Dry Eye after Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis

Shen, Zeren; Zhu, Yanan; Song, Xiaohui; Yan, Jie; Yao, Ke

doi:10.1371/journal.pone.0168081

Cited by 39 publications

(32 citation statements)

References 32 publications

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“…We consider a procedure of the ReLEx SMILE type to be a method with a lesser influence on the quality of the lachrymal film, with a quicker return to the original values of osmolarity and potentially greater comfort for the patient malised in the group of patients who had undergone ReLEx SMILE. The ST value remained worsened in both groups, in the FS-LASIK group the OSDI also remained worsened [17].…”

Section: Resultsmentioning

confidence: 82%

Change of tear osmolarity after refractive surgery

Kacerovská¹,

Kacerovsky²,

Hlaváčková³

et al. 2018

CSO

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To compare the influence of the LASIK and ReLEx SMILE refractive method on tear osmolarity Methods: Prospective non-randomized comparative study. We evaluated the results in two groups of patients who underwent binocular refractive surgery to remove myopia and possibly astigmatism in the eye clinic of Horní Počernice. In each group were 15 patients (30 eyes), patients of one group undergoing FS-LASIK refractive surgery, in the second group a ReLEx SMILE procedure. Bilateral measurement of the tear film osmolarity using the TearLab instrument on the day of surgery, the first day after surgery, one month and 3 months after surgery was performed on each patient. Results: The mean preoperative value of the osmolarity of the tear film was practically the same in both groups, in the ReLEx SMILE group 294.9 ± 13.4 mOsm/l and in the FS-LASIK group 296.4 ± 13.1. One and three months after the surgery in the ReLEx SMILE group, these values increased to 301.4 and 296.4 ± 13.3 mOsm/l respectively, the elevation of values one month after surgery was statistically significant. In the FS-LASIK group, one month after surgery, the osmolarity was 320.1 ± 14.7, three months postoperatively 306.5 ± 13.1 mOsm / l. Both of these values compared to the preoperative value were statistically significantly higher. The increase of the mean osmolarity was statistically significantly higher in the FS-LA-SIK group compared to the ReLEx SMILE. Three months after surgery, the difference between groups was not statistically significant. Conclusion: In our group of patients, after the FS-LASIK refraction procedure, we noted a higher mean osmolarity of tear film in comparison with patients after the ReLEx SMILE in all evaluated timepoints (1 day, 1 month and 3 months after surgery). We consider ReLEx SMILE as a method with less impact on the quality of tear film, with a faster return to original osmolarity and potentially higher patient comfort.

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Section: Resultsmentioning

confidence: 82%

Change of tear osmolarity after refractive surgery

Kacerovská¹,

Kacerovsky²,

Hlaváčková³

et al. 2018

CSO

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“…This is in good accordance with the previously published literature. 8 – 12 Since 2016, five meta-analyses 8 – 12 have been conducted to assess possible differences in clinical outcomes when FS-LASIK and SMILE were used to correct myopia and myopic astigmatism, showing that FS-LASIK and SMILE were comparable in terms of efficacy, predictability, and safety. 8 , 9 However, it is noteworthy that there are only few studies, which have been conducted on patient satisfaction and dry eye symptoms with a self-reporting questionnaire.…”

Section: Discussionmentioning

confidence: 99%

“… 8 – 11 According to one recent meta-analysis, SMILE does not show superiority over FS-LASIK with similar and acceptable objective parameters, but SMILE may have milder subjective symptoms. 12 In this study, we investigated the factors affecting patient satisfaction in subjects who underwent FS-LASIK or SMILE for myopic eyes. Dry eye symptoms and patient satisfaction were reported in this real-life situation study in the self-questionnaire based on the visual analog scale (VAS) grading.…”

Section: Introductionmentioning

confidence: 99%

Uncorrected visual acuity, postoperative astigmatism, and dry eye symptoms are major determinants of patient satisfaction: a comparative, real-life study of femtosecond laser in situ keratomileusis and small incision lenticule extraction for myopia

