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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024; 35:278-283. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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2
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Huang Y, Zhan B, Han T, Zhou X. Effective optical zone following small incision lenticule extraction: a review. Graefes Arch Clin Exp Ophthalmol 2024; 262:1657-1665. [PMID: 37851133 DOI: 10.1007/s00417-023-06263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/18/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023] Open
Abstract
Small incision lenticule extraction (SMILE) is a "flapless" keratorefractive surgery with excellent safety, efficacy, stability, and predictability for myopia correction. A recent global multicenter study also reported good refractive outcomes for hyperopic SMILE. SMILE has shown advantages including improved biomechanical strength, fewer dry eye symptoms, less corneal denervation, and fewer surgery-induced higher-order aberrations over laser in situ keratomileusis (LASIK). However, night vision complaints, including glare, halos, and starbursts, could still occur after SMILE. These symptoms have been proven to be closely related to the effective optical zone (EOZ), which is defined as the achieved area of corneal ablation. A larger postoperative EOZ may indicate better visual quality, making EOZ an important safety parameter for keratorefractive surgeries. As SMILE has gained wider application globally, the EOZ following SMILE has also been increasingly studied in the field of refractive surgery. This review provides an update on topics related to the EOZ after SMILE, including its measurement and influencing factors, aiming to benefit the personalization of the surgical algorithm and ultimately improve the visual quality after the SMILE procedure.
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Affiliation(s)
- Yangyi Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Biyun Zhan
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Fudan University, No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia Fudan University Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China.
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Tsatsos M, Giachos I, Tsinopoulos I, Ziakas N, Jacob S. Something to SMILE about. Is small incision lenticule extraction ready to become the gold standard in laser refractive surgery? Yes. Eye (Lond) 2024; 38:636-638. [PMID: 37731050 PMCID: PMC10920690 DOI: 10.1038/s41433-023-02745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- M Tsatsos
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - I Giachos
- Corneal Department, Dr Agarwal's Hospital, Chennai, India
| | - I Tsinopoulos
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Ziakas
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Jacob
- Corneal Department, Dr Agarwal's Hospital, Chennai, India
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Tsatsos M, Giachos I, Prousali E, Jacob S, Ziakas N. Something to SMILE about. Is small incision lenticule extraction (SMILE) ready to become the gold standard in laser refractive surgery? no. Eye (Lond) 2024; 38:633-635. [PMID: 37731051 PMCID: PMC10920905 DOI: 10.1038/s41433-023-02746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- M Tsatsos
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - I Giachos
- Dr Agarwal's Hospital, Corneal Department, Chennai, India
| | - E Prousali
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Jacob
- Dr Agarwal's Hospital, Corneal Department, Chennai, India
| | - N Ziakas
- 2nd Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Liu Y, He Y, Deng Y, Wang L. Lenticule addition keratoplasty for the treatment of keratoconus: A systematic review and critical considerations. Indian J Ophthalmol 2024; 72:S167-S175. [PMID: 38271413 DOI: 10.4103/ijo.ijo_695_23] [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: 03/11/2023] [Accepted: 09/09/2023] [Indexed: 01/27/2024] Open
Abstract
Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its progression, restore normal corneal strength, prevent acute complications, and save vision. Penetrating keratoplasty and deep anterior lamellar keratoplasty as conventional surgical methods for advanced keratoconus are limited by relatively high rates of immune intolerance, slow post-operational recovery, high costs, and shortage of donor corneas. Recently, the development of lenticule addition keratoplasty enables the restoration of corneal thickness simply by implanting a lenticule into the stromal pocket created with the femtosecond laser, which can originate from cadaver corneas or more appealing, be extracted from patients via a small-incision lenticule extraction (SMILE) surgery. As the first systematic review in this field, we critically review publications on lenticule addition keratoplasty and provide our perspectives on its clinical application and the focus of future research.
