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Vanathi M. Kerato-lenticule Extraction (KLex) surgeries - Current perspectives. Indian J Ophthalmol 2024; 72:459-460. [PMID: 38546463 PMCID: PMC11149513 DOI: 10.4103/ijo.ijo_675_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- M Vanathi
- Professor of Ophthalmology, Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Saad A, Klabe K, Kirca M, Kretz FAT, Auffarth G, Breyer DRH. Refractive outcomes of small lenticule extraction (SMILE) Pro® with a 2 MHz femtosecond laser. Int Ophthalmol 2024; 44:52. [PMID: 38340212 PMCID: PMC10858925 DOI: 10.1007/s10792-024-02915-2] [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: 07/10/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To evaluate the initial visual outcomes of Small Incision Lenticule Extraction (SMILE) Pro® using a 2 MHz femtosecond laser (VisuMax 800, Carl Zeiss Meditec) and to assess the efficacy, safety, predictability, accuracy, and complication rate. METHODS This retrospective analysis included eyes which underwent the SMILE Pro® procedure using VisuMax 800 femtosecond laser to correct myopia. All surgeries were performed by one surgeon (DB). Follow-up was conducted 3 months postoperatively to evaluate visual outcomes after neuroadaptation, corrected visual acuity (CDVA) and intra- and postoperative complications. RESULTS One hundred and fifty-two eyes of 82 patients (mean age 31 ± 6 years) results at 3 months are presented. The mean spherical equivalent (SE) was - 4.44 ± 1.86 D preoperatively while -0.24 ± 0.32 D postoperatively. 99% of eyes achieved SE within ± 1.0 D of attempted correction and 91% were within ± 0.5 D. Efficacy index was 0.93 while the safety index was 1. No complications occurred intra- or postoperatively. No eyes lost more than 1 line of their preoperative CDVA. All highly myopic eyes (- 6.25 to - 10.00 D; n = 18) achieved 20/20 at 3 months postoperatively and were within 0.5 D from the attempted SE and no eyes lost more than 1 line of CDVA. CONCLUSION The SMILE Pro® is a safe, efficient, and predictable procedure for the treatment of myopia and myopic astigmatism, with comparable results of conventional SMILE surgery. High myopic eyes achieve better results than low and moderate myopia. No complications were recorded in our patients.
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Affiliation(s)
- Amr Saad
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany.
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany.
| | - Karsten Klabe
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Mücella Kirca
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
| | - Florian A T Kretz
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Precise Vision, Kretz & Colleagues, Rheine, Germany
| | - Gerd Auffarth
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Detlev R H Breyer
- Breyer, Kaymak & Klabe Eye Surgery, Martin-Luther-Platz 22, 40212, Duesseldorf, Germany
- Institution for International Innovative Ophthalmic Surgery, Duesseldorf, Germany
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Ladi JS, Gaikwad A, Shah NA. Comparative study of small incision refractive lenticule extraction with 5 mm versus 6.5 mm optic zone for myopia. Indian J Ophthalmol 2023; 71:2717-2721. [PMID: 37417110 PMCID: PMC10491035 DOI: 10.4103/ijo.ijo_2559_22] [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: 10/03/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To compare residual stromal thickness (RST) in eyes undergoing small incision refractive lenticule extraction (SMILE) using a lenticular diameter of 6.5 mm versus those with a diameter of 5 mm. Methods: In this retrospective comparative case series. , consecutive patients who underwent SMILE between 2016 and 2021 with at least 6 months of follow-up were included. Preoperative best-corrected distance visual acuity (BCDVA), refractive error, contrast sensitivity, central corneal thickness, keratometry, higher order aberrations, and scotopic pupil size were recorded using a Placido disk topography with Sheimpflug tomography-based system. Patients underwent SMILE with a lenticular diameter of 6.5 mm until 2018 (n = 372 eyes). Thereafter, the lenticular diameter was reduced to 5 mm (n = 318). The RST, postoperative refraction, aberrations, subjective glare, and halos were compared across groups at 1 and 6 months. Results The mean age of participants was 26.8 ± 5.8 years with a mean preoperative spherical equivalent of -4.48 D ± 2.16 D (range: -0.75 to -12.25 D) and mean scotopic pupil of 3.7 ± 0.75 mm. Eyes in the 5 mm group had 30.6 m (95% confidence interval [CI] = 28 to 33 m, P < 0.001) greater RST compared to the 6.5 mm group after adjusting for spherical equivalent and preoperative pachymetry. There were no differences in vision, contrast sensitivity, aberrations (wavefront error of 0.19 ± 0.2 vs. 0.25 ± 0.2, P = 0.19) or glare between the two groups. Conclusion SMILE performed with a lenticular diameter of 5 mm leads to greater RST across the myopic range, but without inducing significant higher-order aberrations.
