Comparing a new hydroexpression technique with conventional forceps method for SMILE lenticule removal

BackgroundWe described a modified ‘hydroexpression’ technique for the lenticule removal during small-incision lenticule extraction (SMILE) surgery and compared the results with conventional forceps method.MethodsThis was a retrospective, comparative study of 50 patients who underwent SMILE surgery by the same surgeon. We compared the 1-week and 3-months postoperative results after SMILE using the hydroexpression technique with the conventional forceps technique. Main outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, refractive accuracy, safety index and efficacy index.ResultsThe baseline characteristics were comparable between both groups. At postoperative 1 week, the safety index in forceps and hydroexpression group was 0.93±0.11 and 0.97±0.10, respectively (P=0.246). At 3 months, they were 1.00±0.06 and 0.99±0.09 (P=0.850). For efficacy indices, at 1 week they were 0.84±0.17 and 0.91±0.17 (P=0.158). At 3 months, they were 0.92±0.13 and 0.94±0.19 (P=0.624). All eyes aimed for a plano target. 96% in forceps group and 90% in hydroexpression group were within ±0.50 dioptre (D) in spherical equivalent refraction (SEQ) correction at postoperative 3 months (P=0.567). The mean errors of SEQ correction were −0.10±0.21 D in forceps group and −0.08±0.30 D in hydroexpression group (P=0.705).ConclusionHydroexpression was simple and safe and had early results comparable to the conventional forceps technique. This technique was particularly useful for cases with more adhesions between lenticule and anterior cap, thin lenticule cases and for the inexperienced SMILE surgeons.

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Clinical outcomes of small incision lenticule extraction versus advanced surface ablation in low myopia

European Journal of Ophthalmology ◽

10.1177/1120672119865699 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1278-1286 ◽

Cited By ~ 1

Author(s):

Suphi Taneri ◽

Saskia Kießler ◽

Anika Rost ◽

Tim Schultz ◽

H Burkhard Dick

Keyword(s):

Visual Acuity ◽

Spherical Equivalent ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Surface Ablation ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Spherical Equivalent Refraction ◽

Lenticule Extraction

Purpose: To compare the visual and refractive outcomes of small incision lenticule extraction and advanced surface ablation for low myopia or myopic astigmatism. Methods: Retrospective, observational case series of our first 50 consecutive small incision lenticule extraction patients compared to refraction-matched 50 advanced surface ablation treatments with attempted spherical equivalent correction ⩽−3.5 D, astigmatism ⩽−1.5 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Only one eye per patient was included. Results: Small incision lenticule extraction: mean attempted spherical equivalent correction was −2.80 ± 0.63 D. Uncorrected distance visual acuity was 0.85 and 1.0 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.02 ± 0.32 D (range: −0.5 to +0.75 D), mean cylinder was −0.24 ± 0.21 D (range: 0 to −0.75 D), mean uncorrected distance visual acuity was 1.27, mean efficacy index was 0.96, and mean safety index was 1.05. Uncorrected distance visual acuity was same or better than corrected distance visual acuity in 96%, astigmatism ⩽0.5 D in 98% and ⩽1 D in 100% of eyes, respectively. Advanced surface ablation: mean attempted spherical equivalent correction was −2.75 ± 0.5 D. Uncorrected distance visual acuity was 0.72 and 0.61 at days 1 and 5, respectively. At 3 months, mean spherical equivalent refraction was 0.22 ± 0.32 D, mean cylinder was −0.27 ± 0.27 D, mean uncorrected distance visual acuity was 1.21, mean efficacy index was 1.03, and mean safety index was 1.08. Conclusion: Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes at 3 months similar to those obtained with advanced surface ablation while offering a quicker visual recovery.

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Myopic lasik outcomes: comparison of three different femtosecond lasers and a mechanical microkeratome using the same excimer laser

10.21203/rs.2.9378/v1 ◽

2019 ◽

Author(s):

Juan Gros-Otero ◽

Isabel Rodriguez-Perez ◽

Miguel A. Teus ◽

Andreas Katsanos ◽

Dimitrios G. Mikropoulos ◽

...