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Affiliation(s)
- Yanling Liu
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yan He
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
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Ganesh S, Brar S, Chopra R. Lamellar surgeries with SMILE-derived lenticules. Taiwan J Ophthalmol 2024; 14:70-77. [PMID: 38654992 PMCID: PMC11034677 DOI: 10.4103/tjo.tjo-d-23-00171] [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: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE derived lenticules in terms of feasibility, safety and predictability; or the potential management of hyperopia, keratoconus, SMILE ectasia and presbyopia. MATERIALS AND METHODS Donor SMILE lenticules were prepared under microscope tocreate doughnut shaped lenticules. For hyperopia, this tissue was then inserted into afemtosecond laser enabled pocket created using VisuMax FS Laser at a depth of 160µm. For ectasia induced by keratoconus and post refractive procedure (SMILE), 0.23% riboflavin dye was instilled into the interface and then lenticule was inserted followed by exposure to UV-A radiation with total energy of 6.3 J. RESULTS Spherical equivalent (S.E.) of within ± 0.5 D was observed in 50% (n=21) eyes and within 1 D was seen in 71% eyes treated for hyperopia. A significant increase in the K mean anterior, central corneal thickness, Q-value and corneal aberrations was seen 2 weeks post-op. Clinical improvement in terms of S.E. and uncorrected distance visual acuity in eyes treated for ectasia after keratoconus and post refractive procedure (SMILE) was seen. CONCLUSION With the ample availability of SMILE- derived lenticules, researchers are exploring the possibility of using this tissue for the treatment of various refractive and corneal conditions.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
| | - Sheetal Brar
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
| | - Riya Chopra
- Nethradhama Eye Hospital, Bengaluru, Karnataka, India
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7
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Xie M, Deng Y, Wang L, Zhang X, Gong R, Tang J. Corneal lenticule implantation combined with PTK and PRK to correct hyperopia. J Fr Ophtalmol 2023; 46:e352-e357. [PMID: 37544781 DOI: 10.1016/j.jfo.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 08/08/2023]
Affiliation(s)
- M Xie
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China; West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Y Deng
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - L Wang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - X Zhang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - R Gong
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China
| | - J Tang
- Department of Ophthalmology, Sichuan University, West China Hospital, No. 37, Guoxue Alley, 610041 Chengdu, Sichuan, China.
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Meziane Elotmani A, Messerschmidt-Roth A, Nehme A, Müller HH, Sekundo W. Comparison of intraocular lens power calculation formulas with and without total keratometry and ray tracing in patients with previous myopic SMILE. J Cataract Refract Surg 2023; 49:467-473. [PMID: 36700932 DOI: 10.1097/j.jcrs.0000000000001139] [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: 01/21/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the prediction error (PE) variance and absolute median PE of different intraocular lens (IOL) calculation formulas including last-generation formulas such as Barrett True-K with K, Okulix and total keratometry (TK)-based calculations with Haigis, and Barrett True-K in a simulation model in post-small-incision lenticule extraction (SMILE) eyes. SETTINGS Department of Ophthalmology, University Hospital Marburg, Marburg, Germany. DESIGN Prospective study. METHODS Preoperative measurements included IOL power calculation before and after SMILE surgery. The target refraction was set to be the lowest myopic refractive error in pre-SMILE eyes. The IOL power targeting at the lowest myopic refractive error in pre-SMILE eyes was selected for the post-SMILE IOL calculation of the same eye. The difference between the predicted refraction of pre- and post-SMILE eyes with the same IOL power was defined as IOL difference. The refractive change induced by SMILE was defined as the difference between preoperative and postoperative manifest refraction. RESULTS 98 eyes from 49 patients underwent bilateral myopic SMILE. The PE variance of Okulix was not significantly different compared with Barrett True-K with TK ( P = .471). The SDs of the mean PEs were ±0.413 D (Haigis-TK), ±0.453 D (Okulix), ±0.471 D (Barrett True-K with TK), ±0.556 D (Haigis-L), and ±0.576 D (Barrett True-K with K). The mean absolute PE was 0.340 D, 0.353 D, 0.404 D, 0.511 D, and 0.715 D for Haigis-TK, Okulix, Barrett True-K with TK, Barrett True-K with K, and Haigis-L, respectively. The highest percentage of eyes within ±0.50 D was achieved by Okulix, followed by Haigis-TK, Barrett True-K with TK, Barrett True-K with K, and Haigis-L. CONCLUSIONS Results suggest that Haigis in combination with TK, Okulix, and Barrett True-K with and without TK offer good options for accurate IOL power calculation after SMILE. Haigis-L showed a tendency for myopic shift in eyes after previous SMILE.
