scholarly journals Small Incision Lenticule Extraction (SMILE) for Moderate and High Myopia: Seven-Year Outcomes of Refraction, Corneal tomography and Wavefront Aberrations

2019 ◽  
Author(s):  
Fei Xia ◽  
Yang Shen ◽  
Tian Han ◽  
Jing Zhao ◽  
Hai-Peng Xu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Spherical Aberration ◽  
Case Series ◽  
Final Visit ◽  
Small Incision Lenticule Extraction ◽  
Wavefront Aberrations ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Uncorrected Distance Visual Acuity ◽  
Lenticule Extraction

Abstract Background To investigate the long-term corneal stability and wavefront aberrations after small incision lenticule extraction (SMILE) for moderate and high myopia.Methods Prospective, non-consecutive case series. A total of 26 patients (42 eyes) who underwent SMILE from May 2010 to March 2013 at the Fudan University Eye and ENT Hospital (Shanghai, China) were enrolled. The periods of follow-up were 1 month, 1 year, 5 years and 7 years after surgery. The routine eye examinations included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction and corneal topography.Results All surgeries were executed without any complications. At the final visit, a UDVA of 20/20 or better was achieved in 42 eyes (100%), 21 eyes (50%) exhibited no change in CDVA. 15 eyes (36%) gained one line, 6 eyes (14%) gained two lines, and no eyes lost CDVA lines. 93% and 100% of eyes were within ±0.5 D and ±1.00 D of the target refraction, respectively. A mean refractive regression of -0.17 D was observed between 1 month and 7 years postoperatively. Mean corneal front curvature (KMF) were significantly increased between pre- and post-SMILE surgery (P<0.0001). Higher-order aberrations (HOAs) and vertical coma were significantly increased after SMILE compared to those measured before surgery (all P<0.001). There were no significant differences in horizontal coma, trefoil and spherical aberration between pre- and post-SMILE surgery (all P>0.05).Conclusions SMILE is an effective, safe and stable procedure for myopia correction, with relatively constant corneal stability and wavefront aberrations.

scholarly journals Small Incision Lenticule Extraction (SMILE) for Moderate and High Myopia: Seven-Year Outcomes of Refraction, Corneal Tomography, and Wavefront Aberrations

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Fei Xia ◽  
Yang Shen ◽  
Tian Han ◽  
Jing Zhao ◽  
Haipeng Xu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
High Myopia ◽  
Spherical Aberration ◽  
Final Visit ◽  
Small Incision Lenticule Extraction ◽  
Wavefront Aberrations ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Lenticule Extraction ◽  
Corneal Tomography

Purpose. To investigate the long-term outcomes of refraction, corneal tomography, and wavefront aberrations after small incision lenticule extraction (SMILE) for moderate and high myopia. Methods. Prospective, nonconsecutive case series. A total of 26 patients (26 eyes) who underwent SMILE from May 2010 to March 2013 at the Fudan University Eye and ENT Hospital (Shanghai, China) were enrolled. The periods of follow-up were 1 month, 1 year, 5 years, and 7 years after surgery. The routine eye examinations included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Results. All surgeries were executed without any complications. At the final visit, an UDVA of 20/20 or better was achieved in 26 eyes (100%) and 11 eyes (42%) exhibited no change in CDVA. 9 eyes (35%) gained one line, 6 eyes (23%) gained two lines, and no eyes lost CDVA. 24 eyes (92%) and 26 eyes (100%) were within ±0.5 D and ±1.00 D of the target refraction, respectively. A mean refractive regression of −0.17 D was observed between 1 month and 7 years postoperatively. Mean corneal front curvature (MCFC) was significantly decreased between pre- and post-SMILE surgery (P<0.0001). Higher-order aberrations (HOAs) and vertical coma were significantly increased after SMILE compared to those measured before surgery (all P<0.001). There were no significant differences in trefoil and spherical aberration between pre- and post-SMILE surgery (all P>0.05). Conclusion. SMILE is an effective, safe, and stable procedure for moderate and high myopia, with relatively constant corneal stability and wavefront aberrations. This trial is registered with ChiCTR-ONRC-13003114.

Small incision lenticule extraction for the correction of high myopia

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.

