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Repeatability and reproducibility of corneal higher-order aberrations measurements after small incision lenticule extraction using the Scheimpfug-Placido topographer

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Eye and Vision 2024年第1期10卷 1-9页

作者： Rui Ning Rongrong Gao David PPiñero Jun Zhang Qingyi Gao Yili Jin Yiran Wang Chenxiao Wang Jinhai Huang Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical UniversityWenzhouZhejiangChina Eye Institute and Department of Ophthalmology Eye and ENT HospitalFudan UniversityShanghaiChina Group of Optics and Visual Perception Department of OpticsPharmacology and AnatomyUniversity of AlicanteAlicanteSpain NHC Key Laboratory of Myopia(Fudan University) Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghaiChina Shanghai Research Center of Ophthalmology and Optometry ShanghaiChina

Background:To evaluate the precision of corneal higher-order aberrations measurements after small incision lenticule extraction(SMILE)using the Sirius Scheimpfug-Placido topographer(CSO,Italy).Methods:Seventy-fve eyes from 75 postoperative subjects were included in this prospective study.Three consecutive corneal aberrometric measurements were obtained with the Scheimpfug-Placido topographer by two experienced operators to assess intra-and inter-observer reproducibility.The within-subject standard deviation(Sw),test-retest repeatability(TRT)and the intraclass correlation coefcient(ICC)were calculated.Results:For intraobserver repeatability of anterior and total corneal aberrations,all ICCs were more than 0.922,except for trefoil(0.722 to 0.768).The ICCs of total root mean square(RMS),coma Z(3,±1),and spherical aberration Z(4,0)were over 0.810 while higher-order RMS,trefoil Z(3,±3),and astigmatism II Z(4,±2)were below 0.634 for posterior corneal surface aberrations.All Sw values for all types of aberrations were equal to or below 0.07μm.Regarding interobserver reproducibility,all TRT values were no more than 0.12μm,0.05μm,and 0.11μm for anterior,posterior,and total corneal aberrations,respectively.The ICC values ranged from 0.875 to 0.989,from 0.686 to 0.976 and over 0.834 for anterior,posterior,and total corneal aberrations,respectively.Conclusions:The repeatability of measurements of anterior and total corneal aberrations with the Sirius system in corneas after SMILE surgery was high,except for trefoil.There was some variability in posterior corneal aberrometric measurements.High reproducibility of corneal aberrometric measurements was observed between measurements of both examiners,except for trefoil,with poor to moderate reproducibility.

关键词： Sirius Higher-order aberrations Repeatability Reproducibility small incision lenticule extraction

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Changes in posterior corneal elevation after small incision lenticule extraction for different myopic diopters

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International Journal of Ophthalmology(English edition) 2024年第3期17卷 491-498页

作者： Xiao-Tong Sun Yang Zhang Xiao-Kun Mei Nan-Nan Zheng Ling-Zhi Niu Xiao-Li Qu Ai-Ping Song Jian Zhuo Department of Ophthalmology the First Affiliated Hospital of Shandong First Medical UniversityShandong Provincial Qianfoshan HospitalJinan 250014Shandong ProvinceChina

●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.

关键词： myopia posterior corneal elevation corneal ectasia small incision lenticule extraction

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Ten-year observation of corneal densitometry and associated factors following small incision lenticule extraction

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International Journal of Ophthalmology(English edition) 2024年第3期17卷 485-490页

作者： Xiao-Song Han Fei Xia Zhuo-Yi Chen Pei-Jun Yao Dong-Mei Yang Jing Zhao Xing-Tao Zhou Eye Institute and Department of Ophthalmology Eye&ENT HospitalFudan UniversityShanghai 200031China NHC Key Laboratory of Myopia(Fudan University) Key Laboratory of MyopiaChinese Academy of Medical SciencesShanghai 200031China Shanghai Research Center of Ophthalmology and Optometry Shanghai 200031China Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care(20DZ2255000) Shanghai 200031China