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Affiliation(s)
- Anouar Meziane Elotmani
- From the Department of Ophthalmology, University Hospital Marburg (UKGM), Philipps University of Marburg, Marburg, Germany (Elotmani, Messerschmidt-Roth, Nehme, Sekundo); Institute of Medical Bioinformatics and Biostatistics, Philipps University of Marburg, Marburg, Germany (Müller)
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9
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Rao J, Zhou Q, Chen J, Gu J, Wang Y, Liu Y. Carbodiimide crosslinked decellularized lenticules as a drug carrier for sustained antibacterial eye treatments. Biomed Mater 2023; 18. [PMID: 36751124 DOI: 10.1088/1748-605x/acb67b] [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: 06/17/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
In this study, the drug-loading and antibacterial activity of carbodiimide/N-hydroxysuccinimide (EDC/NHS) crosslinked decellularized lenticules (CDLs) were evaluated. Small incision lenticule extraction derived lenticules were decellularized and modified with crosslinking concentrations of 0.00 (E/L00, non-crosslinked), 0.01 (E/L01), 0.05 (E/L05) and 0.25 mmol (E/L25) EDC per mg lenticules at 5:1 EDC/NHS ratios with non-decellularized non-crosslinked lenticules (NDLs) as controls. NDLs and EDC/NHS CDLs had similar water contents. The light transmittance percentages (400-800 nm) were 91.55 ± 1.16%, 88.68 ± 1.19%, 80.86 ± 1.94%, 85.12 ± 2.42% and 85.62 ± 2.84% for NDLs, E/L00, E/L01, E/L05 and E/L25, respectively (P< 0.01). The EDC/NHS CDLs (diameter: 6.36 ± 0.18 mm; central thickness: 117.31 ± 3.46 μm) were soaked in 3% (wt./vol.) levofloxacin (LEV) solution for 3 h. The drug release concentrations of LEV-impregnated EDC/NHS CDLs were determined by high-performance liquid chromatography. Zone inhibition (ZOI) againstStaphylococcus aureusof E/L01, E/L05 and E/L25 were superior to E/L00 CDLs (P< 0.01) and among the different crosslinked groups, E/L05 lenticules produced the largest ZOIs and their drug concentration release over 21 d was the highest. EDC/NHS crosslinking can improve the drug-loading effect and antibacterial activity of decellularized lenticules. LEV-impregnated EDC/NHS CDLs are promising drug delivery carriers.
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Affiliation(s)
- Jing Rao
- Department of Ophthalmology, Chongqing Opyometry Eye Hospital, Chongqing 400020, People's Republic of China
| | - Qizhi Zhou
- Department of Ophthalmology, Chongqing Opyometry Eye Hospital, Chongqing 400020, People's Republic of China
| | - Jiansu Chen
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Jianing Gu
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Yini Wang
- Department of Ophthalmology, Aier Eye Institute, Changsha 410000, People's Republic of China
| | - Yonghuan Liu
- Department of Ophthalmology, Aier Eye Hospital (Changsha), Changsha 410015, People's Republic of China
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Hu X, Wei R, Liu C, Wang Y, Yang D, Sun L, Xia F, Liu S, Li M, Zhou X. Recent advances in small incision lenticule extraction (SMILE)-derived refractive lenticule preservation and clinical reuse. ENGINEERED REGENERATION 2023. [DOI: 10.1016/j.engreg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Reinstein DZ, Sekundo W, Archer TJ, Stodulka P, Ganesh S, Cochener B, Blum M, Wang Y, Zhou X. SMILE for Hyperopia With and Without Astigmatism: Results of a Prospective Multicenter 12-Month Study. J Refract Surg 2022; 38:760-769. [PMID: 36476297 DOI: 10.3928/1081597x-20221102-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the safety and effectiveness of small incision lenticule extraction (SMILE) in patients who have hyperopia with or without astigmatism. METHODS This was a prospective multicenter trial including 374 eyes of 199 patients treated by SMILE for hyperopia using the VisuMax femtosecond laser (Carl Zeiss Meditec AG). Inclusion criteria were sphere up to +6.00 diopters (D), cylinder up to 5.00 D, and maximum hyperopic meridian up to +7.00 D, with preoperative corrected distance visual acuity (CDVA) of 20/25 or better. The optical zone was 6.3 mm with a transition zone of 2 mm. The minimum lenticule thickness was set at 25 µm in the center and at 10 µm at the edge. Patients were examined at 1 day, 1 week, and 1, 3, 6, 9, and 12 months after surgery. Standard refractive surgery outcomes analysis was performed. RESULTS The preoperative spherical equivalent was +3.20 ± 1.48 D (range: +0.25 to +6.50 D). At the 12-month follow-up visit, 81% of eyes treated were within ±0.50 D and 93% of eyes were within ±1.00 D of intended correction. A total of 1.2% of eyes lost two or more lines of CDVA at the 12-month follow-up visit, and 83% were at least 20/20, corresponding to a safety index of 1.005 at 12 months. Of the 219 eyes with plano target, 68.8% had an uncorrected distance visual acuity of 20/20 or better and 88% were at least 20/25 uncorrected at 12 months. There were no statistically significant changes in contrast sensitivity. CONCLUSIONS SMILE was found to be an effective treatment method for the correction of compound hyperopic astigmatism, demonstrating a high level of efficacy, predictability, safety, and stability. [J Refract Surg. 2022;38(12):760-769.].
