were recorded as posterior central elevation (PCE), posterior corneal surface at thinnest point (PTE) and posterior corneal mean elevation (PME). Patients were followed up at 6-month and 5-year interval to investigate the impact of the ablation ratio on posterior corneal elevation after SMILE and FS-LASIK surgery. RESULTS PCE dropped at the 6-month follow-up for both SMILE (decreased by -1.11 ± 2.93 μm, P < 0.05) and FS-LASIK groups (decreased by -0.46 ± 3.72 μm, P < 0.05). PTE also dropped in SMILE (reduced by -2.04 ± 3.02 μm, P < 0.05) and FS-LASIK group (reduced by -1.28 ± 4.21 μm, P < 0.05) at the 6-month follow-up. Stable PCE (elevation change: SMILE -0.28 ± 4.03 μm; FS-LASIK 0.79 ± 4.13 μm, P > 0.05) and PTE (elevation change: SMILE -0.08 ± 4.28 μm; FS-LASIK 1.42 ± 3.85 μm, P > 0.05) for both groups were recorded at the 5-year follow-up compared to the 6-month visit. Ablation ratio was strongly correlated with 5-year postoperative PCE (β = 2.68 ± 1.05, P < 0.01) and PTE (β = 2.35 ± 1.17, P < 0.05). Cut-off value for 5-year postoperative raised PCE and PTE was 27.3 and 27.1%, respectively. CONCLUSIONS Ablation ratio was strongly correlated with postoperative posterior corneal elevation in a 5-year follow-up in both SMILE and FS-LASIK groups. PCE and PTE underwent slight backward displacement 6-month postoperatively and remain stable at the 5-year follow-up. Threshold of the ablation ratio for resisting forward displacement of posterior corneal surface was 27.3 and 27.1% for SMILE and FS-LASIK groups, respectively.
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Affiliation(s)
- Meiyan Li
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Danjuan Yang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yu Zhao
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Weiming Yang
- Department of Ophthalmology and Optometry, Children's Hospital of Fudan University, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xueyi Zhou
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Peijun Yao
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xue Lin
- Department of Ophthalmology, Dalian Municipal Women and Children's Medical Center, Dalian, China.
| | - Xingtao Zhou
- Department of Ophthalmology, EYE & ENT Hospital, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China. .,Department of Ophthalmology and Optometry, Children's Hospital of Fudan University, Shanghai, China.
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Chen Y, Liao H, Sun Y, Shen X. Short-term changes in the anterior segment and retina after small incision lenticule extraction. BMC Ophthalmol 2020; 20:397. [PMID: 33028265 PMCID: PMC7539406 DOI: 10.1186/s12886-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE). Methods Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density. Results Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p < 0.05), while LT was thickened after surgery (p < 0.05). MT at the fovea decreased 1 day and 1 week after surgery (p < 0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. ΔACD and ΔLT showed no significant correlation 1 day after surgery. ΔACD was negatively correlated with ΔLT and sphere 1 week after surgery (r = − 0.847, p < 0.000; r = − 0.398, p = 0.002). ΔLT was positively correlated with the sphere 1 week after surgery (r = 0.256, p = 0.048). Conclusion The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
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Affiliation(s)
- Yanwei Chen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huaping Liao
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Longitudinal evaluation of posterior corneal power by anterior segment optical coherence tomography 18 months following photorefractive keratectomy. J Cataract Refract Surg 2020; 46:1159-1164. [PMID: 32355080 DOI: 10.1097/j.jcrs.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the change in anterior, posterior, and net corneal power more than 18 months after photorefractive keratectomy (PRK) by RTVue anterior segment optical coherence tomography (OCT). SETTING Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. DESIGN Prospective observational study. METHODS PRK was performed using Technolas TENEO 317 laser platform. Anterior, posterior, and net corneal power was measured by the RTVue-XR anterior segment OCT system with the Pachymetry + Cpwr scan pattern at baseline and months 1, 3, 6, 12, 18, and more than 18 (up to 27) after PRK. RESULTS Three hundred twenty-six eyes of 163 patients (61 men [37.4%], 102 women [62.6%]; mean age 29.71 years; range 18.5 to 46.5 years) were enrolled in this study. Mean preoperative spherical equivalent was -3.15 ± 1.50 diopter (D) (range -8.37 to -0.62 D). The mean change in net corneal power was 3.052 D, 3.281 D, 3.324 D, 3.114 D, 3.446 D, and 3.972 D at months 1, 3, 6, 12, 18, and more than 18 postoperatively compared with baseline, respectively (P < .001 for all comparisons). The mean change in posterior corneal power at postoperative visits compared with baseline was not statistically significant (P > .1) except for 1 month postoperatively, which increased by 0.13 D (P < .001). Changes in posterior corneal power were not correlated with any of the preoperative clinical and Scheimpflug variables. CONCLUSIONS Posterior corneal power did not change for more than 18 months after PRK, except for an early small increase at 1 month postoperatively.