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

2019 ◽  
Vol 30 (6) ◽  
pp. 1278-1286 ◽  
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.

scholarly journals Corneal Spherical Aberration and Corneal Asphericity after Small Incision Lenticule Extraction and Femtosecond Laser-Assisted LASIK

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Hui Zhang ◽  
Yan Wang ◽  
Hua Li
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Spherical Aberration ◽  
Laser In Situ Keratomileusis ◽  
Anterior Surface ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Corneal Asphericity ◽  
Lenticule Extraction

Purpose. To investigate corneal spherical aberration and corneal asphericity after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Methods. This study enrolled 70 patients having SMILE and 64 subjects receiving FS-LASIK. The preoperative spherical equivalent (SE) was −5.83 ± 1.23 diopters (D) and −6.20 ± 1.52 D, respectively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), SE, corneal spherical aberration, and asphericity over the 6.0 mm cornea were evaluated preoperatively and postoperatively. Results. At 6 months, the UDVA, CDVA, and SE were −0.12 ± 0.11, −0.05 ± 0.05, and −0.16 ± 0.19 D in SMILE and −0.10 ± 0.06, −0.03 ± 0.06, and −0.08 ± 0.25 D in FS-LASIK. There was no difference between groups in the postoperative UDVA, CDVA, or SE (P>0.05). SMILE showed lower inductions of spherical aberration along the anterior surface and the total cornea and less increases in corneal asphericity of the anterior surface postoperatively than FS-LASIK (P<0.01). There were significant correlations between the changes in spherical aberration and corneal asphericity (P<0.001). Conclusions. SMILE and FS-LASIK exhibited excellent visual results and refractive outcomes. SMILE induced less increase in corneal spherical aberration and better preserved the corneal asphericity of the anterior corneal surface than FS-LASIK. Corneal asphericity changes contributed to the corneal spherical aberration changes following SMILE and FS-LASIK.

scholarly journals Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Tamer H. Massoud ◽  
Osama Ibrahim ◽  
Kitty Shehata ◽  
Moones F. Abdalla
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Refractive Outcomes ◽  
Laser Vision ◽  
Lenticule Extraction ◽  
The Mean ◽  
Myopic Astigmatism

Purpose. To evaluate the visual and refractive outcomes after small incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism after penetrating keratoplasty (PKP).Design. Case-series.Methods. Ten eyes of 10 patients with previous PKP and residual myopic astigmatism for whom pentacam imaging and thickness measurements were acceptable for laser vision correction. Manifest refraction (MR), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained preoperatively and one day, one week, and one, 3, and 6 months postoperatively. Cases were operated on the VisuMax® femtosecond laser platform with 500 kHz repetition rate.Results. The mean correction ratio for spherical errors was0.84±0.19 D and for the mean refractive spherical equivalent (MRSE) was0.79±0.13 D. Vector analysis showed a mean astigmatism reduction at the intended axis of67±25.25%, a correction index of0.81±0.21, and an overall mean percentage of success of astigmatism surgery of53±37.9%. The postoperative MRSE was stable throughout the 6-month follow-up period. The efficacy index was 0.93 and the safety index was 1.12.Conclusion. SMILE for correction of post-PKP myopia and astigmatism is effective, safe, and stable with moderate accuracy and predictability. Centration of the treatment within the grafts was easily performed.

scholarly journals A Case Report Of Retained Lenticules After SMILE Surgery

2019 ◽  
Author(s):  
YangCheng Zou ◽  
Kaiwei Cao ◽  
Ting Yu ◽  
Ji Bai ◽  
Ting Liu
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Female Patient ◽  
Separation Method ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Uncorrected Distance Visual Acuity ◽  
Second Surgery ◽  
Lenticule Extraction

Abstract A 28-year-old female patient (right eye: -3.75DS, left eye: -4.00DS) underwent bilateral small incision lenticule extraction. One week after small incision lenticule extraction, her left eye uncorrected distance visual acuity (UDVA) did not reach her preoperative best corrected distance visual acu¬ity (BCDVA) as expected. Examination confirmed that corneal stromal lens fragments remained in the left eye. The lens fragments were removed with a second surgery, and the patient's vision was restored to her preoperative BCDVA. The results of this case yield the following suggestions: ① The lens separation method must be gentle and performed in the same plane. ② It is necessary to confirm the integrity of the lens after the lens is removed.

scholarly journals Small incision lenticule extraction (SMILE) monovision for presbyopia correction

2017 ◽  
Vol 28 (3) ◽  
pp. 287-293 ◽  
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.