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Han T, Zhao L, Shen Y, Chen Z, Yang D, Zhang J, Sekundo W, Shah R, Tian J, Zhou X. Twelve-year global publications on small incision lenticule extraction: A bibliometric analysis. Front Med (Lausanne) 2022; 9:990657. [PMID: 36160168 PMCID: PMC9493269 DOI: 10.3389/fmed.2022.990657] [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: 07/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the development process of small incision lenticule extraction (SMILE) surgery in a 12-year period. Methods We conducted a literature search for SMILE research from 2011 to 2022 using the Science Citation Index Expanded (SCIE) of the Web of Science Core Collection (WoSCC). The VOS viewer, and CiteSpace software were used to perform the bibliometric analysis. Publication language, annual growth trend, countries/regions and institutions, journals, keywords, references, and citation bursts were analyzed. Results A total of 731 publications from 2011 to 2022 were retrieved. Annual publication records grew from two to more than 100 during this period. China had the highest number of publications (n = 326). Sixty-five keywords that appeared more than four times were classified into six clusters: femtosecond laser technology, dry eye, biomechanics, visual quality, complications, and hyperopia. Conclusion The number of literatures has been growing rapidly in the past 12 years. Our study provides a deep insight into publications on SMILE for researchers and clinicians with bibliometric analysis for the first time.
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Affiliation(s)
- Tian Han
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Liang Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yang Shen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Zhi Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Dong Yang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jiaoyan Zhang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- The School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Walter Sekundo
- The Department of Ophthalmology, Philipps University of Marburg, Marburg, Germany
| | - Rupal Shah
- New Vision Laser Centers, Vadodara, Gujarat, India
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- *Correspondence: Jinhui Tian,
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
- Xingtao Zhou,
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Brar S, Ganesh S, Sriganesh SS, Bhavsar H. Femtosecond Intrastromal Lenticule Implantation (FILI) for Management of Moderate to High Hyperopia: 5-Year Outcomes. J Refract Surg 2022; 38:348-354. [PMID: 35686714 DOI: 10.3928/1081597x-20220503-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the long-term clinical experience following femtosecond intrastromal lenticule implantation (FILI) for the management of moderate to high hyperopia. METHODS Eligible patients who underwent FILI for moderate to high hyperopia from July 2013 to October 2020 were included. A donor small incision lenticule extraction lenticule, matched for refractive error, was implanted into the recipient's corneal pocket created using a femtosecond laser at 160 µm depth. Visual and refractive outcomes and long-term complications were evaluated at the end of a mean follow-up of 68 ± 17.28 months (5.6 years). RESULTS Forty-two eyes of 25 patients (mean age: 27.29 ± 5.52 years) were analyzed. The mean spherical equivalent reduced significantly from +5.50 ± 1.96 to +0.66 ± 1.17 diopters (D) at last follow-up visit. Thirty eyes (71%) were within ±1.00 D of spherical equivalent correction. Cumulative uncorrected distance visual acuity of 20/40 or better was achieved in 34 eyes (81%). Efficacy and safety indices were 0.86 ± 0.19 and 1.17 ± 0.39, respectively. There was a significant increase in mean keratometry (Kmean) anterior, central corneal thickness, Q-value, and corneal higher order aberrations and a decrease in Kmean posterior 2 weeks postoperatively, without any significant change in these parameters thereafter (P > .05). Four eyes of 3 patients underwent enhancement and another 4 eyes underwent explantation of the lenticule followed by exchange (2 eyes) and hyperopic laser in situ keratomileusis (2 eyes). No eye lost more than one line of CDVA. CONCLUSIONS At 5 years of follow-up, FILI for moderate to high hyperopia showed good safety, efficacy, and reversibility. Modification of nomograms and surgical planning may be employed for further refinement of the outcomes. [J Refract Surg. 2022;38(6):348-354.].
