SMILE – Small Incision Lenticule Extraction

Steinwender, Gernot; Shajari, Mehdi; Mayer, Wolfgang J.; Kook, Daniel; Dirisamer, Martin; Kohnen, Thomas

doi:10.1055/a-1291-9041

Cited by 2 publications

(1 citation statement)

References 58 publications

(65 reference statements)

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“…Extensive studies have shown that compared with LASIK, SMILE results in less iatrogenic dry eye, less corneal nerve damage, fewer induced higher-order aberrations and avoids corneal flap-related complications. [14–16]…”

Section: Discussionmentioning

confidence: 99%

Corneal biomechanics after small incision lenticule extraction and femtosecond laser in situ keratomileusis: A systematic review and meta-analysis

Chen¹,

Zhao³

2023

Medicine

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Background: Small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK) have been extensively studied as the main surgical methods for corneal refractive surgery. However, there is no consensus on whether SMILE is superior to FS-LASIK in corneal biomechanics. Therefore, this systematic review and meta-analysis used the results of ocular response analyzer and corvis ST to explore whether SMILE is superior to FS-LASIK in corneal biomechanics. Methods: The literature was searched in PubMed, EMBASE, and Controlled Trials Register databases. The Cochrane Collaboration’s “risk of bias” tool was used to evaluate the quality of the included randomized clinical trials, and the Newcastle-Ottawa Scale was used to evaluate the included non-randomized controlled trials. The results were analyzed using Revman 5.3. Results: Sixteen studies (3 randomized clinical trials and 13 non-randomized controlled trials) were included in this meta-analysis. There was no statistical difference in corneal biomechanics between SMILE and FS-LASIK in corneal hysteresis [mean difference (MD), 0.20; 95% confidence interval (CI): −0.09, 0.49; P = .18] and corneal resistant factor (MD, 0.31; 95% CI: −0.09, 0.71; P = .13), A1 time (MD, −0.02; 95% CI: −0.11, 0.07; P = .66), A1 length (MD, 0.01; 95% CI: −0.01, 0.03; P = .42), A1 velocity (MD, 0.00; 95% CI: −0.01, 0.01; P = .85), A2 velocity (MD, −0.01; 95% CI: −0.11, 0.09; P = .86), HC time (MD, 0.12; 95% CI: −0.13, 0.38; P = .35), The stiffness parameter at first applanation (MD, −7.91; 95% CI: −17.96, 2.14; P = .12), The ratio between the deformation amplitude 2 mm away from apex and the apical deformation (MD, 0.01; 95% CI: −0.26, 0.27; P = .96). Conclusion: A comprehensive assessment of the parameters of ocular response analyzer and corvis ST showed that SMILE is not superior to LASIK in corneal biomechanics 3 months post-surgery.

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Section: Discussionmentioning

confidence: 99%

Corneal biomechanics after small incision lenticule extraction and femtosecond laser in situ keratomileusis: A systematic review and meta-analysis

Chen¹,

Zhao³

2023

Medicine

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Three patterns for identifying the posterior plane of a lenticule during SMILE

et al. 2023

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Purpose To describe three patterns of posterior plane edge identification in small-incision lenticule extraction and to prevent lenticule mis-dissection. Methods Femtosecond laser application was performed for small-incision lenticule extraction (SMILE) by one surgeon. The surgical videos of SMILE were recorded and re-watched by the surgeon after operation. Results Small-incision lenticule extraction was performed in 52 eyes of 28 patients, and no patient had cap-lenticular adhesion. Three patterns of posterior plane of lenticule were noticed when the surgical videos were re-watched. A “double lines” attached to the dissector were visible, signifying the reflective tape of the edge of the lenticule and the cap. During the expansion of the posterior lamellar separation, a fusiform opening between the lenticule edge and the underlying matrix layer was assumed to be a “leaf sign.” With some unintentional operation, the posterior lamella was pushed away from the surgeon. The edge of the lenticule away from the anatomical part, the marking of the femtosecond laser cut, and the edge of the cap layer showed three reflective bands, which formed a “triple lines.” The “double lines,” “leaf sign,” and “triple lines” were observed in 30 eyes (57.7%), 21 eyes (40.4%), and 1 eye (1.9%), respectively. Conclusion These three signs cover possible situations and provide visual landmarks to identify the correct dissection of the posterior plane, which can help shorten the learning curve of novice doctors.

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SMILE – Small Incision Lenticule Extraction

Cited by 2 publications

References 58 publications

Corneal biomechanics after small incision lenticule extraction and femtosecond laser in situ keratomileusis: A systematic review and meta-analysis

Corneal biomechanics after small incision lenticule extraction and femtosecond laser in situ keratomileusis: A systematic review and meta-analysis

Three patterns for identifying the posterior plane of a lenticule during SMILE

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