Keyword(s):

Visual Acuity ◽

Excimer Laser ◽

Femtosecond Lasers ◽

Safety Index ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Observational Cohort ◽

Efficacy Index ◽

Retrospective Observational Cohort Study

Abstract BACKGROUND To compare the influence of four different microkeratomes on myopic LASIK outcomes. METHODS Retrospective, observational cohort study. We compared 134 eyes treated with the IntraLase 60 kHz, 112 eyes treated with the Femto LDV Z6, 206 eyes treated with the FS200 and 98 eyes treated with the Hansatome zero compression microkeratome. All eyes were operated using the same surgical protocol with the same excimer laser (Wavelight Allegretto) and were allocated in refraction-matched groups. Uncorrected distance visual acuity, best corrected distance visual acuity and residual refraction were evaluated 1 and 7 days, 1 and 3 months postoperatively. RESULTS One day and one week postoperatively, uncorrected distance visual acuity was significantly lower in the FS200 group compared to others (P=0.0001). This difference disappeared at the 1- and 3-month postoperative visits. Significant differences were found among groups in terms of safety index (P=0.0001), residual sphere (P=0.0001) and residual cylinder (P=0.02) at the 3-months postoperative visit. No significant differences were found in corrected distance visual acuity or efficacy index. CONCLUSIONS According to our results, a slight delay in visual restoration after FS200 LASIK surgery might be expected. This delay was statistically significant at 1 day and 1 week postoperatively, but there were no differences from the 1-month visit onwards.

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Small incision lenticule extraction for the correction of high myopia

European Journal of Ophthalmology ◽

10.1177/1120672119861481 ◽

2019 ◽

Vol 30 (5) ◽

pp. 917-927

Author(s):

Suphi Taneri ◽

Saskia Kießler ◽

Anika Rost ◽

Tim Schultz ◽

H Burkhard Dick

Keyword(s):

Visual Acuity ◽

High Myopia ◽

Case Series ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Refractive Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Lenticule Extraction

Purpose: Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to −8 D with astigmatism of −3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis. Methods: Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾−8 or−3 to −7.75 D with astigmatism ⩽−3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better. Results: A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of −0.28 ± 0.41 D (range: −1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable. Conclusion: We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.

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Comparison of the Early Clinical Outcomes between Combined Small-Incision Lenticule Extraction and Collagen Cross-Linking versus SMILE for Myopia

Journal of Ophthalmology ◽

10.1155/2016/2672980 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Alex L. K. Ng ◽

Tommy C. Y. Chan ◽

George P. M. Cheng ◽

Vishal Jhanji ◽

Cong Ye ◽

...

Keyword(s):

Corneal Thickness ◽

Early Postoperative Period ◽

Safety Index ◽

Corrected Distance Visual Acuity ◽

Spherical Equivalent Refraction ◽

Lenticule Extraction ◽

Efficacy Index ◽

Bed Thickness ◽

The Mean ◽

And Control

Background. To compare the early outcome of combined SMILE and collagen crosslinking (SMILE Xtra) with SMILE.Method. Prospective, comparative interventional study of 21 eyes receiving SMILE Xtra using a low energy protocol and 32 control eyes receiving SMILE only. The outcomes were compared at 1, 3, and 6 months postoperatively.Results. Both groups had myopia with spherical equivalent refraction (SEQ) > 4.00 D. The SMILE Xtra group had thinner preoperative central corneal thickness and residual stromal bed thickness (p<0.021). At 6 months, no eyes lost more than 1 line in corrected distance visual acuity. The safety index was0.96±0.06and1.00±0.00in SMILE Xtra and control, respectively (p<0.001). 89% and 94% of eyes were within ±0.50 D of target refraction, respectively, with the mean error in SEQ correction being-0.17±0.26 D for SMILE Xtra and+0.03±0.25 D for control (p=0.021). The efficacy index was0.88±0.13and0.97±0.06, respectively (p=0.005).Conclusion. SMILE Xtra had good overall safety profile and predictability at 6 months. However, when compared with control, the safety index and efficacy index were statistically significantly lower in the early postoperative period.