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

2016 ◽  
Vol 27 (2) ◽  
pp. 153-159 ◽  
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.

scholarly journals Impact of extreme (flat and steep) keratometry on the safety and efficacy of small incision lenticule extraction (SMILE)

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nikolaus Luft ◽  
Jakob Siedlecki ◽  
Franziska Reinking ◽  
Wolfgang J. Mayer ◽  
Benedikt Schworm ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Spherical Aberration ◽  
Spherical Equivalent ◽  
Small Incision Lenticule Extraction ◽  
Safety And Efficacy ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Department Of Ophthalmology ◽  
Corrected Distance Visual Acuity ◽  
Lenticule Extraction

AbstractLittle is known about the connection between preoperative keratometry and postoperative results of myopic small-incision lenticule extraction (SMILE). To determine the influence of extreme (flat and steep) corneal keratometry on the safety and efficacy of SMILE, the databases of the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, and SMILE Eyes Linz, Austria, were screened for patients with steep and flat keratometry who had undergone SMILE. In this cross-sectional matched comparative cohort study, eyes with markedly flat (< 42.0 diopters; D) or steep (≥ 47.0D) preoperative corneal keratometry were matched to a cohort of eyes with regular keratometry (42.0–46.9D) by preoperative manifest refractive spherical equivalent and cylinder, age, corrected distance visual acuity and surgical SMILE parameters. The standardized graphs and terms for refractive surgery results were applied to compare the three groups. Changes in higher order aberrations (HOAs) were evaluated on Scheimpflug imaging. In total, 63 eyes (21 each) of 54 patients with a mean refractive spherical equivalent of  − 5.21 ± 1.59 D were followed up for a mean of 9.2 ± 6.1 (minimum ≥ 3) months. Mean baseline keratometry was 41.3 ± 0.7D (flat), 45.5 ± 1.0D (regular) and 47.7 ± 0.6D (steep) (p < 0.0001). Compared to the regular group, the flat and the steep cornea group resulted in a non-inferior percentage of eyes within ± 0.50 D of target refraction (p = 0.20), uncorrected distance visual acuity (p = 0.95) and corrected distance visual acuity (p = 0.20). Flat corneas however experienced a stronger induction of spherical aberration (SA) compared to the steep group (p = 0.0005). In conclusion, non-inferior outcomes of SMILE can also be expected in eyes with steep (≥ 47D) or flat (< 42D) preoperative keratometry, while SMILE however induces more SA in eyes with a flat keratometry.

scholarly journals Corneal Safety and Stability in Cases of Small Incision Lenticule Extraction with Collagen Cross-Linking (SMILE Xtra)

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Ihab Mohamed Osman ◽  
Hany Ahmed Helaly ◽  
Mohsen Abou Shousha ◽  
Amir AbouSamra ◽  
Islam Ahmed
Keyword(s):  
Visual Acuity ◽  
Cross Linking ◽  
Small Incision Lenticule Extraction ◽  
Distance Visual Acuity ◽  
Small Incision ◽  
Corneal Densitometry ◽  
Lenticule Extraction ◽  
Safety And Stability ◽  
Collagen Cross Linking

Purpose. To assess the safety and stability in cases of small incision lenticule extraction with collagen cross-linking (SMILE Xtra). Methods. This study was a retrospective interventional comparative study that included 60 eyes of 30 patients divided equally into two groups: SMILE Xtra and SMILE alone. The inclusion criteria were patients >18 years of age, myopic error >6 D, thinner cornea <520 microns, and abnormal corneal topography. Outcome data were recorded including uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness, average keratometry, endothelial cell density, corneal resistance factor (CRF), and corneal densitometry. The follow-up period was 24 months. Results. There was a significant difference between the 2 groups regarding UDVA, CDVA, and MRSE at 1 month. In the SMILE Xtra group, 90% of eyes had postoperative UDVA of 20/20 and 97% had UDVA of 20/30 at 24 months. At 24 months, 26 eyes (87%) vs. 25 eyes (84%) were within ±0.50 D of attempted correction in SMILE Xtra and SMILE groups, respectively. Regarding stability, both groups showed improvement of MRSE at 1st month postoperatively and remained stable along the 24 months of follow-up. CRF and corneal densitometry were higher in the SMILE Xtra group along the whole follow-up period (p=0.001). Conclusion. Combining corneal cross-linking with SMILE procedure (SMILE Xtra) is a promising tool to prevent ectasia in high-risk patients. It is a safe and simple procedure that can be offered to patients undergoing SMILE with risk for ectasia. Trial registration no: PACTR201810577524718.

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