●AIM:To investigate the long-term changes of corneal densitometry(CD)and its contributing elements after small incision lenticule extraction(SMILE).●METHODS:Totally 31 eyes of 31 patients with mean spherical equivalent of-6.46±1.50 D and mean age 28.23±7.38y were enrolled.Full-scale examinations were conducted on all patients preoperatively and during followup.Visual acuity,manifest refraction,axial length,corneal thickness,corneal higher-order aberrations,and CD were evaluated.●RESULTS:All surgeries were completed successfully without complications or adverse events.Ten-year safety index was 1.17±0.20 and efficacy 1.04±0.28.CD value of 0–6 mm zones in central layer was statistically significantly lower 10y postoperatively,compared with preoperative values(0–2 mmΔ=-1.62,2–6 mmΔ=-1.24,P<0.01).There were no correlations between CD values and factors evaluated.●CONCLUSION:SMILE is a safe and efficient procedure for myopia on a long-term basis.CD values get lower 10y postoperatively,whose mechanism is to be further discussed.

关键词： myopia small incision lenticule extraction corneal densitometry

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small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity:case series

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International Journal of Ophthalmology(English edition) 2023年第2期16卷 301-308页

作者： Zhi Fang Xiao-Ying He Wei Han Department of Eye Center the Second Affiliated HospitalZhejiang University School of MedicineHangzhou 310009Zhejiang ProvinceChina Zhejiang Provincial Key Lab of Ophthalmology Hangzhou 310009Zhejiang ProvinceChina

AIM:To report the safety,efficacy,and accuracy of small-incision lenticule extraction(SMILE)or femtosecondassisted laser in situ keratomileusis(FS-LASIK)for the correction of myopia or myopic astigmatism in patients with deep corneal opacity denoted by anterior segment optical coherence tomography(AS-OCT).METHODS:Four patients with monocular corneal opacity(3 due to mechanical injury,1 due to a firecracker wound)were recruited and treated with refractive surgery(3 for SMILE,1 for FS-LASIK combined with limbal relaxing incision(LRI).Preoperative ocular manifestations,surgical details,postoperative visual outcomes,corneal opacity parameters,and corneal topography were analyzed.RESULTS:Preoperatively,spherical diopter ranged from-3.0 D to-4.75 D with cylinder ranging from-0.75 to-5.0 D,and corrected distance visual acuity(CDVA)ranging from 20/25 to 20/20.One eye’s corneal opacity was located in the central zone and three were in the mid-peripheral optical zone.Three patients underwent uneventful SMILE in both eyes,whilst one patient underwent FS-LASIK for high astigmatism in both eyes and LRI in the right eye.CDVA of the eye with corneal opacity ranged from 20/22to 20/20 one to six weeks postoperatively.Two patients achieved better CDVA and no patients lost Snellen lines.The postoperative diopter was within±0.75 D for all eyes.Significant edema existed above the corneal opacity in one eye and dissipated soon.No eccentric corneal topography or morphological anomaly of the corneal cap or flap was observed.CONCLUSION:The cases demonstrate that SMILE or FS-LASIK is safe and effective to treat myopic astigmatism combined with deep corneal opacity lesions after comprehensive preoperative evaluation and appropriate candidate selection.FS-LASIK combined with LRI is also sufficient for correcting high astigmatism due to corneal scarring.

关键词： small incision lenticule extraction femtosecond-assisted laser in situ keratomileusis corneal opacity

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Simple method of measuring ocular rotation in supine position during small incision lenticule extraction

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International Journal of Ophthalmology(English edition) 2022年第8期15卷 1331-1337页

作者： Jiho Song Hwanho Lee Moon Sun Jung Jae-hyung Kim Seoul Daabom Eye Center CheongjuChungbuk 28396Republic of Korea Department of Ophthalmology Chungbuk National University HospitalCollege of MedicineChungbuk National UniversityCheongjuChungbuk 28644Republic of Korea

