Comparison of Four Different VisuMax Circle Patterns for Flap Creation After Small Incision Lenticule Extraction

Riau, Andri K.; Ang, Heng Pei; Lwin, Nyein Chan; Chaurasia, Shyam S.; Tan, Donald; Mehta, Jodhbir S.

doi:10.3928/1081597x-20130318-02

Cited by 59 publications

(40 citation statements)

References 29 publications

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“…In all eyes, the S-size contact glass was used and the laser was activated for photodissection in the following sequence. [18] The posterior surface of the refractive lenticule (spiral in) was created, after which the lenticule border was created. The anterior surface of the refractive lenticule (spiral out) was formed, extending beyond the posterior lenticule diameter by 0.5 mm to form the anterior flap.…”

Section: Methodsmentioning

confidence: 99%

Intraoperative centration during small incision lenticule extraction (SMILE)

Wong

Htoon

et al. 2017

Medicine

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To evaluate intraoperative decentration from pupil center and kappa intercept during small incision lenticule extraction (SMILE) and its impact on visual outcomes.This was a retrospective noncomparative case series. A total of 164 eyes that underwent SMILE at the Singapore National Eye Center were included. Screen captures of intraoperative videos were analyzed. Preoperative and 3 month postoperative vision and refractive data were analyzed against decentration.The mean preoperative spherical equivalent (SE) was −5.84 ± 1.77. The mean decentration from the pupil center and from kappa intercept were 0.13 ± 0.06 mm and 0.47mm ± 0.25 mm, respectively. For efficacy and predictability, 69.6% and 95.0% of eyes achieved a visual acuity (VA) of 20/20 and 20/30, respectively, while 83.8% and 97.2% of eyes were within ±0.5D and ±1.0D of the targeted SE. When analyzed across 3 groups of decentration from the pupil center (<0.1 mm, 0.1–0.2 mm, and >0.2 mm), there was no statistically significant association between decentration, safety, efficacy, and predictability. When analyzed across 4 groups of decentration from kappa intercept (<0.2 mm, 0.2–<0.4 mm, 0.4–<0.6 mm, and ≥0.6 mm), there was a trend toward higher efficacy for eyes with decentration of kappa intercept between 0.4 and <0.6 mm (P = .097). A total of 85.4% of eyes in the 0.4 to <0.6 mm group had unaided distance VA of 20/20 or better, as compared to only 57.8% of eyes in ≥0.6 mm group.Decentration of 0.13 mm from the pupil center does not result in compromised visual outcomes. Decentration of greater than 0.6 mm from the kappa intercept may result in compromised visual outcomes. There was a trend toward better efficacy in eyes which had decentered treatment from 0.4 to <0.6 mm from the kappa intercept. Patients with a large kappa intercept (>0.6 mm) should have their lenticule created 0.4 to 0.6 mm from the kappa intercept and not close to the pupil.

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Section: Methodsmentioning

confidence: 99%

Intraoperative centration during small incision lenticule extraction (SMILE)

Wong

Htoon

et al. 2017

Medicine

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“…Our rabbit experimental model for SMILE was performed as described previously. 17 All the procedures were performed by one surgeon (JSM). A myopic correction of À6.00 D was performed with a 500-kHz femtosecond laser (Visumax; Carl Zeiss Meditec).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Early Corneal Nerve Damage and Recovery Following Small Incision Lenticule Extraction (SMILE) and Laser In Situ Keratomileusis (LASIK)

Mohamed-Noriega

Riau

Lwin

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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107

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“…60 In a rabbit model, the conversion of a SMILE cap to a flap has been demonstrated, allowing subsequent intrastromal photoablation. 21 Still, the optimal approach for SMILE enhancements needs to be established. …”

Section: Retreatmentsmentioning

confidence: 99%

New Developments in the Lenticule Extraction Procedure

Hjortdal¹,

Ivarsen²

2014

European Ophthalmic Review

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31Over the last few years, surgical extraction of a refractive lenticule, or ReLEx ® , has evolved as a new treatment in the field of keratorefractive surgery. Currently, the VisuMax ® femtosecond (FS) laser (Carl Zeiss Meditec, Jena, Germany) is the only platform to offer this treatment.The 500 kHz VisuMax laser generates very fast pulses (10 -15 s range) in the near-infrared spectrum. Depending on the specific laser settings, each pulse conveys approximately 150 nJ, which causes localised photodisruption at the focal point. The generated plasma expands, creating a cavitation bubble, and, as individual cavitation bubbles fuse, the stroma is cut with a minimum of collateral damage. The VisuMax FS laser uses a high numerical aperture and a concave contact glass to focus the laser pulses with very high precision. Thus, laser spots of approximately 1 μm diameter are placed with a defined distance of 2-5 μm in a spiral pattern. To ensure centration on the visual axis, the patient fixates on a blinking light and suction is applied at the limbus to maintain stability of the eye. Initially, the posterior refractive surface of the lenticule is cut, followed by creation of the plano anterior surface, which is slightly enlarged in diameter to facilitate surgical manipulation.This review article reviews the current state of the technique, updated clinical results, 1 experimental studies and, finally, presents some of the challenges that need to be addressed by new technologies.Depending on the method used to access the lenticule, ReLEx can be split into FLEx, in which a laser-assisted in situ keratomileusis ( In contrast to LASIK, ReLEx is a one-laser approach, where the critical laser treatment is performed on the intact cornea rather than on exposed corneal stroma. Consequently, the potential variability associated with the excimer laser photoablation is avoided.In addition, the minimally invasive SMILE treatment has several theoretical advantages over flap-based treatments, including little trauma to the corneal surface, less corneal denervation and better biomechanical strength due to an almost intact anterior stroma. Since AbstractFor the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism.Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualise...

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Comparison of Four Different VisuMax Circle Patterns for Flap Creation After Small Incision Lenticule Extraction

Abstract: Pattern D, a lamellar ring adjacent to the cap cut, was the most optimal to be used for flap creation in cases of SMILE re-treatment.

Cited by 59 publications

References 29 publications

Intraoperative centration during small incision lenticule extraction (SMILE)

Intraoperative centration during small incision lenticule extraction (SMILE)

Early Corneal Nerve Damage and Recovery Following Small Incision Lenticule Extraction (SMILE) and Laser In Situ Keratomileusis (LASIK)

New Developments in the Lenticule Extraction Procedure

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