Small-incision lenticule extraction for the correction of myopic astigmatism

Taneri, Suphi; Kießler, Saskia; Rost, Anika; Schultz, Tim; Dick, H. Burkhard

doi:10.1016/j.jcrs.2018.08.030

Cited by 29 publications

(15 citation statements)

References 27 publications

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“…In all cases, care was taken to align the patient with the laser bed and to avoid head tilt to minimize rotational alignment errors as we have described recently. 15 To clarify, a manual rotation of the eye after docking as proposed by Ganesh et al 16 was not performed. The right eye was always treated first.…”

Section: Surgical Techniquementioning

confidence: 99%

Small incision lenticule extraction for the correction of high myopia

Taneri

Kießler

Rost

et al. 2019

European Journal of Ophthalmology

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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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Section: Surgical Techniquementioning

confidence: 99%

Small incision lenticule extraction for the correction of high myopia

Taneri

Kießler

Rost

et al. 2019

European Journal of Ophthalmology

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“…21 Undercorrection was noted in both SMILE and LASIK for high astigmatism correction, but better outcome was noted in LASIK for low-to-moderate astigmatism correction. 22,23…”

Section: Factors Affecting Astigmatism Correction Using Smilementioning

confidence: 99%

Astigmatism Correction Using SMILE

Chow

Lee

et al. 2019

Asia-Pacific Journal of Ophthalmology

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Small incision lenticule extraction (SMILE) was introduced in the recent decade for the treatment of myopia and myopic astigmatism. This flap-free technique has a high efficacy and safety profile and also carries potential advantages over laser in situ keratomileusis such as a better corneal biomechanical stability, reduction in dry eyes rate, and the avoidance of flap complications. However, there have been concerns regarding the precision of astigmatism correction that undercorrection has been reported to be apparent. Various factors that affect astigmatism correction have been identified in the literature. The purpose of this review is to discuss the factors that affect astigmatism correction in SMILE and several techniques to improve the refractive outcomes.

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“…5,6 In 2018, the US FDA approved SMILE for the treatment of myopic astigmatism from >−0.50 to ≤−3.00 diopters (D), 7 and the use of SMILE for this indication has since been further investigated. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Previous studies on the treatment of astigmatism with SMILE have found that it is safe and effective, but these studies were conducted outside of the United States. Our study will assess a single site's initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes with FDA results and published literature.…”

Section: Introductionmentioning

confidence: 99%

<p>Initial Single-Site Experience Using SMILE for the Treatment of Astigmatism in Myopic Eyes and Comparison of Astigmatic Outcomes with Existing Literature</p>

Moshirfar¹,

Thomson²,

West³

et al. 2020

OPTH

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Purpose To assess a single site’s initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature. Patients and Methods Forty-eight eyes (29 patients) with mean preoperative sphere of −5.11 ± 1.31 diopters (D) and cylinder of −1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >−0.50 to ≤−3.00 D. Results At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to −0.38 ± 0.38 D with 78.1% achieving ≤±0.50 D. Uncorrected distance visual acuity (UDVA) ≥20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of <−1.00 D, ≥−1.00 to <−2.00 D, and ≥−2.00 D, respectively. Mean angle of error was −1.58 ± 11.61° ranging from −24.22° to 37.75°. Conclusion We found SMILE to be an effective and safe means of achieving spectacle independence and improving visual acuity in patients with myopic astigmatism. SMILE has the potential for improved clinical outcomes with better nomogram guidance and advancements in technique. However, surgeons must be aware of the potential for undercorrection in with-the-rule astigmatism and at higher preoperative cylinders and as well as the potential for overcorrection in against-the-rule and lower preoperative cylinder astigmatism.

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Small-incision lenticule extraction for the correction of myopic astigmatism

Cited by 29 publications

References 27 publications

Small incision lenticule extraction for the correction of high myopia

Small incision lenticule extraction for the correction of high myopia

Astigmatism Correction Using SMILE

<p>Initial Single-Site Experience Using SMILE for the Treatment of Astigmatism in Myopic Eyes and Comparison of Astigmatic Outcomes with Existing Literature</p>

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