AIM:To introduce a novel measurement method of static cyclotorsion in small incision lenticule extraction(SMILE)and to investigate the effect of preoperative parameters on cyclotorsion and the effect of cyclotorsion on postoperative outcomes.METHODS:The medical records of 242 patients and 484 eyes who under went SMILE surger y were retrospectively reviewed.Preoperative intraocular pressure,refractive error,and corneal thickness were investigated.Refractive values and visual acuity were measured at 1d,1,3,and 6mo.Ocular cyclotorsion in the supine position was measured by calculating the location and angle of the incision site of the cornea in the anterior slit photograph taken after surgery.RESULTS:Of the total 484 eyes in 242 patients,preopera tive means phericale quivalent(SE)was-4.10±1.64 D,and the mean astigmatism was-0.82±0.74 D.Uncorrected distance visual acuity(UCVA)and SE improved significantly after the surgery.Moreover,219(45.2%)eyes had excyclotorsion,235(48.6%)eyes had incyclotorsion,and 30(6.2%)eyes had no torsion.The right eyes tended to be excyclotorted,and the left eyes tended to be incyclotorted(Psmaller the preoperative sphere,the higher the amount of cyclotorsion(r=0.11,P=0.016).There was no significant association between the amount of cyclotorsion and preoperative astigmatism.There was no correlation between sex,preoperative corneal thickness,preoperative intraocular pressure,amount of cyclotorsion,and direction of cyclotorsion.The ratio of right eye excyclotorsion and left eye incyclotorsion on 1d was higher than that at 1,3,and 6mo(all P<0.01).There was no difference between the 1,3,and 6mo results in the right and left eyes(P=0.15,P=0.16,respectively).CONCLUSION:The newly devised ocular cyclotorsion measurement method can be used to evaluate ocular cyclotorsion after SMILE.Preoperative SE is associated with the amount of cycl

关键词： anterior slit photograph astigmatism cyclotorsion myopia small incision lenticule extraction

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Comparative study of functional optical zone:small incision lenticule extraction versus femtosecond laser assisted excimer laser keratomileusis

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International Journal of Ophthalmology(English edition) 2023年第2期16卷 238-244页

作者： Yao-Wen Song Meng-Fan Cui Yi Feng Min Qu Yan Gao Rui He Department of Excimer Laser Shanxi Eye HospitalTaiyuan 030002Shanxi ProvinceChina The First Clinical Medical College Shanxi Medical UniversityTaiyuan 030001Shanxi ProvinceChina

AIM:To investigate the size of functional optical zone(FOZ)after small incision lenticule extraction(SMILE)versus femtosecond laser assisted excimer laser keratomileusis(FS-LASIK)for myopia correction and potential associated factors for FOZ.METHODS:A total of 133 patients who received corneal refractive surgery in our hospital between November 2018 and July 2021 were retrospectively enrolled.There were 63 patients(123 eyes)in SMILE group and 70patients(139 eyes)in FS-LASIK group.The size of FOZ was measured using Pentacam 3-dementional anterior segment analyzer before and 3mo after surgery,so as to analyze postoperative achieved functional optical zone(AFOZ)and its contributing parameters.RESULTS:When planned functional optical zone(PFOZ)was 6.5 mm for both groups,AFOZ was 1.45±0.27 and 1.67±0.25 mm smaller than preoperative FOZ in SMILE group and FS-LASIK group 3mo after surgery.AFOZ in SMILE group was significantly larger than that in FS-LASIK group(Psmaller than preoperative FOZ in both SMILE and FS-LASIK groups.With the same PFOZ,larger AFOZ is achieved in SMILE group than in FS-LASIK group.

关键词： functional optical zone small incision lenticule extraction femtosecondlaser assisted excimer laser keratomileusis spherical equivalent spherical aberration

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small incision lenticule extraction(SMILE)in the correction of myopic astigmatism:outcomes and limitations-an update

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Eye and Vision 2017年第1期4卷 151-158页

作者： Jorge L.Aliódel Barrio Verónica Vargas Olena Al-Shymali Jorge L.Alió Cornea Cataract and Refractive Surgery UnitVissum CorporaciónAlicanteSpain Division of Ophthalmology School of MedicineUniversidad Miguel HernándezAlicanteSpain

small incision lenticule extraction(SMILE)is a flap-free intrastromal technique for the correction of myopia and myopic astigmatism.To date,this technique lacks automated centration and cyclotorsion control,so several concerns have been raised regarding its capability to correct moderate or high levels of astigmatism.The objective of this paper is to review the reported SMILE outcomes for the correction of myopic astigmatism associated with a cylinder over 0.75 D,and its comparison with the outcomes reported with the excimer laser-based corneal refractive surgery techniques.A total of five studies clearly reporting SMILE astigmatic outcomes were identified.SMILE shows acceptable outcomes for the correction of myopic astigmatism,although a general agreement exists about the superiority of the excimer laser-based techniques for low to moderate levels of astigmatism.Manual correction of the static cyclotorsion should be adopted for any SMILE astigmatic correction over 0.75 D.