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Myopic Laser-Assisted Subepithelial Keratectomy (LASEK) outcomes using three different excimer laser platforms: a retrospective observational study

BMC Ophthalmology ◽

10.1186/s12886-019-1214-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Isabel Rodríguez-Pérez ◽

Juan Gros-Otero ◽

Miguel A. Teus ◽

Rafael Cañones ◽

Montserrat García-González

Keyword(s):

Visual Acuity ◽

Excimer Lasers ◽

Distance Visual Acuity ◽

Refractive Outcomes ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Observational Cohort ◽

Efficacy Index ◽

Application Protocols ◽

Retrospective Observational Cohort Study

Abstract Background To compare the visual and refractive outcomes after myopic LASEK using three different excimer lasers and standardized surgical and mitomycin C (MMC) application protocols. Methods In this retrospective, observational cohort study, we examined 122 eyes treated with Allegretto, 135 eyes treated with Esiris and 137 eyes treated with Technolas excimer lasers. All eyes were treated under the same surgical protocol, and a standardized MMC dosage was used. The three groups were refraction-matched, and both visual and refractive outcomes were evaluated at 1 and 7 days and 1 and 3 months after surgery. Results At 3 months postsurgery, Allegretto provided significantly better outcomes than Esiris and Technolas in terms of postoperative uncorrected distance visual acuity (UDVA) (1.11 ± 0.2 vs 1.01 ± 0.2 vs 0.98 ± 0.2) (P = 0.0001), corrected distance visual acuity (CDVA) (1.13 ± 0.2 vs 1.10 ± 0.1 vs 1.04 ± 0.2) (P = 0.0001), residual sphere (− 0.01 ± 0.2 vs + 0.29 ± 0.7 vs + 0.27 ± 0.6) (P = 0.0001), and efficacy index (0.99 ± 0.2 vs 0.90 ± 0.2 vs 0.91 ± 0.2) (P = 0.0004). Conclusions We found slightly better visual and refractive outcomes in the Allegretto group at 3 months post-op after LASEK with MMC to correct myopia.

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Toric phakic IOLs in keratoconus—evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-020-05041-8 ◽

2021 ◽

Author(s):

Isaak R. Fischinger ◽

Jascha Wendelstein ◽

Kristin Tetz ◽

Matthias Bolz ◽

Manfred R. Tetz

Keyword(s):

Visual Acuity ◽

Anterior Chamber ◽

Intraocular Lenses ◽

Distance Visual Acuity ◽

Uncorrected Distance Visual Acuity ◽

Significant Difference ◽

Corrected Distance Visual Acuity ◽

Lens Implantation ◽

Efficacy Index ◽

The Mean

Abstract Purpose To evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus. Methods In this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed. Results The mean postoperative uncorrected distance visual acuity (UDVApost) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVApre), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVApost/CDVApre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia (n = 14) showed significantly (p = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus (n = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (p = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVApost. The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D (p < 0.001). No significant difference was found in endothelial cell count. Conclusion The results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.

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Small incision lenticule extraction (SMILE) monovision for presbyopia correction

European Journal of Ophthalmology ◽

10.5301/ejo.5001069 ◽

2017 ◽

Vol 28 (3) ◽

pp. 287-293 ◽

Cited By ~ 13

Author(s):

Nikolaus Luft ◽

Jakob Siedlecki ◽

Walter Sekundo ◽

Christian Wertheimer ◽

Thomas C. Kreutzer ◽

...