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Small Incision Lenticule Extraction (SMILE) for Moderate and High Myopia: Seven-Year Outcomes of Refraction, Corneal Tomography, and Wavefront Aberrations. J Ophthalmol 2020; 2020:3825864. [PMID: 32377418 PMCID: PMC7195656 DOI: 10.1155/2020/3825864] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the long-term outcomes of refraction, corneal tomography, and wavefront aberrations after small incision lenticule extraction (SMILE) for moderate and high myopia. Methods Prospective, nonconsecutive case series. A total of 26 patients (26 eyes) who underwent SMILE from May 2010 to March 2013 at the Fudan University Eye and ENT Hospital (Shanghai, China) were enrolled. The periods of follow-up were 1 month, 1 year, 5 years, and 7 years after surgery. The routine eye examinations included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Results All surgeries were executed without any complications. At the final visit, an UDVA of 20/20 or better was achieved in 26 eyes (100%) and 11 eyes (42%) exhibited no change in CDVA. 9 eyes (35%) gained one line, 6 eyes (23%) gained two lines, and no eyes lost CDVA. 24 eyes (92%) and 26 eyes (100%) were within ±0.5 D and ±1.00 D of the target refraction, respectively. A mean refractive regression of −0.17 D was observed between 1 month and 7 years postoperatively. Mean corneal front curvature (MCFC) was significantly decreased between pre- and post-SMILE surgery (P < 0.0001). Higher-order aberrations (HOAs) and vertical coma were significantly increased after SMILE compared to those measured before surgery (all P < 0.001). There were no significant differences in trefoil and spherical aberration between pre- and post-SMILE surgery (all P > 0.05). Conclusion SMILE is an effective, safe, and stable procedure for moderate and high myopia, with relatively constant corneal stability and wavefront aberrations. This trial is registered with ChiCTR-ONRC-13003114.
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Tian M, Jian W, Zhang X, Sun L, Zhou X. Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus. Br J Ophthalmol 2020; 104:1608-1612. [PMID: 32051139 PMCID: PMC7587222 DOI: 10.1136/bjophthalmol-2019-315260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/22/2019] [Accepted: 01/28/2020] [Indexed: 11/24/2022]
Abstract
Purpose To investigate the long-term safety and efficacy of accelerated transepithelial cornealcross-linking (ATE-CXL) in children with progressive keratoconus. Methods Fifty-three eyes of 41 paediatric patients (34 boys, 7 girls; mean age 14.81±1.96 years) undergoing ATE-CXL were enrolled in the study. Corrected distance visual acuity (CDVA) and manifest refraction were assessed preoperatively and 36 months postoperatively. Corneal keratometry, corneal thickness and posterior elevation were measured using Pentacam preoperatively and 1, 6, 12 and 36 months postoperatively. Pachymetry and epithelial thicknesses were measured using optical coherence tomography preoperatively and 6, 12, and 36 months postoperatively. Results Thirty-six months postoperatively, CDVA improved from 0.32±0.28 to 0.26±0.25 in logarithm of the minimum angle resolution (p=0.025). Maximum keratometry was 58.73±9.70 D preoperatively and 59.20±10.24, 58.28±9.33, 57.88±9.99 and 58.98±10.79 D at 1, 6, 12 and 36 months postoperatively throughout the 36-month follow-up period (p>0.05). Similarly, corneal central thickness, which was 492.42±33.83 µm postoperatively, also remained stable during the 36-month follow-up (p>0.05). Both posterior central elevation and posterior highest elevation were stable at 12 months after ATE-CXL (p>0.05), but increased at 36 months postprocedure (p<0.05). Corneal pachymetry and epithelial thicknesses remained stable throughout the follow-up period (p>0.05). Conclusions ATE-CXL is a safe and effective treatment in paediatric progressive keratoconus patients, leading to stable keratometry and corneal thickness throughout the 36-month follow-up.