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Affiliation(s)
- Jeevan S Ladi
- Department of Ophthalmology, Dada Laser Eye Institute, Pune, Maharashtra, India
| | - Anita Gaikwad
- Department of Ophthalmology, Dada Laser Eye Institute, Pune, Maharashtra, India
| | - Nitant A Shah
- Department of Ophthalmology, Dada Laser Eye Institute, Pune, Maharashtra, India
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Janiszewska-Bil D, Czarnota-Nowakowska B, Grabarek BO, Dobrowolski D, Wylęgała E, Lyssek-Boroń A. Comparison of Vision Correction and Corneal Thickness at 180-Day Follow-Up After Femtosecond Laser-Assisted In-Situ Keratomileusis (FS-LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE): A Study from a Single Center in Poland of 120 Patients with Myopia. Med Sci Monit 2023; 29:e939099. [PMID: 36793199 PMCID: PMC9942428 DOI: 10.12659/msm.939099] [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: 02/01/2023] Open
Abstract
BACKGROUND This study from a single center in Poland included 120 patients with myopia, and the aim was to compare vision correction and corneal thickness at the 180-day follow-up after femtosecond laser-assisted in-situ keratomileusis (FS-LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). MATERIAL AND METHODS The effectiveness and safety of laser vision correction (LVC) procedures were evaluated by determining pre- and post-procedure uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) values on the Snell chart. Twenty patients with diagnosed mild myopia (sphere maximum -3.0 diopters D; cylinder maximum 0.5 D) were qualified for PRK surgery. Fifty patients with diagnosed intolerance (sphere maximum -6.0 D; cylinder maximum 5.0 D) were eligible for the FS-LASIK procedure. Fifty patients with diagnosed myopia (sphere maximum -6.0 D cylinder 3.5 D) were qualified for the SMILE procedure. RESULTS Regardless of which procedure was performed, both UDVA and CDVA improved significantly postoperatively (P<0.05). In addition, the UDVA and CDVA values were similar in the postoperative period (P>0.05). For each procedure, the EI was no less than 0.94. Regardless of which type of LVC procedure was performed, CET at the center and 1.5 mm from the center in 4 meridians thickened, and this change was not statistically significant over the observation period (P>0.05). CONCLUSIONS Our analysis demonstrated similar effectiveness of the 3 methods - PRK, FS-LASIK, and SMILE - in patients with mild and moderate myopia.
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Affiliation(s)
- Dominika Janiszewska-Bil
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland,Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland,Optegra Clinic in Katowice, Katowice, Poland
| | | | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, Academy of Silesia, Zabrze, Poland
| | - Dariusz Dobrowolski
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland,Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, The Medical University of Silesia in Katowice, Katowice, Poland,Department of Ophthalmology, District Railway Hospital, Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology, Trauma Centre, St. Barbara Hospital, Sosnowiec, Poland,Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland,Optegra Clinic in Cracow, Cracow, Poland
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Sharma VK, Sati A, Kumar S. Small incision lenticule extraction (SMILE) refractive surgery: Our initial experience. Med J Armed Forces India 2022; 78:S105-S110. [PMID: 36147395 PMCID: PMC9485860 DOI: 10.1016/j.mjafi.2021.07.012] [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: 09/23/2020] [Accepted: 07/24/2021] [Indexed: 10/20/2022] Open
Abstract
Background Small incision lenticule extraction (SMILE) is femtosecond laser based, minimally invasive, flap-free refractive surgery gaining worldwide acceptance as a safe alternative to flap based refractive surgeries. Methods A retrospective data review study was done where preoperative and postoperative data were collected for 202 eyes of 101 patients who underwent SMILE surgery at a tertiary care Armed Forces hospital from Jan 2019 to Dec 2019. All participants included in the study were followed up for 3 months postoperative period. Results Mean age of the participants was 24.139 ± 0.515 years (males 22.1 years, females 25.3 years). Male participants were 36 (72 eyes) while female participants were 65 (130 eyes). Of the participants, 75.2% underwent the procedure for cosmetic indication, while 24.8% underwent clearing some medical examination later. Preoperative UCVA was 1.049 ± 0.028 logMAR units, which improved on first postoperative day to 0.038 ± 0.01 logMAR units, at 1 wk 0.015 ± 0.01 logMAR units, at 1 month 0.006 ± 0.005 logMAR units and at 3 months postoperative period to 0.03 ± 0.003 logMAR units. There were two adverse events of difficult lenticule extraction with small (<1 mm) cap tear. Conclusion SMILE surgery is a flap-free refractive surgical technique. It reduces postoperative complications like dry eyes and flap-related complications. Hence, it may be recommended for all serving personnel after a thorough preoperative screening protocol.