Keyword(s):

Visual Acuity ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Uncorrected Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Effective Option ◽

Near Visual Acuity ◽

Lenticule Extraction ◽

Target Refraction

Purpose: To evaluate the outcomes of myopic small incision lenticule extraction (SMILE) monovision in presbyopic patients. Methods: This study included 49 presbyopic patients older than 45 years seeking surgical correction of myopia or myopic astigmatism who underwent bilateral SMILE with planned monovision in the SMILE Eyes Clinic Linz, Austria. Target refraction was plano for dominant (distance) eyes and ranged between -1.25 and -0.50 D for nondominant (near) eyes. Best-corrected distance visual acuity, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity, as well as spectacle dependence were assessed after a mean postoperative period of 7.2 ± 4.8 months. Results: Mean age was 49 ± 3 years and female to male ratio was 30:19. Distance eyes achieved a spherical equivalent correction of ±0.50 D from target refraction in 80% of patients and 96% were within ±1.0 D. Binocular UDVA of 20/20 or better was achieved by 90% of patients and all patients achieved 20/25 or better. The proportion of patients with a binocular UDVA of 20/20 or better who could read J2 or better amounted to 84%. Complete spectacle independence was achieved by 84% of patients and independence from reading glasses was achieved in 92% of cases. No patient requested refractive enhancement or monovision reversal. Conclusions: This first evaluation of SMILE monovision endorses the approach as a safe and effective option for the correction of presbyopia in myopic patients seeking refractive surgery.

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Short-Term Outcomes of Small-Incision Lenticule Extraction (SMILE) for Low, Medium, and High Myopia

European Journal of Ophthalmology ◽

10.5301/ejo.5000849 ◽

2016 ◽

Vol 27 (2) ◽

pp. 153-159 ◽

Cited By ~ 12

Author(s):

Joaquín Fernández ◽

Almudena Valero ◽

Javier Martínez ◽

David P. Piñero ◽

Manuel Rodríguez-Vallejo

Keyword(s):

Visual Acuity ◽

High Myopia ◽

Small Incision Lenticule Extraction ◽

Distance Visual Acuity ◽

Small Incision ◽

Uncorrected Distance Visual Acuity ◽

Manifest Refraction ◽

Corrected Distance Visual Acuity ◽

Lenticule Extraction

Purpose To determine the safety, efficacy, and predictability of small-incision lenticule extraction at 6-month follow-up, depending on the level of the myopic refractive error. The surgeries were performed by a surgeon new to this technique. Methods Seventy-one subjects with a mean age of 31.86 ± 5.57 years were included in this retrospective observational study. Subjects were divided into 3 groups depending on the preoperative spherical equivalent (SE): low group from -1.00 D to -3.00 D, medium from -3.25 D to -5.00 D, and high from -5.25 D to -7.00 D. Manifest refraction, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) were measured before surgery and at 6 months after the treatment. Results In total, 1.4% of the eyes lost 1 line of CDVA after the procedure, whereas 95.8% remained unchanged and 2.8% gained 1 line. A significant undercorrection (p = 0.031) was found in the high myopia group (median -0.50 D), whereas the low and medium groups remained near to emmetropia. In terms of efficacy, no statistically significant intergroup differences for postoperative UDVA (p = 0.282) were found. The vector analysis also showed undercorrection of the preoperative cylinder, even though the standard deviations decreased from 0.9 D in the x axis and 0.7 D in the y axis to 0.24 D and 0.27 D, respectively. Conclusions Small-incision lenticule extraction might be a safe, effective, and predictable procedure even for inexperienced surgeons. No differences in efficacy were found among myopia levels even though undercorrections were found for SE and cylinder in high myopia.

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Implanting a posterior chamber phakic intraocular lens in highly myopic eyes with peripheral primary iris and ciliary body cysts

European Journal of Ophthalmology ◽

10.1177/1120672118766445 ◽

2018 ◽

Vol 29 (2) ◽

pp. 171-177 ◽

Cited By ~ 3

Author(s):

Jing Zhao ◽

Dongqiang Luo ◽

Yong Sun ◽

Lingling Niu ◽

Feng Zhao ◽

...