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Affiliation(s)
- Mi Tian
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China
| | - Weijun Jian
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China
| | - Xiaoyu Zhang
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China
| | - Ling Sun
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China .,NHC Key Laboratory of Myopia, Shanghai, China
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Wang Y, Ma J. Future Developments in SMILE: Higher Degree of Myopia and Hyperopia. Asia Pac J Ophthalmol (Phila) 2019; 8:412-416. [PMID: 31490200 PMCID: PMC6784781 DOI: 10.1097/01.apo.0000580128.27272.bb] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/13/2019] [Indexed: 11/25/2022] Open
Abstract
Small incision lenticule extraction (SMILE) is a novel 1-step refractive procedure with femtosecond laser for the correction of myopia and myopic astigmatism. Although it has shown good clinical results in efficacy, safety, predictability, and stability, there are still some concerns. In this study, we review the published clinical outcomes of high myopia correction and exploration in hyperopia correction. Results have suggested that SMILE has acceptable outcomes in correction for high myopia <10.0 diopters (D), and it is a feasible and effective procedure for the treatment of hyperopia. However, it is unsuitable for the treatment of extremely high myopia because there is undercorrection and regression as existed in laser-assisted in situ keratomileusis (LASIK), and compound hyperopic astigmatism currently could not be corrected either. More technical and clinical improvements are required to make SMILE competitive.
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Affiliation(s)
- Yan Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
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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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Visual and refractive outcomes of 100 small incision lenticule extractions (SMILE) in moderate and high myopia: a 24-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2019; 257:1561-1567. [PMID: 31119423 DOI: 10.1007/s00417-019-04349-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE We aimed to present the visual results obtained in 100 small incision lenticule extraction (SMILE) refractive surgeries, demonstrate whether the technique is effective in the treatment of moderate and high myopia, and observe the follow-up of these patients over 24-month period. METHODS One hundred eyes of 50 consecutive patients were treated with SMILE. The preoperative spherical equivalent refraction was - 5.64 ± 1.23 D. During the postoperative period, patients were examined at 3, 6, 12, and 24 months. We analysed the efficacy, safety, predictability, and stability of the technique. RESULTS The Snellen visual acuity of 99% of the patients was 20/20 or better after 24 months of follow-up. Two eyes had a loss of two lines of visual acuity; 1% of the patients had a loss of one line of visual acuity. The postoperative spherical refraction was - 0.04 ± 0.35 D (- 1.00 to 0.50 D). The postoperative spherical equivalent refraction was - 0.19 ± 0.38 D (- 1.25 to 0.50 D). Eighty-three percent of the eyes were within ± 0.50 D, and 87% obtained a residual astigmatism of 0.50 D or less. CONCLUSION The SMILE technique was demonstrated to be an effective, predictable, safe, and stable technique in the treatment of moderate-to-severe myopia during the 24-month follow-up. Long-term follow-up should be undertaken to observe possible refractive regressions.