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Affiliation(s)
- Vijay K. Sharma
- Senior Advisor (Ophthalmology) & Anterior Segment Surgeon, Command Hospital (Eastern Command), Kolkata, India
| | - Alok Sati
- Senior Advisor (Ophthalmology) & Anterior Segment Surgeon, Army Hospital (Research & Referral), New Delhi, India
| | - Santosh Kumar
- Classified Specialist (Ophthalmology) & Anterior Segment Surgeon, Command Hospital (Air Force), Bengaluru, India
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贾 园, 贺 瑞, 李 晓, 宋 耀, 魏 俊, 秦 宏, 杨 昕, 陈 维. [Effects of SMILE with different residual stromal thicknesses on corneal biomechanical properties of rabbits in vivo]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2022; 39:679-684. [PMID: 36008331 PMCID: PMC10957367 DOI: 10.7507/1001-5515.202203069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Indexed: 06/15/2023]
Abstract
Femtosecond laser small incision lenticule extraction (SMILE) with different residual stromal thicknesses (RST) is set to investigate its effect on corneal biomechanical properties of rabbits in vivo. In this study, 24 healthy adult Japanese rabbits were randomly divided into group A and B. The RST of group A was set 30% of the corneal central thickness (CCT), and the RST of group B was 50% of the CCT. The thickness of the corneal cap in both groups was set one third of CCT. Corneal visualization Scheimpflug technology (Corvis ST) and Pentacam three-dimensional anterior segment analyzer were used to determine corneal biomechanical and morphological parameters before surgery, and 1 week, 1 month and 3 months after surgery. Pearson correlation analysis was used to analyze factors affecting corneal biomechanical parameters after SMILE. The results showed that the corneal stiffness of group A was significantly higher than that of group B at 1 week and 1 month after surgery, and most biomechanical parameters returned to preoperative levels at 3 months postoperatively. The results of correlation analysis showed that postoperative CCT and RST were the main factors affecting corneal biomechanical parameters after SMILE. There was no significant difference in corneal posterior surface height (PE) between 3 months after surgery and before surgery in both two groups. It indicates that although the ability to resist deformation of cornea decreases in SMILE with thicker corneal cap and less RST, there is no tendency to keratoconus, which may be related to the preservation of more anterior stromal layer.
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Affiliation(s)
- 园 贾
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 瑞 贺
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 晓娜 李
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 耀文 宋
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 俊超 魏
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 宏伟 秦
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 昕 杨
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
| | - 维毅 陈
- 太原理工大学 生物医学工程学院(太原 030024)College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, P. R. China
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Preoperative Predictors for Acute Pain After Photorefractive Keratectomy. Cornea 2022; 41:940-949. [PMID: 35543577 DOI: 10.1097/ico.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain. METHODS This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors. RESULTS This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05). CONCLUSIONS Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.