Keyword(s):

Visual Acuity ◽

Ciliary Body ◽

Posterior Chamber ◽

Safety Index ◽

Implantable Collamer Lens ◽

Distance Visual Acuity ◽

Corrected Distance Visual Acuity ◽

Efficacy Index ◽

Chamber Implantable

Purpose: To investigate the safety and efficacy of implanting a posterior chamber implantable collamer lens with a central hole in cases of high myopia with peripheral primary iris or ciliary body cysts. Methods: A total of 37 eyes of 19 patients with primary iris or ciliary body cysts detected by ultrasonic biological microscope were included, with spherical powers of −10.26 ± 3.28 D and cylinder powers of −1.71 ± 1.18 D. Each patient received ultrasonic biological microscope and a routine examination before implantation of the implantable collamer lens. A routine postoperative follow-up was performed to observe changes in the iris or ciliary body cyst, ranging from 3 to 18 months. Results: There were no complications. At the last follow-up, 56.8% (21/37) of eyes achieved the same corrected distance visual acuity as their preoperative measurements, 43.2% of eyes were enhanced by ≥1 line, and no patients’ corrected distance visual acuity declined. The efficacy index and safety index were 0.95 and 1.11, respectively. After 18 months, 66.7% of the spherical equivalents were between ±0.5 D with 100% between ±1.0 D. The postoperative mean spherical equivalents at 1, 3, 6, 12, and 18 months were −0.45 ± 0.31 D, −0.39 ± 0.29 D, −0.36 ± 0.30 D, −0.39 ± 0.38 D, and −0.48 ± 0.23 D (p = 0.789). The vaults were 516 ± 140, 548 ± 124, 498 ± 133, 582 ± 161, and 557 ± 110 μm (p = 0.355). There were no changes in size (p > 0.05), number, or position of the iris or ciliary body cysts. Conclusion: Implantable collamer lens implantation is safe and effective for highly myopic patients with peripheral primary iris and ciliary body cysts. The cysts did not change after operation in this study.

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Impact of Treatment Decentration on Higher-Order Aberrations after SMILE

Journal of Ophthalmology ◽

10.1155/2017/9575723 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Ying Yu ◽

Wenwen Zhang ◽

Xinliang Cheng ◽

Jianru Cai ◽

Hui Chen

Keyword(s):

Visual Acuity ◽

Spherical Aberration ◽

Higher Order ◽

Safety Index ◽

Higher Order Aberrations ◽

Wavefront Aberrations ◽

Corrected Distance Visual Acuity ◽

Lenticule Extraction ◽

Efficacy Index ◽

The Mean

Purpose. To evaluate decentration following femtosecond laser small incision lenticule extraction (SMILE) and sub-Bowman keratomileusis (SBK) and its impact on higher-order aberrations (HOAs). Methods. Prospective, nonrandom, and comparison study. There were 96 eyes of 52 patients who received SMILE and 96 eyes of 49 patients who received SBK in this study. Decentration was calculated 6 months after surgery with Pentacam. HOAs and visual acuity after the surgery were examined for patients in both groups before and 6 months after surgery. Results. The mean decentration displacement in SMILE group was significantly less than SBK group (P=0.020). 89 eyes were decentered within 0.50 mm after SMILE and SBK. The association between vertical decentration and the induced spherical aberration was insignificant in SMILE group (P=0.035). There was an association between decentration and safety index, efficacy index, vertical coma, spherical aberration, and HOAs in root mean square (RMS, μm) after SBK (all P<0.05). No difference was found in uncorrected and corrected distance visual acuity, safety index, efficacy index, and wavefront aberrations between the two subgroups at any delimited value after SMILE (all P>0.05). Decentration exceeding 0.37 mm affected vertical coma and RMSh of SBK eyes (P=0.002, 0.005). Conclusion. SMILE surgery achieved more accurate centration than SBK surgery. Vertical decentration is associated with the induced spherical aberration in SMILE.

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