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Enhancement of refractive outcomes of small-incision lenticule extraction via tear-film control

  • Refractive Surgery
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To suggest that tear film is a refractive outcome predictor in small-incision lenticule extraction (SMILE) for myopia and describe methods of controlling the tear film and its effects on refractive outcomes.

Methods

In this retrospective case–control study, the tear film was kept clear and appropriate in amount during tear-film-controlled SMILE (TFC-SMILE). In contrast, no special care to the tear film was given in direct-docking SMILE (DD-SMILE). Both procedures were performed by the same experienced surgeon, using the same surgical parameters, over defined periods. In select cases, scanning electron microscopy (SEM) of the lenticule and surgical videos of opaque bubble layers (OBLs) were obtained and compared.

Results

Forty-one eyes had DD-SMILE and 55 eyes had TFC-SMILE. Multivariate analysis showed that TFC-SMILE and the patient’s age were significant predictors of refractive outcomes. The refractive predictability of TFC-SMILE was better than that of DD-SMILE, and under-correction of high myopia was evident in the latter patients. The predictive errors of DD-SMILE became more myopic and variable during 1 year than those of TFC-SMILE. The lenticular surface on SEM was more serrated in DD-SMILE. Severe OBLs were evident in four cases of DD-SMILE and the OBL pattern was sporadic at the anterior surface of the lenticule.

Conclusions

The presence of a clear and appropriate tear film in SMILE enhanced predictability, minimized variability, and ensured stability of refractive outcomes. An uncontrolled tear film might render cutting imprecise and trigger severe OBL formation. TFC-SMILE had more predictable results than DD-SMILE.

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1607010116).

Author information

Authors and Affiliations

  1. SU Yonsei Eye Clinic, Seoul, Republic of Korea

    Il Hwan Koh, Seong Bae Park, Hun Yang & InSik Kim

  2. Department of Ophthalmology, Institute of Vision Research, Eye and Ear Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Kyoung Yul Seo

  3. Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea, 13496

    Sang Min Nam

Authors
  1. Il Hwan Koh
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  2. Kyoung Yul Seo
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  3. Seong Bae Park
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  4. Hun Yang
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  5. InSik Kim
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  6. Sang Min Nam
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Corresponding author

Correspondence to Sang Min Nam.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

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The authors declare that they have no conflict of interest.

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The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see:http://www.textcheck.com/certificate/0UrV39

Electronic supplementary material

Supplementary video

Comparison of direct-docking SMILE with tear-film-controlled SMILE. Video presentation for the tear-film-controlling procedure and severe opaque-bubble-layer in direct-docking SMILE. (MP4 155,320 kb)

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Koh, I.H., Seo, K.Y., Park, S.B. et al. Enhancement of refractive outcomes of small-incision lenticule extraction via tear-film control. Graefes Arch Clin Exp Ophthalmol 256, 2259–2268 (2018). https://doi.org/10.1007/s00417-018-4074-x

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  • DOI: https://doi.org/10.1007/s00417-018-4074-x

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