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Nicula CA, Nicula D, Bolboacă SD, Bulboacă AE. One year outcomes after small incision lenticule extraction ReLEX in the correction of myopia and myopic astigmatism. BMC Ophthalmol 2021; 21:423. [PMID: 34879853 PMCID: PMC8656009 DOI: 10.1186/s12886-021-02195-9] [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: 01/24/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To report the visual and refractive outcomes of small incision lenticule extraction ReLEX (SMILE) technique using VisuMax femtosecond laser in myopia and myopic astigmatism patients. Material and methods A non-randomized clinical study has been conducted on patients with myopia and myopic astigmatism who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser system (Carl Zeiss Meditec AG, Jena, Germany) at Oculens Clinic, Cluj-Napoca, Romania. Patients older than 18 years, with ocular astigmatism up to -5 diopters (D), spherical equivalent up to -10.00 D, corrected distance visual acuity (CDVA) of 0.3 or better before the surgery, stable refraction for one year, and with a minimum calculated post operator residual stromal bed of 250μ were included in the study. Results The study involved a total of 25 myopic eyes (median of sphere diopters equal with -4D) and 67 myopic astigmatic eyes (median of cylinder diopters equal with -1.5 D). The mean refractive spherical equivalent (MRSE) on patients with myopic eyes reduced from -4.25D (median) to -0.5D at one month follow-up, -0.25 D at 6 and 12 months. The mean refractive spherical equivalent (MRSE) on patients with astigmatic myopic eyes reduced from-6.25 D to -0.67 D at one month, -0.62 D at six and twelve months. The value of sphere decreased postoperatively on myopic eyes with a median of -0.25D at one, six and twelve months. The value of cylinder decreased postoperatively on myopic astigmatic eyes with a median of -0.50 D at one month, -0.25 D at six months and -0.50 D at 12 months. At 6 and 12 months, 20 (80.0%) of myopic eyes were maintained within ±0.5 D and 22 (88.0%) with ±1D. On both groups (myopic eyes and myopic astigmatic eyes), statistically significant differences were observed when the keratometric baseline values were compared to each follow-up (P-values < 0.0001), without any significant differences between follow-ups (P-values>0.15). At 1-month follow-up, uncorrected distance visual acuity (UDVA) was better than or equal to 0.5 in 88.0% of myopic eyes and 82.1% of myopic astigmatic eyes. UDVA remained stable in all cases of myopic eyes at six months and the percentage increased at 92.0% in myopic eyes. UDVA slightly increased at 6-months (85.1%) and remained at the same value at 12-months in myopic astigmatism eyes. Conclusions SMILE proved an effective and safe refractive corneal procedure and provided a predictable and stable correction of myopia and myopic astigmatism. SMILE technique demonstrated very good outcomes in terms of keratometric, cylinder, spherical measurements.
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Affiliation(s)
- Cristina Ariadna Nicula
- Department of Ophthalmology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Victor Babeș Str., no. 8, 400012, Cluj-Napoca, Romania.,Oculens Clinic, Calea Turzii, No. 134-136, 400501, Cluj-Napoca, Romania
| | - Dorin Nicula
- Oculens Clinic, Calea Turzii, No. 134-136, 400501, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Louis Pasteur Str., no. 6, 400349, Cluj-Napoca, Romania.
| | - Adriana Elena Bulboacă
- Department of Pathophysiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Victor Babeș Str., no. 8, 400012, Cluj-Napoca, Romania
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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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Management of small-incision lenticule extraction ectasia using tissue addition and pocket crosslinking. J Cataract Refract Surg 2021; 47:407-412. [PMID: 32694305 DOI: 10.1097/j.jcrs.0000000000000335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
The feasibility of managing ectasia after small-incision lenticule extraction (SMILE) using tissue addition and pocket corneal crosslinking (CXL) is described. Four eyes of 3 patients (mean age 25.7 years) developed features of keraectasia at a mean period of 3 years after SMILE for myopia. All cases were managed with insertion of heterologous SMILE lenticules in the previously created pocket, followed by simultaneous accelerated CXL. At a mean follow-up of 7.67 months, there was improvement in corrected distance visual acuity and reduction in keratometry and higher-order aberrations in all eyes. The visual, refractive, and topographic parameters remained stable at the last visit compared with the 2-week follow-up visit. No eye developed haze, infection, or rejection requiring tissue explantation. Early experience showed tissue addition with simultaneous pocket CXL to be a feasible approach for managing ectasia after SMILE. However, further follow-up is required to establish the long-term safety and effects on corneal stabilization.
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Brar S, Batra A, Shah ML, Ganesh S. Outcomes of bioptics with small-incision lenticule extraction as a sequential treatment after implantable collamer lens for management of extreme myopia. J Cataract Refract Surg 2021; 47:741-747. [PMID: 33252563 DOI: 10.1097/j.jcrs.0000000000000502] [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: 07/22/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the safety and efficacy of bioptics using implantable collamer lens (ICL) followed by small-incision lenticule extraction (SMILE) for management of extreme myopia. SETTING Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN Retrospective case series. METHODS Data were analyzed for patients who underwent bioptics using ICL in the first stage and SMILE in the second stage for correction of the residual refractive error. The mean interval between stage 1 and stage 2 correction was 24.2 ± 13.33 days. The mean follow-up after the SMILE procedure was 12.26 ± 1.39 (range 11 to 14) months. RESULTS Fifteen eyes from 9 patients with mean age 26 ± 4.69 years were included. Preoperatively, the mean SE was -22.89 ± 3.04 diopter (D) (-16.50 to -28.00 D), which decreased to -3.40 ± 1.89 D after ICL and further reduced to -0.48 ± 0.24 D after final correction with SMILE, at the end of the mean follow-up. The mean cylinder reduced from -2.88 ± 1.69 D to -1.93 ± 1.07D post-ICL and to -0.38 ± 0.24 D post-SMILE surgery. The mean corrected distance visual acuity (CDVA) significantly improved from 0.38 ± 0.22 to 0.068 ± 0.09 logMAR after SMILE correction (P = .00). The mean uncorrected distance visual acuity (UDVA) at the end of follow-up was 0.15 ± 0.09 logMAR, with all eyes achieving UDVA of 0.3 logMAR or greater. All eyes had gain in CDVA, with 53% eyes gaining 2 or more lines. No wound-, intraocular pressure-, or ICL-related complications were observed during and after the SMILE surgery. No patient required spectacles, contact lenses, or enhancement for further improvement of vision. CONCLUSIONS Bioptics with SMILE after ICL implantation might be a valid option for extremely myopic patients, resulting in significant improvements in visual acuity and high patient satisfaction.