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Liu S, Wei R, Choi J, Li M, Zhou X. Visual Outcomes After Implantation of Allogenic Lenticule in a 100-µm Pocket for Moderate to High Hyperopia: 2-Year Results. J Refract Surg 2021; 37:734-740. [PMID: 34756142 DOI: 10.3928/1081597x-20210730-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate 2-year visual outcomes, stability, and predictability after allogenic lenticule implantation in a 100-µm pocket for moderate to high hyperopia correction. METHODS In this prospective case series, 14 eyes of 9 patients with moderate to high hyperopia ranging from +3.00 to +8.00 diopters sphere were included between March and September 2018. Allogenic lenticules extracted from myopic small incision lenticule extraction were implanted into a pocket created by femtosecond laser at a 100-µm depth in recipients with hyperopia. All patients were followed up for 2 years. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, corneal topography, Fourier-domain optical coherence tomography, and in vivo confocal microscopy were examined. RESULTS At postoperative 2 years, 2 eyes (14.3%) gained one line of CDVA, 11 eyes (78.6%) had unchanged CDVA, and 1 eye (7.1%) lost one line of CDVA. No eyes lost two or more lines of CDVA. Twelve of the treated eyes (85.7%) had postoperative uncorrected near visual acuity equal to or better than pre-operative values. The spherical equivalent decreased from +5.53 ± 1.45 D preoperatively to -0.60 ± 1.20 D at postoperative year 2 (P < .001). The anterior mean keratometric readings increased from 42.41 ± 1.03 D preoperatively to 48.38 ± 1.98 D at postoperative year 2 (P < .001). Of 14 treated eyes, 10 eyes (71.4%) had spherical equivalent within ±1.00 D. CONCLUSIONS The findings suggest that allogenic lenticule transplantation may be a promising option for the correction of moderate to high hyperopia. [J Refract Surg. 2021;37(11):734-740.].
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Dowdle TS, Jenkins JC, Bertolio M, Monson BK. Monson small-incision lenticule extraction fixation device. J Cataract Refract Surg 2021; 47:e29-e30. [PMID: 33577277 DOI: 10.1097/j.jcrs.0000000000000554] [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: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
Small-incision lenticule extraction (SMILE) is a stromal based, flapless, minimally invasive form of laser vision correction for the treatment of myopia and myopic astigmatism. SMILE surgery is a more technical procedure compared with other refractive surgeries and generally has a longer skill mastery acquisition period. Thus far, no new stabilization devices or techniques have been proposed. To rectify this, a new distal corneal countertraction device for SMILE surgery, the Monson SMILE Fixation Device, is introduced. This device provides reliable corneal and globe stabilization during delamination and lenticular dissection. It may minimize tissue distortion and manipulation, simplify lenticule dissection, and may decrease operation times and improve cosmesis. Countertraction can also easily be adjusted throughout the procedure.
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Affiliation(s)
- Travis S Dowdle
- From the Texas Tech University Health Sciences Center - School of Medicine, Lubbock, Texas (Dowdle); Rocky Vista University - College of Osteopathic Medicine, Ivins, Utah (Jenkins); Monson Vision, Logan, Utah (Bertolio, Monson)
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16
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[Regression and ablation profiles in corneal refractive surgery]. J Fr Ophtalmol 2021; 44:1059-1075. [PMID: 34148702 DOI: 10.1016/j.jfo.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.