关键词： small incision lenticule extraction SMILE Astigmatism Refractive surgery

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Postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens implantation versus small incision lenticule extraction in myopic eyes:a Meta-analysis

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International Journal of Ophthalmology(English edition) 2023年第3期16卷 442-452页

作者： Hong-Yu Li Zi Ye Zhao-Hui Li Medical School of Chinese PLA Beijing 100853China Senior Department of Ophthalmology the Third Medical Center of PLA General HospitalBeijing 100853China

AIM:To compare the postoperative efficacy,safety,predictability,and visual quality of implantable collamer lens(ICL)implantation versus small incision lenticule extraction(SMILE)in myopia eyes.METHODS:Pub Med,EMBASE,Web of Science,Cochrane Library and several Chinese databases were searched at May 2021 to select relevant studies in comparison of clinical outcomes between ICL implantation and SMILE for myopia.The primary outcomes were efficacy,safety,and predictability.And the secondary outcomes were postoperative higher-order ocular aberrations(HOAs),modulation transfer function cutoff frequency(MTF),objective scatter index(OSI),contrast sensitivity and a quality of vision(Qo V)questionnaire.RESULTS:A total of 1036 eyes from 10 studies,of which 503 eyes underwent ICL implantation and 533 eyes underwent SMILE,were enrolled in this Meta-analysis.Pooled results revealed that ICL group had a better safety index and post-corrected distance visual acuity(CDVA)(P=0.007,6mo),ICL group had a lower total HOA,coma,and spherical aberration than SMILE group(P=0.003,<0.00001,0.04).Yet higher trefoil was found in ICL group at 6mo after surgery(P=0.003).Additionally,ICL group also had a higher MTF value(P=0.02),and a higher contrast sensitivity score for spatial frequencies of 1.5,6,and 12 cpds(P=0.02,0.005,0.02,respectively).And it also had a lower score of bothersome in Qo V questionnaire than SMILE group(P=0.003).CONCLUSION:ICL implantation and SMILE have similar and comparable outcomes in term of the efficacy and predictability for correcting high myopia.However,ICL group is relatively safer and also has better visual quality in comparison of SMILE group.

关键词： implantable collamer lens small incision lenticule extraction myopia refractive surgery Meta-analysis

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A 3-month comparison study of subjective and objective visual quality of small incision lenticule extraction and transepithelial photorefractive keratectomy in patients with low and moderate myopia

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International Journal of Ophthalmology(English edition) 2023年第4期16卷 608-615页

作者： Li-Xiang Wang Xiao-Li Wang Jing Tang Ke Ma Hong-Bo Yin Ying-Ping Deng Department of Ophthalmology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Ophthalmology the People’s Hospital of Jianyang CityChengdu 641400Sichuan ProvinceChina

