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Visual recovery after small incision lenticule extraction (SMILE) in relation to pre-operative spherical equivalent

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

Abstract

Purpose

To assess visual recovery after small incision lenticule extraction (SMILE) in relation to pre-operative spherical equivalent.

Methods

Two hundred fourteen eyes of 107 patients were enrolled. Following surgery, patients were examined pre-operatively, 1 day, 2 weeks, 1 month and 3 months later. High myopia was defined as pre-operative spherical equivalent ≤ − 5 D. A linear mixed-effects model was used.

Results

Mean ± standard deviation pre-operative spherical equivalent was − 5.30 ± 1.36 D that reduced significantly to 0.04 ± 0.70 D (p < 0.001) at 1 month and − 0.02 ± 0.66 D (p < 0.001) at 3 months. Mean pre-operative LogMAR uncorrected distance visual acuity ± SD was 0.97 ± 0.09 that improved significantly to 0.04 ± 0.06 at 2 weeks (p < 0.001), 0.01 ± 0.04 at 1 month (p < 0.001) and 0.01 ± 0.04 at 3 months (p < 0.001). Eighty-eight eyes (41.2%) had uncorrected distance visual acuities of 0.0 at 1 day, 154 eyes (72.0%) at 2 weeks,194 eyes (90.7%) at 1 month and 199 eyes (93.0%) at 3 months. Significantly more eyes with low myopia (> − 5 D) achieved acuities of 0.0 at 1 day and 2 weeks (p = 0.041 and p < 0.001). Post-operative acuities were not associated with refractive targets, laser cut energy settings or other variables. Two hundred nine eyes (97.7%) were within ± 0.5 D of target and 213 eyes (99.5%) were within ± 1 D.

Conclusions

SMILE for low myopia had faster visual recovery in the early post-operative period with no significant differences between groups detected by 1 and 3 months.

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Notes

  1. SMILE – laser vision correction. Carl Zeiss Meditec AG website. https://www.zeiss.com/meditec/int/c/smile/laser-vision-correction.html. Accessed April 18th, 2020

References

  1. Ang EK, Couper T, Dirani M et al (2009) Outcomes of laser refractive surgery for myopia. J Cataract Refract Surg 35:921–933

    Article  Google Scholar 

  2. Sekundo W, Kunert KS, Blum M (2011) Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol 95:335–339. https://doi.org/10.1136/bjo.2009.174284

    Article  PubMed  Google Scholar 

  3. Liu M, Chen Y, Wang D et al (2016) Clinical outcomes after SMILE and femtosecond laser-assisted LASIK for myopia and myopic astigmatism: a prospective randomized comparative study. Cornea 35:210–216

    Article  CAS  Google Scholar 

  4. Zhang Y, Shen Q, Jia Y et al (2016) Clinical outcomes of SMILE and FS-LASIK used to treat myopia: a meta-analysis. J Refract Surg 32:256–265

    Article  Google Scholar 

  5. Shah R, Shah S, Sengupta S (2011) Results of small incision lenticule extraction: all-in-one femtosecond laser refractive surgery. J Cataract Refract Surg 37:127–137

    Article  Google Scholar 

  6. Mohamed-Noriega K, Riau AK, Lwin NC et al (2014) Early corneal nerve damage and recovery following small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). Invest Ophthalmol Vis Sci 55:1823–1834

    Article  Google Scholar 

  7. Wu D, Wang Y, Zhang L et al (2014) Corneal biomechanical effects: small incision lenticule extraction versus femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg 40:954–962. https://doi.org/10.1016/j.jcrs.2013.07.056

    Article  PubMed  Google Scholar 

  8. Reinstein DZ, Archer TJ, Randleman JB (2013) Mathematical model to compare the relative tensile strength of the cornea after PRK, Lasik and small incision lenticule extraction. J Refract Surg 29:454–460

    Article  Google Scholar 

  9. Sinha Roy A, Dupps WJ Jr, Roberts CJ (2014) Comparison of biomechanical effects of small incision lenticule extraction and laser in situ keratomileusis: finite element analysis. J Cataract Refract Surg 40:971–980

    Article  Google Scholar 

  10. Seven I, Vahdati A, Pedersen IB et al (2017) Contralateral eye comparison of SMILE and flap-based corneal refractive surgery: computational analysis of biomechanical impact. J Refract Surg 33:444–453

    Article  Google Scholar 

  11. Ganesh S, Brar S, Arra RR (2018) Refractive lenticule extraction small incision lenticule extraction: a new refractive surgery paradigm. Indian J Ophthalmol 66:10–19. https://doi.org/10.4103/ijo.IJO_761_1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Seet B, Wong TY, Tan DT et al (2001) Myopia in Singapore: taking a public health approach. Br J Ophthalmol 85:521–526

    Article  CAS  Google Scholar 

  13. Tay E, Bajpai R (2020) Small incision lenticule extraction (SMILE) lenticule thickness readout compared to change in axial length measurements with the IOLMaster. Graefes Arch Clin Exp Ophthalmol 258:917–924. https://doi.org/10.1007/s00417-019-04529-2