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Affiliation(s)
- Sheetal Brar
- From the Nethradhama Super Speciality Eye Hospital, Bangalore, India
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Song Y, Fang L, Zhu Q, Du R, Guo B, Gong J, Huang J. Biomechanical responses of the cornea after small incision lenticule extraction (SMILE) refractive surgery based on a finite element model of the human eye. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:4212-4225. [PMID: 34198433 DOI: 10.3934/mbe.2021211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the biomechanical responses of the human cornea after small incision lenticule extraction (SMILE) procedures, especially their effects of SMILE surgery on stress and strain. METHODS Based on finite element analysis, a three-dimensional (3D) model of the human eye was established to simulate SMILE refractive surgery procedures. Stress and strain values were calculated by inputting the intraocular pressure (IOP). RESULTS After SMILE refractive surgery procedures, the stress and strain of the anterior and posterior corneal surfaces were significantly increased. The equivalent stress and strain on the anterior and posterior corneal surfaces increased with increasing diopter and were concentrated in the central area, whereas the values of stress and strain at the incision site on the anterior surface of the cornea were approximately 0. Compared with the anterior corneal surface, the stress and strain of the posterior surface were larger. Increasing IOP caused an approximately linear change in stress and a nonlinear increase in corneal strain. In addition, we found that the incision sizes and direction had less of an influence on stress and strain. In summary, SMILE surgery increased the equivalent stress and strain on the human cornea. CONCLUSIONS The equivalent stress and strain of the anterior and posterior human corneal surfaces increased after SMILE refractive surgery; these increases were particularly noticeable on the posterior surface of the cornea.
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Affiliation(s)
- Yinyu Song
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Lihua Fang
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Qinyue Zhu
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Ruirui Du
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Binhui Guo
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Jiahui Gong
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
| | - Jixia Huang
- Key Laboratory of Nondestructive Test (Ministry of Education), Nanchang Hangkong University, Nanchang 330063, China
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Shuber HS, Alhamami HA, Alasadi SZ. Small-incision lenticule extraction for correction of refractive error after 2 years of follow-up. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Tay E, Bajpai R. Visual recovery after small incision lenticule extraction (SMILE) in relation to pre-operative spherical equivalent. Graefes Arch Clin Exp Ophthalmol 2020; 259:1053-1060. [PMID: 33047249 DOI: 10.1007/s00417-020-04954-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess visual recovery after small incision lenticule extraction (SMILE) in relation to pre-operative spherical equivalent. METHODS Two hundred fourteen eyes of 107 patients were enrolled. Following surgery, patients were examined pre-operatively, 1 day, 2 weeks, 1 month and 3 months later. High myopia was defined as pre-operative spherical equivalent ≤ - 5 D. A linear mixed-effects model was used. RESULTS Mean ± standard deviation pre-operative spherical equivalent was - 5.30 ± 1.36 D that reduced significantly to 0.04 ± 0.70 D (p < 0.001) at 1 month and - 0.02 ± 0.66 D (p < 0.001) at 3 months. Mean pre-operative LogMAR uncorrected distance visual acuity ± SD was 0.97 ± 0.09 that improved significantly to 0.04 ± 0.06 at 2 weeks (p < 0.001), 0.01 ± 0.04 at 1 month (p < 0.001) and 0.01 ± 0.04 at 3 months (p < 0.001). Eighty-eight eyes (41.2%) had uncorrected distance visual acuities of 0.0 at 1 day, 154 eyes (72.0%) at 2 weeks,194 eyes (90.7%) at 1 month and 199 eyes (93.0%) at 3 months. Significantly more eyes with low myopia (> - 5 D) achieved acuities of 0.0 at 1 day and 2 weeks (p = 0.041 and p < 0.001). Post-operative acuities were not associated with refractive targets, laser cut energy settings or other variables. Two hundred nine eyes (97.7%) were within ± 0.5 D of target and 213 eyes (99.5%) were within ± 1 D. CONCLUSIONS SMILE for low myopia had faster visual recovery in the early post-operative period with no significant differences between groups detected by 1 and 3 months.
