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Impact of the preoperative cylinder on astigmatism correction in femtosecond lenticule extraction (FLEX): a prospective observational study

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

Abstract

Purpose

To explore the impact of the preoperative manifest cylinder on astigmatism correction via femtosecond lenticule extraction (FLEX), or small incision lenticule extraction (SMILE).

Methods

This was a prospective observational study. Eyes were categorized into mild (n = 88), moderate (n = 46), and severe (n = 53) astigmatism groups, based on the preoperative manifest cylinder. Vector analysis was conducted with the back vertex distance set at 12 mm. The primary outcome was the correction index (CI), with secondary outcomes including the safety, efficacy, predictability, and vectoral alterations related to FLEX.

Results

The average target-induced astigmatism was 0.45 ± 0.20 D, 0.95 ± 0.17 D, and 1.99 ± 0.65 D in the three groups (P < 0.001), and the average CI was 1.12± 0.05, 1.01 ± 0.03, and 0.95 ± 0.02 (P = 0.020), with the severe astigmatism group displaying a notably lower CI. The efficacy, safety, predictability, or stability of FLEX did not demonstrate any significant differences among the three groups. The CIs exhibited a significant difference in eyes with with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism from the mild to severe astigmatism group. In eyes with oblique astigmatism, the average CI exceeded one.

Conclusion

Patients with manifest cylinder exceeding 1.25 D have a heightened risk of under-correction in WTR and ATR astigmatism compared to those with mild astigmatism, and mild over-correction may occur in cases of oblique astigmatism.

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Author notes

  1. Xiuyu Mao and Han Chen contributed equally to this work and were listed as coauthors.

Authors and Affiliations

  1. Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China

    Xiuyu Mao, Yinzhen Zhao, Shunmei Ji & Jinhui Dai

  2. Department of Ophthalmology, Eye & ENT Hospital Affiliated to Fudan University, Shanghai, 200031, China

    Xiuyu Mao, Han Chen & Shunmei Ji

  3. Fujian Provincial Hospital, Fuzhou, 350001, China

    Han Chen

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Contributions

XM, HC, and JD: conception and design; XM and HC: data acquisition and analysis; XM and SJ: writing the manuscript and data interpretation; XM, HC, SJ, and JD: critical revision of the manuscript. All authors gave final approval of the manuscript.

Corresponding author

Correspondence to Jinhui Dai.

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Ethics approval

The study adhered to the Declaration of Helsinki, and written informed consent was obtained from all the patients. The ethics committee approved this prospective study of the Eye and Ear, Nose, and Throat (EENT) Hospital of Fudan University (No. KJ 2008-10).

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The authors declare no competing interests.

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Mao, X., Chen, H., Zhao, Y. et al. Impact of the preoperative cylinder on astigmatism correction in femtosecond lenticule extraction (FLEX): a prospective observational study. Graefes Arch Clin Exp Ophthalmol 262, 631–639 (2024). https://doi.org/10.1007/s00417-023-06211-0

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