Pietilä¹,

Huhtala²,

Mäkinen³

et al. 2018

OPTH

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PurposeTo compare factors affecting patient satisfaction after femtosecond laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia in the real-life situation study.MethodsThe SMILE group included 100 eyes (51 patients) and the FS-LASIK group 200 eyes (102 patients). In addition to clinical examination, dry eye symptoms and patient satisfaction with far and near vision were reported and graded on the visual analog scale preoperatively and one month after the operation. Case–control pairs were selected for the SMILE patients from FS-LASIK-treated patients to ensure the homogeneity in spherical equivalent refraction, preoperative dry eye, and visual satisfaction.ResultsEighty percent of SMILE eyes and 83% of FS-LASIK eyes achieved an uncorrected distance visual acuity of 20/20 or better. Predictability (±0.5 D of mean target spherical equivalent refraction) was 91% in SMILE and 93.5% in FS-LASIK. No eyes lost two or more Snellen lines of corrected distance visual acuity. Based on case–control pairs, dry eye symptoms remained the same after one month in the FS-LASIK-treated eyes (P=0.87) but decreased in the SMILE-treated eyes (P=0.01) compared with the preoperative situation. Patient satisfaction with far vision improved significantly in both groups (P<0.001), but satisfaction with near vision improved significantly only in FS-LASIK (P<0.001) and not in SMILE (P=0.58). There was more postoperative astigmatism in SMILE in comparison with FS-LASIK (P=0.002).ConclusionsIn a real-life situation, patients with preoperative dry eye experience were often directed to the SMILE operation, which resulted in beneficial decrease in their dry eye symptoms. Patient satisfaction with far vision decreased with increasing dry eye symptoms and postoperative astigmatism in both SMILE- and FS-LASIK-treated emmetropic patients. Safety, efficacy, and predictability were comparable in both treatments.

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“…Many studies, including meta-analyses, found that SMILE is less invasive to the corneal nerves and reduces the incidence of postoperative dry eye compared to femtosecond LASIK. [28][29][30] In these studies, dry eye symptoms and TBUT were significantly better in SMILE; however, the Schirmer values and tear osmolality did not differ between LASIK and SMILE. The postoperative tear secretion after SMILE determined by the Schirmer test varied among the previous studies.…”

Section: Mechanisms Involved In Post-lasik Dry Eyementioning

confidence: 98%

Dry Eye After LASIK

Toda

2018

Invest. Ophthalmol. Vis. Sci.

113

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Post-LASIK dry eye is the most common postoperative dry eye after ophthalmic surgeries. The clinical signs of post-LASIK dry eye include positive vital staining of the ocular surface, decreased tear breakup time and Schirmer test values, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs usually last for about 1 month after LASIK. A small number of patients continue to experience symptoms more than 1 year postoperatively. It has been suggested that the loss of corneal innervation caused by flapmaking is the major cause, affecting the corneal-lacrimal gland, corneal-blinking, and blinkingmeibomian gland reflexes, resulting in decreased aqueous and lipid tear secretion and mucin expression. A new type of corneal refractive surgery, SMILE, which has less impact on corneal nerves, induces less postoperative dry eye, supporting the association between corneal denervation and postoperative dry eye. As LASIK enhancement by flap-lifting induces fewer dry eye symptoms and signs than initial surgery, factors other than neurotrophic effects may be involved in the mechanisms of post-LASIK dry eye. Post-LASIK ocular surface pain is a type of postoperative chronic pain and discomfort, and is thought to be a different clinical entity from dry eye, possibly induced by abnormal reinnervation or neural sensitization of peripheral nerves and the central nervous system after LASIK. Treatments include tear supplements, anti-inflammatory agents, meibomian gland dysfunction management, ointment and eye patches, punctal plugs, and autologous serum eye drops. For patients with preoperative dry eye, careful patient selection, and preoperative ocular surface management are mandatory.

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Dry Eye after Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis

Cited by 39 publications

References 32 publications

Change of tear osmolarity after refractive surgery

Change of tear osmolarity after refractive surgery

Uncorrected visual acuity, postoperative astigmatism, and dry eye symptoms are major determinants of patient satisfaction: a comparative, real-life study of femtosecond laser in situ keratomileusis and small incision lenticule extraction for myopia

Dry Eye After LASIK

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