    Article  PubMed  Google Scholar 

  14. Wu HM, Seet B, Yap EP et al (2001) Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Optom Vis Sci 78:234–239

    Article  CAS  Google Scholar 

  15. Na KS, Chung SH, Kim JK et al (2012) Comparison of LASIK and surface ablation by using propensity score analysis: a multicenter study in Korea. Invest Ophthalmol Vis Sci 53:7116–7121

    Article  Google Scholar 

  16. Kaiserman I, Sadi N, Mimouni M et al (2017) Corneal breakthrough haze after photorefractive keratectomy with mitomycin C: incidence and risk factors. Cornea 36:961–966. https://doi.org/10.1097/ICO.0000000000001231

    Article  PubMed  Google Scholar 

  17. Vestergaard A, Ivarsen A, Asp S et al (2013) Femtosecond (FS) laser vision correction procedure for moderate to high myopia: a prospective study of ReLEx(®)flex and comparison with a retrospective study of FS-laser in situ keratomileusis. Acta Ophthalmol 91:355–362. https://doi.org/10.1111/j.1755-3768.2012.02406.x

    Article  PubMed  Google Scholar 

  18. Shah R, Shah S (2011) Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery. J Cataract Refract Surg 37:1636–1647. https://doi.org/10.1016/j.jcrs.2011.03.056

    Article  PubMed  Google Scholar 

  19. Agca A, Ozgurhan EB, Yildirim Y et al (2014) Corneal backscatter analysis by in vivo confocal microscopy: fellow eye comparison of small incision lenticule extraction and femtosecond laser-assisted LASIK. J Ophthalmol:265012. https://doi.org/10.1155/2014/265012

  20. Donate D, Thaëron R (2019) SMILE with low energy levels: assessment of early visual and optical quality recovery. J Refract Surg 35:285–293. https://doi.org/10.3928/1081597X-20190416-01

    Article  PubMed  Google Scholar 

  21. Donate D, Thaëron R (2016) Lower energy levels improve visual recovery in small incision Lenticule extraction (SMILE). J Refract Surg 32:636–642. https://doi.org/10.3928/1081597X-20160602-01

    Article  PubMed  Google Scholar 

  22. Ji YW, Kim M, Kang DSY et al (2017) Lower laser energy levels lead to better visual recovery after small-incision lenticule extraction: prospective randomized clinical trial. Am J Ophthalmol 179:159–170. https://doi.org/10.1016/j.ajo.2017.05.005

    Article  PubMed  Google Scholar 

  23. Shetty R, Shroff R, Kaweri L et al (2016) Intra-operative cap repositioning in small incision lenticule extraction (SMILE) for enhanced visual recovery. Curr Eye Res 41:1532–1538. https://doi.org/10.3109/02713683.2016.1168848

    Article  PubMed  Google Scholar 

  24. Liu YC, Jayasinghe L, Ang HP et al (2015) Effect of intraoperative corneal stromal pocket irrigation in small incision lenticule extraction. Biomed Res Int 2015:928608. https://doi.org/10.1155/2015/928608

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kind R, Kiraly L, Taneri S et al (2019) Flushing versus not flushing the interface during small-incision lenticule extraction. J Cataract Refract Surg 45:562–568. https://doi.org/10.1016/j.jcrs.2018.12.001

    Article  PubMed  Google Scholar 

  26. Kim WS, Jo JM (2001) Corneal hydration affects ablation during laser in situ keratomileusis surgery. Cornea 20:394–397

    Article  CAS  Google Scholar 

  27. Zhong Y, Li M, Han T et al (2020) Four-year outcomes of small incision lenticule extraction (SMILE) to correct high myopic astigmatism. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2019-315619

  28. Wang Y, Ma J, Zhang J et al (2017) Incidence and management of intraoperative complications during small-incision lenticule extraction in 3004 cases. J Cataract Refract Surg 43:796–802. https://doi.org/10.1016/j.jcrs.2017.03.039

    Article  PubMed  Google Scholar 

  29. Wong CW, Chan C, Tan D et al (2014) Incidence and management of suction loss in refractive lenticule extraction. J Cataract Refract Surg 40:2002–2010. https://doi.org/10.1016/j.jcrs.2014.04.031

    Article  PubMed  Google Scholar 

  30. Sambhi RS, Sambhi GDS, Mather R et al (2020) Dry eye after refractive surgery: a meta-analysis. Can J Ophthalmol 55:99–106. https://doi.org/10.1016/j.jcjo.2019.07.005

    Article  PubMed  Google Scholar 

  31. Kobashi H, Kamiya K, Shimizu K (2017) Dry eye after small incision lenticule extraction and femtosecond laser-assisted LASIK: meta-analysis. Cornea 36:85–91

    Article  Google Scholar 

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Authors and Affiliations

  1. Singapore Eye Research Institute, The Academia, 20 College Road, Singapore, 169856, Singapore

    Eugene Tay

  2. School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK

    Ram Bajpai

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Correspondence to Eugene Tay.

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Tay, E., Bajpai, R. Visual recovery after small incision lenticule extraction (SMILE) in relation to pre-operative spherical equivalent. Graefes Arch Clin Exp Ophthalmol 259, 1053–1060 (2021). https://doi.org/10.1007/s00417-020-04954-8

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