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Tanriverdi C, Ozpinar A, Haciagaoglu S, Kilic A. Sterile Excimer Laser Shaped Allograft Corneal Inlay for Hyperopia: One-year Clinical Results in 28 Eyes. Curr Eye Res 2021; 46:630-637. [PMID: 33599172 DOI: 10.1080/02713683.2021.1884728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: This study aimed to evaluate the one-year clinical results of an allograft corneal inlay (ACI) implantation in a case series of 28 hyperopic eyes of 16 patients.Methods: Patients with manifest refraction spherical equivalent (MRSE) between +1.00 and +6.00 D and having a cylindrical refraction of less than 1 D were included in this prospective study. The refractive powers of excimer laser-shaped ACIs were determined based on the refractive error of the individual subject's eyes. After the creation of a femtosecond flap, the inlays were centered on the pupillary axis. Visual acuities, refractive results, and other clinical findings were reported for the 6- and 12-month follow-up exams.Results: The mean age of the patients included in the study was 36.2 ± 12.4 years (range 22-65 years). The mean pre-operative MSRE of 3.6 ± 1.51 D decreased to 0.21 ± 0.56 D (P < .001). The uncorrected distance and near visual acuity increased from 0.33 ± 0.22 and 0.17 ± 0.13 to 0.75 ± 0.22 (P < .001) and 0.72 ± 0.19 (P < .001), respectively. The corrected distance visual acuity remained unchanged (pre-OP: 0.79 ± 0.22; post-OP: 0.80 ± 0.21; P = .916), and the corrected near visual acuity increased from 0.78 ± 0.22 to 0.84 ± 0.20 (P = .003). The mean K-value and central corneal thickness increased from 42.57 ± 0.81 D and 557.5 ± 43.0 µm to 44.8 ± 1.4 D (P < .001) and 597.1 ± 58.1 µm (P < .001), respectively. No significant postoperative complications such as diffuse lamellar keratitis, epithelial ingrowth, or decentralization were observed.Conclusion: Excimer laser-shaped ACI offers an alternative treatment modality for patients with hyperopia. Acceptable visual results and similar regression rates were observed with ACI implantation compared with other laser refractive procedures.
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Affiliation(s)
- Cafer Tanriverdi
- Faculty of Medicine, Ophthalmology Department, Medipol University, Istanbul, Turkey
| | - Ayse Ozpinar
- Faculty of Medicine, Ophthalmology Department, Medipol University, Istanbul, Turkey
| | - Sezer Haciagaoglu
- Faculty of Medicine, Ophthalmology Department, Medipol University, Istanbul, Turkey
| | - Aylin Kilic
- Faculty of Medicine, Ophthalmology Department, Medipol University, Istanbul, Turkey
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Sioufi K, Zheleznyak L, MacRae S, Rocha KM. Femtosecond Lasers in Cornea & Refractive Surgery. Exp Eye Res 2021; 205:108477. [PMID: 33516763 DOI: 10.1016/j.exer.2021.108477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Abstract
Since the introduction of femtosecond laser (FS) systems for corneal flap creation in laser-assisted in-situ keratomileusis there have been numerous applications for FS laser in corneal surgery. This manuscript details the utility of FS lasers in corneal surgical procedures including refractive laser surgeries, intracorneal ring segment tunnels, presbyopic treatments, and FS-assisted keratoplasty. We also review the role of FS lasers in diagnostic procedures such as two photon excitation fluorescence and second harmonic generation.
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Affiliation(s)
- Kareem Sioufi
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | | | - Scott MacRae
- Flaum Eye Institute and the Institute of Optics, University of Rochester, Rochester, NY, USA
| | - Karolinne M Rocha
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA.
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Steinwender G, Shajari M, Mayer WJ, Kook D, Dirisamer M, Kohnen T. SMILE – Small Incision Lenticule Extraction. AUGENHEILKUNDE UP2DATE 2020. [DOI: 10.1055/a-1075-9225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie SMILE (small incision lenticule extraction) zählt zu den Verfahren der
refraktiven Lentikel-Extraktion und hat sich im letzten Jahrzehnt zu einem
etablierten Bestandteil des modernen refraktivchirurgischen Spektrums
entwickelt. Dieser Beitrag gibt einen Überblick über Patientenselektion,
Operationsmethode, mögliche Komplikationen und klinische Ergebnisse dieser
Methode.