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Zhou X, Shang J, Qin B, Zhao Y, Zhou X. Two-year observation of posterior corneal elevations after small incision lenticule extraction (SMILE) for myopia higher than -10 dioptres. Br J Ophthalmol 2019; 104:142-148. [PMID: 31036587 PMCID: PMC6922016 DOI: 10.1136/bjophthalmol-2018-313498] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/05/2019] [Accepted: 03/29/2019] [Indexed: 12/01/2022]
Abstract
Aim To investigate the change in posterior corneal elevations (PCEs) of eyes with extremely high myopia 2 years after small incision lenticule extraction (SMILE). Methods We evaluated 39 eyes of 39 patients with spherical equivalent higher than −10.00 dioptres (D). Using a Scheimpflug camera (Pentacam), we measured change in PCEs at 1 day, 3 months, 6 months and 2 years after SMILE. Another 34 eyes of 34 patients who underwent femtosecond laser-assisted in situ keratomileusis (FS-LASIK) were examined before, at 1 day and long-term after surgery as the control group. For each eye, elevations at central, thinnest, maximal points and 24 other predetermined points were measured. Results No significant forward displacements of PCEs were observed in both surgeries. The maximal but not significant forward displacement occurred around 3–6 months following SMILE, and all returned to original levels 6 months postoperatively except superior area. The peripheral area tended to displace backward, while the central area tended forwardly. In both procedures, elevations along horizontal meridians, inferior and temporal hemispheres were significantly higher than those along vertical meridians, superior and nasal hemispheres, respectively (p<0.05). Elevation on the 4 mm, 6 mm diameters at 1 day and on the 6 mm diameter and temporal hemisphere at long-term follow-up postoperatively were significantly higher in FS-LASIK than SMILE (p<0.05). Change in elevations on the 6 mm diameter circle correlated with residual bed thickness (p=0.047). Conclusions SMILE is a safe way to correct for myopia higher than −10 D, with PCEs remaining stable 2 years after surgery.
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Affiliation(s)
- Xueyi Zhou
- Ophthalmology, Eye and ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jianmin Shang
- Ophthalmology, Eye and ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Bing Qin
- Ophthalmology, Eye and ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yu Zhao
- Ophthalmology, Eye and ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Ophthalmology, Eye and ENT Hospital of Fudan University, NHC Key Laboratory of Myopia, Shanghai, China .,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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Bao F, Cao S, Wang J, Wang Y, Huang W, Zhu R, Zheng X, Huang J, Chen S, Li Y, Wang Q, Elsheikh A. Regional changes in corneal shape over a 6-month follow-up after femtosecond-assisted LASIK. J Cataract Refract Surg 2019; 45:766-777. [PMID: 30876782 DOI: 10.1016/j.jcrs.2018.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the regional changes in corneal shape after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in patients with different myopia extents. SETTING Eye Hospital, Wenzhou Medical University, Wenzhou, China. DESIGN Retrospective case series. METHODS A retrospective study of myopic eyes treated with FS-LASIK was conducted to assess the shape changes within different corneal regions after surgery. Corneal curvature was measured in the central region (0 mm to 3.0 mm diameter), pericentral region (3.0 mm to 6.0 mm diameter) and peripheral region (6.0 mm to 9.0 mm diameter) preoperatively and from 1 week to 6 months postoperatively. RESULTS The study comprised 608 myopic eyes. During the 6-month follow-up, the anterior cornea became steeper in the central and pericentral regions, but flatter in the peripheral region (P < .01), representing a partial, gradual, yet significant reversal of the immediate change in corneal shape after laser ablation. In contrast, the posterior surface experienced significantly less change than the anterior surface, with the cornea becoming slightly flatter (P < .01) in the central region at 1 week postoperatively, and steeper elsewhere (P < .05), and then remaining stable during the rest of the follow-up. On the other hand, the anterior astigmatism had significant decreases in the central region (P < .01) and slight increases in the peripheral region (P < .01) 1 week postoperatively, and that remained stable over the follow-up period. In contrast, there were little or non-significant changes in the posterior astigmatism throughout the follow-up (P > .05). CONCLUSIONS Postoperative corneal shape changes were different in different regions. There were shape changes in individual corneal regions during the 6-month follow-up period that represented reverse trends; however, the changes were much smaller than the short-term changes observed 1 week after surgery.