AIM:To compare the subjective and objective visual quality between small incision lenticule extraction(SMILE)and transepithelial photorefractive keratectomy(t PRK)in patients with low and moderate myopia.METHODS:Patients undertaking SMILE or t PRK for the correction of low and moderate myopia were consecutively recruited in this prospective cohort study with a 3-month follow-up period.Objective evaluation[visual acuity test,manifest refraction,wavefront aberrations,the total cut-off value of the total modulation transfer function(MTFcut-off),and Strehl ratio(SR)]and subjective evaluation of visual quality(quality-of-life questionnaire)were conducted before surgery and at days 1,7,30,and 90 after surgery.RESULTS:A total of 47 patients(94 eyes)with SMILE and 22 patients(22 eyes)with t PRK were enrolled.The uncorrected visual acuity(UCVA)was better in SMILE patients on day 7 after surgery(1.13±0.13 vs 0.99±0.17,t=4.85,P<0.001)but was comparable at days 30 and 90.At day 90,the SMILE group had a lower spherical equivalent(SE)than the t PRK group(0.04±0.31 vs 0.19±0.43,t=2.08,P=0.042).Total higher order aberrations(HOAs)were induced in both surgical types,which were more evident in the t PRK group with 3-mm pupil diameter(0.16±0.07 vs0.11±0.05,t=4.27,P<0.001)and 5-mm pupil diameter(0.39±0.17 vs 0.36±0.11,t=2.33,P=0.022).The MTFcut-offand SR showed a trend of improvement in both SMILE and t PRK patients but were statistically better in the SMILE group with both pupil diameters.There was a significant improvement of contrast sensitivity(CS)over baseline levels at the spatial frequency of 18 cycles/degree(c/d)in the SMILE group(F=2.72,P=0.033)and at 3 c/d(F=3.03,P=0.031),12 c/d(F=3.72,P=0.013),and 18 c/d(F=4.62,P=0.004)in the t PRK group.The subjective quality of life questionnaire showed a steady improvement in the SMILE group(F=8.31,P<0.001)but not the t PRK group.CONCLUSION:SMILE and t PRK are both safe and effective ways to correct low and moderate myopia.A generally better and quicker recovery of visual quality favor

关键词： corneal refractive surgery small incision lenticule extraction transepithelial photorefractive keratectomy myopia visual quality

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Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery:a surgery assisted by fibrin glue

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International Journal of Ophthalmology(English edition) 2023年第4期16卷 547-553页

作者： Jiao-Lian Liu Jia-Yue Ji Qing Ye Liu-Qing Wei Xin Zhong Lin-Zhi Jiang Jing Zeng Department of Ophthalmology the First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi Zhuang Autonomous RegionChina Department of Ophthalmology Hubei Provincial Hospital of Integrated Chinese and Western MedicineWuhan 430015Hubei ProvinceChina Department of Ophthalmology Fangchenggang First People’s HospitalFangchenggang 538001Guangxi Zhuang Autonomous RegionChina

AIM:To observe the clinical efficacy of the combined use of small incision lenticule extraction(SMILE)-derived lenticule patches in corneal dermoid excision,with fixation of the lenticule patches assisted by fibrin glue.METHODS:Seventeen eyes of 17 patients with corneal dermoid were treated with dermoid removal combined with SMILE-derived lenticule transplantation.All lenticule patches were fixed by fibrin glue.Ocular changes were assessed using slit lamp microscopy and anterior-segmental optical coherence tomography.The best-corrected visual acuity(BCVA)and ocular dioptric variations were examined preoperatively and postoperatively.Intraocular pressure(IOP)was also monitored in all visited time.RESULTS:Totally,18 lenticule patches were used on 17 eyes of 17 cornea dermoid patients.The mean follow-up time was 11.47±5.28mo.All lenticule patches we resuccessfullyg lued,kept on its location and maintained transparent during the follow-up time,with a consecutive epithelial cover for 1wk.Nine of the patients could coordinate visual and optometry exam well.Their preoperative BCVA is 0.60±0.35 in decimal,significantly improved to 0.80±0.26 in decimal at 6mo postoperatively(Z=-2.392,P=0.017),but the changes of their corneal astigmatism diopters showed no significance,with 2.22±1.91 D preoperatively,and 2.28±1.31 D at 6mo postoperatively(Z=-0.135,P=0.893).Limbal pannus formation occurred in 4(23.52%)cases and decreased with the application of tacrolimus eyedrops.IOP increased in 2(11.76%)cases,but well decreased by timolol maleate eyedrops.All the adult patients or guardians of minor patients were satisfied with the cosmetic improvement.CONCLUSION:Dermoid excision combined with transplantation of SMILE-derived lenticule patches using fibrin glue is a safe and effective novel tectonic keratoplasty procedure for corneal dermoid.

关键词： corneal dermoid small incision lenticule extraction fibrin glue

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