Association Between Corneal Deformation and Ease of Lenticule Separation From Residual Stroma in Small Incision Lenticule Extraction

Shetty, Rohit; Kaweri, Luci; Pahuja, Natasha; Deshpande, Kalyani; Thakkar, Maithil; Roy, Abhijit Sinha

doi:10.1097/ico.0000000000000463

Cited by 8 publications

(5 citation statements)

References 19 publications

(40 reference statements)

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“…Inclusion criteria were patients undergoing 6-month follow-up after the procedure with preoperative spherical equivalent (SE) between -1 D and -7 D and astigmatism under 3.5 D, stable myopia for at least 1 year before surgery, and CDVA of 20/25 or better. Exclusion criteria were pregnancy at time of surgery or follow-up, a preoperative central corneal thickness of less than 480 µm, an expected postoperative residual stromal bed of less than 250 µm, topographic map compatible with subclinical keratoconus or other ectatic corneal disorder, and any other ocular disease for which laser refractive surgery procedures are not indicated (15). The procedure was explained to all the patients who signed the preoperative informed consent, and the study complied with the tenets of the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

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

Fernández¹,

Valero²,

Martínez³

et al. 2016

European Journal of Ophthalmology

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Section: Methodsmentioning

confidence: 99%

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

Fernández¹,

Valero²,

Martínez³

et al. 2016

European Journal of Ophthalmology

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“…As SMILE essentially retains the anterior stromal architecture, it would be expected that the strongest part of the cornea will continue to contribute and maintain its strength post‐operatively. Of interest, Shetty et al recently described a relationship between corneal deformation and the ease of lenticule separation. Against this, Agca et al found no difference between LASIK and SMILE cohorts in terms of biomechanical parameters.…”

Section: Patient Selectionmentioning

confidence: 99%

Small incision lenticule extraction (SMILE) in 2015

Chan

Lawless

Sutton

et al. 2016

Clinical and Experimental Optometry

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Small incision lenticule extraction (SMILE) represents a recent addition to the refractive surgeon's range of procedures. Although there remains a number of similarities to existing techniques in terms of patient selection and treatment parameters, consideration is required to optimise patient outcomes and satisfaction. Here, we review the selection criteria, contraindications, indications and existing published safety and efficacy outcomes.

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“…Small OZ leaves limited space for morphological adaptation. In addition, biomechanical weakening of the cornea indicates less resistance to corneal deformation (18). We suspect that the correction of more severe myopia, accompanied by thicker lenticule and thinner RBT, makes it more difficult to retain corneal biomechanics or maintain corneal shape.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Observation of Higher-Order Aberrations and Microdistortions in Bowman’s Layer After Small Incision Lenticule Extraction for the Correcting Myopia With Spherical Equivalent Higher Than −9.0 Diopters

et al. 2022

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PurposeTo evaluate the outcomes in corneal higher-order aberrations (HOAs) and microdistortions in the Bowman’s layer after femtosecond laser small incision lenticule extraction (SMILE) for correcting extremely high myopia.MethodsThis prospective study included patients with myopia with spherical equivalent ≥ -9.0 Diopters (D). SMILE was performed in forty eyes of 40 patients. Pentacam was used to evaluate HOAs before and at 1 day, 3 months, 6 months, and 2 years after surgery. Fourier-domain optical coherence tomography was used to evaluate microdistortions at 2 years postoperatively. Thirty-two eyes of 32 patients receiving femtosecond laser-assisted in situ keratomileusis (FS-LASIK) were enrolled as the control group. HOAs were measured before, at 1 day and at least 1 year postoperatively.ResultsAfter SMILE, the long-term safety and effectiveness index was 1.25 and 0.85, respectively. Microdistortions were observed in 73.5% of the eyes at 2 years, with an average number of 1.20 ± 1.22 microdistortions and an average width of 287.37 ± 259.00 μm. We detected more microdistortions in the horizontal meridian than in the vertical meridian (p = 0.035). The average number and width of microdistortions were both higher in the central region (≤4 mm) than in the peripheral region (4–8 mm) (both p < 0.001). With the exception of horizontal trefoil in the SMILE group and vertical trefoil in the FS-LASIK group, significant changes over time were observed in all other HOAs (all p < 0.05). Meanwhile, we detected significant increases in the total corneal HOA, spherical aberration (SA), and coma at all time-points after both surgeries (all p < 0.01). Compared with FS-LASIK, SMILE induced less SA (p < 0.001) and more horizontal coma (p = 0.036). In the SMILE group, the HOA, SA, and trefoil were more in the small optical zone (≤6.0 mm) than in the large optical zone (>6.0 mm) (all p < 0.05). The increase in SA and most trefoil correlated with the mean number of central microdistortions number (all p < 0.05).ConclusionFor myopia over −9.0D, the microdistortions in the Bowman’s layer were still detectable in most eyes long-term after SMILE. Both SMILE and FS-LASIK induced more HOAs, mainly HOA, SA, and coma. The small optical zone and microdistortions may affect postoperative aberrations.

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Association Between Corneal Deformation and Ease of Lenticule Separation From Residual Stroma in Small Incision Lenticule Extraction

Abstract: CD was inversely correlated with the ease of lenticule separation from the residual stroma and may assist in customization of the energy parameters of the laser.

Cited by 8 publications

References 19 publications

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

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

Small incision lenticule extraction (SMILE) in 2015

Long-Term Observation of Higher-Order Aberrations and Microdistortions in Bowman’s Layer After Small Incision Lenticule Extraction for the Correcting Myopia With Spherical Equivalent Higher Than −9.0 Diopters

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