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Affiliation(s)
- FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China; Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Si Cao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China; Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Yuan Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Huang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rong Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China; Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - JinHai Huang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - ShiHao Chen
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - YiYu Li
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.
| | - QinMei Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China; Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China.
| | - Ahmed Elsheikh
- School of Biological Science and Biomedical Engineering, Beihang University, Beijing, China; School of Engineering, University of Liverpool, London, England; National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, England
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Comparison of the posterior corneal elevation and biomechanics after SMILE and LASEK for myopia: a short- and long-term observation. Graefes Arch Clin Exp Ophthalmol 2019; 257:601-606. [DOI: 10.1007/s00417-018-04227-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022] Open
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Contralateral Eye Comparison Between 2 Cap Thicknesses in Small Incision Lenticule Extraction: 110 Versus 130 μm. Cornea 2018; 38:617-623. [DOI: 10.1097/ico.0000000000001835] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang L, Wang Y, Zhao W, Cheng W, Cui T. Corneal remodeling and spatial profiles following small incision lenticule extraction. Int Ophthalmol 2018; 39:1827-1836. [PMID: 30171445 DOI: 10.1007/s10792-018-1010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the three-dimensional corneal spatial profiles following small incision lenticule extraction (SMILE) based on corneal asphericity, thickness, and volume. MATERIALS AND METHODS Eighty-three eyes in 83 patients who underwent SMILE were examined before and 1 and 6 months after surgery. The asphericity of the anterior and posterior corneal surfaces was analyzed. Corneal volume (CV) was measured in corneal regions measuring 3.0 mm, 5.0 mm, and 7.0 mm in diameter. Mean corneal thickness (CT) values were acquired at the apex (0.0 mm) and in four concentric radial zones from the apex (with diameters of 2.0, 4.0, 6.0, and 8.0 mm). RESULTS The mean anterior Q value increased from - 0.32 preoperatively to 0.67 at 1 month and 0.62 at 6 months postoperatively. The mean posterior Q value decreased from - 0.30 preoperatively to - 0.26 at 1 month and to - 0.25 at 6 months postoperatively. The CV increased by 0.05 ± 0.06 mm3 (1.40%), 0.06 ± 0.11 mm3 (0.83%), and 0.09 ± 0.17 mm3 (0.73%) along the radial zones with respective diameters of 3.0 mm, 5.0 mm, and 7.0 mm. The CT increased by 6.02 ± 6.48 µm (1.36%) at the apex and then decreased with increasing distance from the center, i.e., to 5.52 ± 6.31 µm (1.20%) at 2.0 mm, 4.72 ± 6.55 µm (0.92%) at 4.0 mm, 4.47 ± 7.86 µm (0.75%) at 6.0 mm, and 4.86 ± 10.31 µm (0.70%) at 8.0 mm. No correlations were observed between changes in CV and CT and refractive fluctuation between 1 month and 6 months postoperatively. CONCLUSIONS The corneal profile displayed a less oblate shift on the anterior surface; however, the posterior surface showed a slight backward shift during the postoperative period. The CV and CT steadily increased after surgery and mainly within the operative zones. Refraction remained stable postoperatively and was not affected by the corneal remodeling.
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Affiliation(s)
- Lin Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China. .,Tianjin Eye Hospital and Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Clinical College of Ophthalmology, Tianjin Medical University, No 4. Gansu Road, Heping District, Tianjin, 300020, China.
| | - Wei Zhao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Wenbo Cheng
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Tong Cui
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
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