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Affiliation(s)
- Eugene Tay
- Singapore Eye Research Institute, The Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Ram Bajpai
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Arba Mosquera S, Verma S. A review of clinical outcomes following SMILE for the treatment of astigmatism. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1810017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Samuel Arba Mosquera
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
| | - Shwetabh Verma
- Biomedical Engineering Office, Research and Development, SCHWIND Eye-tech-solutions GmbH, Kleinostheim, Germany
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16
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Medeiros CS, Santhiago MR. Corneal nerves anatomy, function, injury and regeneration. Exp Eye Res 2020; 200:108243. [PMID: 32926895 DOI: 10.1016/j.exer.2020.108243] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
Abstract
The cornea is a highly innervated tissue, exhibiting a complex nerve architecture, distribution, and structural organization. Significant contributions over the years have allowed us to come to the current understanding about the corneal nerves. Mechanical or chemical trauma, infections, surgical wounds, ocular or systemic comorbidities, can induce corneal neuroplastic changes. Consequently, a cascade of events involving the corneal wound healing, trophic functions, neural circuits, and the lacrimal products may interfere in the corneal homeostasis. Nerve physiology drew the attention of investigators due to the popularization of modern laser refractive surgery and the perception of the destructive potential of the excimer laser to the corneal nerve population. Nerve fiber loss can lead to symptoms that may impact the patient's quality of life, and impair the best-corrected vision, leading to patient and physician dissatisfaction. Therefore, there is a need to better understand preoperative signs of corneal nerve dysfunction, the postoperative mechanisms of nerve degeneration and recovery, aiming to achieve the most efficient way of treating nerve disorders related to diseases and refractive surgery.
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Affiliation(s)
| | - Marcony R Santhiago
- University of São Paulo, São Paulo, SP, Brazil; University of Southern California, Los Angeles, CA, United States
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17
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Yesilkaya C, Arıcı M, Yıldırım Y, Agca A, Demircan A, Taskapılı M. Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience. J Fr Ophtalmol 2020; 43:753-760. [PMID: 32620412 DOI: 10.1016/j.jfo.2019.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/29/2019] [Accepted: 11/13/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). METHODS Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. RESULTS Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. CONCLUSION This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.
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Affiliation(s)
- C Yesilkaya
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey.
| | - M Arıcı
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
| | - Y Yıldırım
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
| | - A Agca
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
| | - A Demircan
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
| | - M Taskapılı
- Department of Ophthalmology, Health Sciences University, Beyoğlu Eye Research and Training Hospital, Istanbul, Turkey
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18
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Khamar P, Nishtala K, Shetty R, Panigrahi T, Shetty K, Pahuja N, Deshpande V, Ghosh A. Early biological responses in ocular tissue after SMILE and LASIK surgery. Exp Eye Res 2020; 192:107936. [PMID: 32001250 DOI: 10.1016/j.exer.2020.107936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/09/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
We studied the early protein profile in the ocular tissue extracted after LASIK and SMILE surgery. SMILE and LASIK was performed in contralateral eyes and stromal tissue samples were collected from 10 eyes of 5 donors. The stromal tissue samples were analyzed using label free quantification approach and ITRAQ labelling approach in LC-MS/MS. Combined functional analysis revealed many differentially expressed proteins which were involved in important biological processes. About 117 unique differentially expressed proteins were identified using two different proteomic approaches. Collagens, proteoglycans, corneal crystallins were enriched and showed differential expression in SMILE and LASIK as compared to the non-surgical control. Apart from these, 14-3-3 class of proteins, Lysozyme (LYZ), Macrophage Migratory Inhibitory Factor protein (MIF), Pigment Epithelial Derived Factor (PEDF) were differentially expressed when compared between LASIK and SMILE. Peroxiredoxin 1 (PRDX1) expression was found to be reduced in LASIK as compared to SMILE. The expression of Lysozyme C and Macrophage Migratory Inhibitory Factor inflammatory response was found to be less in SMILE as compared to LASIK. Western blot validation of specific markers such as Collagen IV (COL4), Keratocan (KERA), Lumican (LUM), Aldehyde dehydrogenase 3 A1 (ALDH3A1), Lysozyme C (LYZC) confirmed the differences in the protein levels observed in SMILE and LASIK operated tissues as compared to non-surgical controls. In conclusion, this study revealed the early molecular changes occurring in the cornea resulting from these two surgical procedures which may have implications on managing post-operative complications.
