Comparison of visual acuity, higher-order aberrations and corneal asphericity after refractive lenticule extraction and wavefront-guided laser-assisted in situ keratomileusis for myopia

Kamiya, Kazutaka; Shimizu, Kimiya; Igarashi, Akihito; Kobashi, Hidenaga; Komatsu, Mari

doi:10.1136/bjophthalmol-2012-302047

Cited by 46 publications

(50 citation statements)

References 29 publications

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“…25 [31]. Other reports on ReLEx smile [11,12,15,16] and 500-kHz ReLEx flex [17][18][19][20][21] have found very similar refractive outcomes in smaller numbers of patients.…”

Section: Refractive Outcomementioning

confidence: 81%

“…In these studies, both ReLEx flex and LASIK were found to increase the total corneal or whole-eye HOAs; however, ReLEx flex induced less spherical aberration than LASIK. Furthermore, in LASIK the induced HOAs were found to increase with the degree of attempted refractive correction, whereas in ReLEx flex no such correlation was found [19]. Parallax error during excimer laser photoablation has been suggested as an explanation for the observed differences in induced spherical aberration after LASIK and ReLEx flex [19].…”

Section: Higher Order Aberrations (Hoas) and Contrast Sensitivitymentioning

confidence: 98%

“…Most existing studies on ReLEx flex or ReLEx smile are too small to properly evaluate the safety of the procedure, and the frequency of a two-line loss in CDVA has been reported to lie between 0 and 8 % (Table 1) [10,11,[15][16][17][18][19][20][21]. In one study on 279 eyes after ReLEx smile, 0.4 % of eyes were reported to have a loss of two or more lines [12].…”

Section: Safety and Complicationsmentioning

confidence: 99%

“…Only three studies have compared the induced HOAs after ReLEx flex and LASIK [19] or FS-LASIK [17,23]. In these studies, both ReLEx flex and LASIK were found to increase the total corneal or whole-eye HOAs; however, ReLEx flex induced less spherical aberration than LASIK.…”

Section: Higher Order Aberrations (Hoas) and Contrast Sensitivitymentioning

confidence: 99%

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All-Femtosecond Laser Keratorefractive Surgery

Ivarsen

Hjortdal

2013

Curr Ophthalmol Rep

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During the last few years, refractive lenticule extraction (ReLEx) has been introduced as a new approach in the field of keratorefractive surgery. In contrast to previous treatments, ReLEx is an all-femtosecond laser treatment where a refractive lenticule is created within the intact cornea. The lenticule can be removed using a flapbased approach (ReLEx flex), but in its latest evolution (ReLEx smile), the lenticule is extracted through a small peripheral incision, leaving most of the anterior stroma untouched. In theory, this approach should spare most of the corneal nerves and minimize the biomechanical impact of the procedure. Clinical studies have shown the safety and the visual and refractive outcomes after ReLEx to be as good as after FS-LASIK. The current article aims to provide an up-to-date overview of all-femtosecond laser keratorefractive surgery with particular emphasis on the most current of approach, ReLEx smile.

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“…25 [31]. Other reports on ReLEx smile [11,12,15,16] and 500-kHz ReLEx flex [17][18][19][20][21] have found very similar refractive outcomes in smaller numbers of patients.…”

Section: Refractive Outcomementioning

confidence: 81%

Section: Higher Order Aberrations (Hoas) and Contrast Sensitivitymentioning

confidence: 98%

Section: Safety and Complicationsmentioning

confidence: 99%

Section: Higher Order Aberrations (Hoas) and Contrast Sensitivitymentioning

confidence: 99%

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All-Femtosecond Laser Keratorefractive Surgery

Ivarsen

Hjortdal

2013

Curr Ophthalmol Rep

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“…2,3,[8][9][10][11][12][13][14] In one study on 279 eyes after SMILE, 0.4 % of eyes were reported to have a loss of two or more lines. 3 By contrast, a 2.4 % risk for a two-line loss was found in 670 eyes by Hjortdal et al 6 However, in the same study, a safety index (CDVA before/CDVA after surgery) of 1.07±0.22 was found, indicating that CDVA on average increased after surgery, as would be expected because of the image magnification of myopic keratorefractive procedures.…”

Section: Safetymentioning

confidence: 99%

New Developments in the Lenticule Extraction Procedure

Hjortdal¹,

Ivarsen²

2014

European Ophthalmic Review

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31Over the last few years, surgical extraction of a refractive lenticule, or ReLEx ® , has evolved as a new treatment in the field of keratorefractive surgery. Currently, the VisuMax ® femtosecond (FS) laser (Carl Zeiss Meditec, Jena, Germany) is the only platform to offer this treatment.The 500 kHz VisuMax laser generates very fast pulses (10 -15 s range) in the near-infrared spectrum. Depending on the specific laser settings, each pulse conveys approximately 150 nJ, which causes localised photodisruption at the focal point. The generated plasma expands, creating a cavitation bubble, and, as individual cavitation bubbles fuse, the stroma is cut with a minimum of collateral damage. The VisuMax FS laser uses a high numerical aperture and a concave contact glass to focus the laser pulses with very high precision. Thus, laser spots of approximately 1 μm diameter are placed with a defined distance of 2-5 μm in a spiral pattern. To ensure centration on the visual axis, the patient fixates on a blinking light and suction is applied at the limbus to maintain stability of the eye. Initially, the posterior refractive surface of the lenticule is cut, followed by creation of the plano anterior surface, which is slightly enlarged in diameter to facilitate surgical manipulation.This review article reviews the current state of the technique, updated clinical results, 1 experimental studies and, finally, presents some of the challenges that need to be addressed by new technologies.Depending on the method used to access the lenticule, ReLEx can be split into FLEx, in which a laser-assisted in situ keratomileusis ( In contrast to LASIK, ReLEx is a one-laser approach, where the critical laser treatment is performed on the intact cornea rather than on exposed corneal stroma. Consequently, the potential variability associated with the excimer laser photoablation is avoided.In addition, the minimally invasive SMILE treatment has several theoretical advantages over flap-based treatments, including little trauma to the corneal surface, less corneal denervation and better biomechanical strength due to an almost intact anterior stroma. Since AbstractFor the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism.Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualise...

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