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Steinwender G, Shajari M, Mayer WJ, Kook D, Dirisamer M, Kohnen T. [SMILE - Small Incision Lenticule Extraction]. Klin Monbl Augenheilkd 2020; 237:e15-e34. [PMID: 33207383 DOI: 10.1055/a-1291-9041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Refractive lenticule extraction is a corneal surgical technique that uses a femtosecond laser exclusively to create an intrastromal refractive lenticule for the correction of myopia and myopic astigmatism. In small incision lenticule extraction (SMILE) the generated refractive lenticule is subsequently extracted through a small incision. The reported efficacy, predictability and safety of the flap-less SMILE procedure is similar to those of femtosecond laser in situ keratomileusis (LASIK). Advantages of SMILE over LASIK include less iatrogenic dry eye, fewer induced higher-order aberrations, and potentially less biomechanical weakening of the cornea. However, there is a steeper surgeon learning curve for SMILE as the procedure is technically more challenging than LASIK. Furthermore, the current SMILE laser platform cannot use cyclotorsion control or eye-tracking technology and retreatment options are more complex compared to LASIK. This review looks at patient selection, surgical method, possible complications, retreatment options, and postoperative outcome of the SMILE technique.
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Li M, Wei R, Yang W, Shang J, Fu D, Xia F, Choi J, Zhou X. Femtosecond Laser-Assisted Allogenic Lenticule Implantation for Corneal Ectasia After LASIK: A 3-Year In Vivo Confocal Microscopic Investigation. J Refract Surg 2020; 36:714-722. [PMID: 33170278 DOI: 10.3928/1081597x-20200826-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate morphological changes in the cornea and the implanted lenticule in patients with corneal ectasia after laser in situ keratomileusis (LASIK) and implantation using a lenticule from small incision lenticule extraction (SMILE). METHODS Eight eyes of 8 patients with ectasia after LASIK from 2015 to 2018 at the Eye and ENT Hospital of Fudan Unversity were analyzed. For recipient eyes, lenticules were transferred with a mean cryopreserved time of 20 ± 21 days extracted from SMILE donors to the exposed stromal bed after lifting the flaps and the flap was repositioned. Uncorrected and corrected distance visual acuity, manifest refraction, and corneal topography were performed. Patients were followed up for 3 years. Changes in lenticules and recipient corneas were analyzed using in vivo confocal microscopy. RESULTS Activated keratocytes in the anterior and posterior stroma were observed near the lenticule at the first 6 months. Elongated, deformed keratocyte nuclei were found in the implanted lenticules in postoperative year 1. The anterior and posterior interfaces showed an absence or decrease of keratocytes and the presence of small particles of varying brightness. Nerve fibers in the implanted lenticules were detected in one case. No obvious difference was detected between cryopreserved and fresh lenticules. CONCLUSIONS The preliminary findings suggest that recipient keratocytes repopulate the lenticules and the keratocytes in lenticules gradually return to their normal morphology. [J Refract Surg. 2020;36(11):714-722.].
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Stodulka P, Hjortdal J, Slovak M. Intrastromal Lenticule Rotation for the Treatment of High Astigmatism. J Refract Surg 2020; 36:415-418. [PMID: 32521030 DOI: 10.3928/1081597x-20200506-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the first clinical case using intrastromal lenticule rotation to surgically correct high astigmatism in an amblyopic eye. METHODS A 31-year-old woman with mixed astigmatism of +2.00 -5.00 × 10° (spherical equivalent -0.50 diopters [D]) in her left eye, uncorrected distance visual acuity (UDVA) of 0.8 logMAR, and corrected distance visual acuity (CDVA) of 0.7 logMAR underwent refractive lenticule rotation surgery. RESULTS Postoperative refractive astigmatism changed to 0.00 D cylinder. There was a postoperative myopic shift and her spherical equivalent refraction was -4.00 D at 1 week, -3.75 D at 1 month, and -3.25 D at 3 and 6 months. The patient noted a slight improvement in UDVA and a significant improvement in her uncorrected near visual acuity from Jaeger 13 (> 1.0 logMAR) to Jaeger 5 (0.3 logMAR) at 1 and 3 months and subsequently to Jaeger 2 (0.1 logMAR). CONCLUSIONS To the best of the authors' knowledge, this is the first clinical case of astigmatism correction using small incision lenticule extraction lenticule rotation. This case of an amblyopic eye demonstrates that the procedure is capable of correcting both corneal and refractive astigmatism, and the short-term result seems stable. [J Refract Surg. 2020;36(6):415-418.].
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