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Affiliation(s)
- Pooja Khamar
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | | | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | | | - Keerthi Shetty
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Natasha Pahuja
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore, India
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; Singapore Eye Research Institute, Singapore.
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Luft N, Siedlecki J, Schworm B, Dirisamer M, Priglinger SG. „Small incision lenticule extraction“ (SMILE): eine Standortbestimmung. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-00444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Lau YTY, Shih KC, Tse RHK, Chan TCY, Jhanji V. Comparison of Visual, Refractive and Ocular Surface Outcomes Between Small Incision Lenticule Extraction and Laser-Assisted In Situ Keratomileusis for Myopia and Myopic Astigmatism. Ophthalmol Ther 2019; 8:373-386. [PMID: 31325106 PMCID: PMC6692806 DOI: 10.1007/s40123-019-0202-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is the most commonly performed laser refractive surgical technique worldwide for the treatment of myopia and myopic astigmatism. In recent years, small incision lenticule extraction (SMILE) has emerged as a promising alternative to LASIK, requiring only a single femtosecond laser to create an intrastromal lenticule, which is then removed via a small incision. The technique obviates the need for a corneal flap. A number of published studies have compared the two techniques in terms of visual, refractive and ocular surface outcomes. This review compares the clinical outcomes between LASIK and SMILE in treating myopia and myopic astigmatism based on studies published in the last 5 years. Twenty-two studies were included, all of which were observational in nature. Results suggest that the two techniques have comparable visual outcomes in terms of safety, efficacy and predictability, although recovery in visual acuity may be slower in SMILE-treated than LASIK-treated eyes. SMILE is found to result in less severe postoperative dry eye symptoms and faster recovery of corneal sensitivity than LASIK. It is important to note, however, that the SMILE technique is limited by the lack of a cyclotorsion-compensation system and option for customized treatment profile. The heterogeneity of results in this review may be attributable to the use of different LASIK platforms in different studies. Few studies compared the outcomes regarding severity of myopia. Future prospective randomized controlled trials with a larger sample size and longer follow-up period will be highly beneficial for progress in this field.
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Affiliation(s)
- Yumi Tsz-Ying Lau
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
| | - Ryan Hin-Kai Tse
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Tommy Chung-Yan Chan
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, USA
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Nagaraja H, Mehta JS, Zhou X, Yam JC, Lam DS. Will SMILE Become the New Benchmark of Corneal Laser Refractive Surgery? Asia Pac J Ophthalmol (Phila) 2019; 8:351-354. [PMID: 31567435 PMCID: PMC6784770 DOI: 10.1097/01.apo.0000579956.14784.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Harsha Nagaraja
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
| | - Jodhbir S. Mehta
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai, China
| | | | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Dennis S.C. Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, China
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22
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Ganesh S, Brar S, Sriprakash K. Post-small incision lenticule extraction phacoemulsification with multifocal IOL implantation: A case report. Indian J Ophthalmol 2019; 67:1353-1356. [PMID: 31332141 PMCID: PMC6677046 DOI: 10.4103/ijo.ijo_2069_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Superspecilaity Eye Hospital, Bangalore, India
| | - Sheetal Brar
- Nethradhama Superspecilaity Eye Hospital, Bangalore, India
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Zhang J, Zheng L, Zhao X, Sun Y, Feng W, Yuan M. Corneal aberrations after small-incision lenticule extraction versus Q value-guided laser-assisted in situ keratomileusis. Medicine (Baltimore) 2019; 98:e14210. [PMID: 30702573 PMCID: PMC6380743 DOI: 10.1097/md.0000000000014210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Previous studies compared ocular aberration and visual quality after small-incision lenticule extraction (SMILE) and Q value-guided femtosecond laser-assisted in situ keratomileusis (Q-FS-LASIK), but anterior corneal surface aberration properties are poorly known. This study aimed to compare the changes in anterior corneal surface aberration after SMILE versus Q-FS-LASIK.This was a prospective, observational cohort study. Patients with myopia and myopic astigmatism underwent SMILE or Q-FS-LASIK at Hangzhou MSK Eye Hospital between January 2015 and November 2015. High order aberration (HOA), primary spherical aberration (PSA), primary coma aberration (PCA), primary vertical coma aberration (PVCA), and primary horizontal coma aberration (PHCA) were assessed using pre- and postoperative Sirius scanning.Both surgery were associated with significant increases in postoperative HOA, PSA, and PCA (both groups P < .01). In the SMILE group (n = 51), the variations in HOA, PSA, and PCA were no longer significant after postoperative week 2 (P > .05). In the Q-FS-LASIK group (n = 73), the variations in HOA and PCA were no longer significant after postoperative day 1 (P > .05). In the SMILE group, the 3-month changes in PCA were not correlated with spherical, spherical equivalent (SE), and spherical plus cylinder measurements. Cylinder measurements were not correlated with HOA, PSA, and PCA. In the Q-FS-LASIK group, the 3-month changes in PCA correlated with spherical, SE, and spherical plus cylinder measurements.Both SMILE and Q-FS-LASIK resulted in an increase in HOA, PSA, and PCA at postoperative day 1, but Q-FS-LASIK introduced lower HOA and showed better stability. Spherical measurement was related to PSA.
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Kim WK, Ryu IH, Kim JS, Jeon GH, Lee IS, Kim HS, Kim JK. Clinical Outcomes of One Day Small-incision Lenticule Extraction Compared with Scheduled Methods for Myopic Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang H, Liu T, Li Y, Zheng H, Guo S, Chen J. A clinical comparative study of effects of different corneal refractive surgeries on postoperative stability of tear film. Minerva Med 2018; 110:480-482. [PMID: 30484593 DOI: 10.23736/s0026-4806.18.05910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Huimin Zhang
- Department of Ophthalmology, Zhoukou Central Hospital, Zhoukou, China
| | - Taotao Liu
- Department of Ophthalmology, First Hospital of Jilin University, Jilin, China
| | - Yujie Li
- Department of Ophthalmology, Pinggu Hospital of Beijing City, Beijing, China
| | - Haitao Zheng
- Department of Ophthalmology, Zhoukou Central Hospital, Zhoukou, China
| | - Shanshan Guo
- Physical Examination Center, PLA Rocket Force General Hospital, Beijing, China
| | - Jingyao Chen
- Department of Ophthalmology, Yan'an affiliated Hospital of Kunming Medical University, Kunming, China -
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26
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Vanathi M. Advances in Cornea. Open Ophthalmol J 2018; 12:130-133. [PMID: 30123377 PMCID: PMC6062899 DOI: 10.2174/1874364101812010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Moshirfar M, Murri MS, Shah TJ, Linn SH, Ronquillo Y, Birdsong OC, Hoopes PC. Initial Single-Site Surgical Experience with SMILE: A Comparison of Results to FDA SMILE, and the Earliest and Latest Generation of LASIK. Ophthalmol Ther 2018; 7:347-360. [PMID: 29959753 PMCID: PMC6258580 DOI: 10.1007/s40123-018-0137-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The primary objective was to show our initial surgical single-site experience with small incision lenticule extraction (SMILE) after the official enrollment in March 2017 following Food and Drug Administration (FDA) approval for simple myopia in late 2016 in the United States and, subsequently, compare our results to the earliest and most advanced generation of excimer platforms for laser-assisted in situ keratomileusis (LASIK) surgery. Methods This was a retrospective single-site study of 68 eyes from 35 patients who had SMILE surgery. The patients’ preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere, manifest cylinder, intraoperative complications, and preoperative and postoperative visual symptoms were collected. We compared our findings to the results from the FDA SMILE study, and to the three earliest (1999–2000) and three of the most updated (2013–2016) platforms for LASIK. Results The cumulative UDVA was 20/20 and 20/40 or better in 74% and 100% of patients, respectively. The intended target refraction was within ± 0.5 and ± 1.00 D in 80% and 93% of cases, respectively. The prevalence of dry eyes decreased by nearly half from 1-week to the 6-month postoperative interval. Patients noted improvement in glare (17%), halos (17%), fluctuation (25%), and depth perception (8%) at the 6-month interval compared to preoperative levels. Conclusions This study’s findings are consistent with current SMILE reports. Notably, the results are superior to the earliest generation of LASIK, however inferior to the latest excimer platforms. SMILE does meet the efficacy and safety criteria met by FDA; however, there is a definite need for further improvement to reach the superior refractive outcomes produced by the latest generation of LASIK platforms.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Utah Lions Eye Bank, Murray, UT, USA. .,HDR Research Center, Hoopes Vision, Draper, UT, USA.
| | - Michael S Murri
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tirth J Shah
- University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
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