Decentration of Optical Zone Center and Its Impact on Visual Outcomes Following SMILE

Liu, Manli; Sun, Yuan; Wang, Danyang; Zhang, Ting; Zhou, Yuefang; Zheng, Hua; Liu, Quan

doi:10.1097/ico.0000000000000383

Cited by 56 publications

(39 citation statements)

References 23 publications

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“…This is within the range of values of 0.10 to 0.32 mm published in earlier reports. [14,33] The mean decentration from the kappa intercept in our study was 0.47 mm. There are no other publications that have reported decentration from the kappa intercept.…”

Section: Discussionmentioning

confidence: 40%

“…[31] With regards to SMILE, good visual results have been reported with treatment centered on the pupil center, [32] CCLR, [33] and corneal vertex. [13,14] However, there are no comparative studies on visual outcomes between different methods of treatment centration.…”

Section: Discussionmentioning

confidence: 99%

“…Better refractive outcomes were achieved when the lenticulecenter was closer to the corneal vertex. [14] Li et al [13] measured decentration from the corneal vertex postoperatively with a Scheimpflug topographer (Pentacam, Oculus) and found good visual outcomes despite mild decentration. Reinstein et al generated a difference map of the tangential curvature of each eye using preoperative and 3 month postoperative Atlas 9000 (Carl Zeiss Meditec AG) topography.…”

Section: Discussionmentioning

confidence: 99%

“…Li et al [13] measured decentration from the corneal vertex postoperatively and found good visual outcomes despite mild decentration. Liu et al [14] also evaluated decentration from pupil center and the corneal vertex against visual outcomes. Better refractive outcomes were achieved when the lenticule center was closer to the corneal vertex.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 40%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative centration during small incision lenticule extraction (SMILE)

Wong

Htoon

et al. 2017

Medicine

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“…In the study of Lazaridis et al [12], the decentration of lenticule from the pupil center was 0.326 ± 0.196 mm after SMILE surgery and 0.452 ± 0.224 mm after FS-LASIK surgery. In a recent article on SMILE surgery, the decentration to the pupil center was 0.07 mm (range, 0–0.17 mm) [13]. Cavanaugh et al reported that 92.7% decentered level was within 1.0 mm and 52.7% within 0.5 mm in PRK [14].…”

Section: Discussionmentioning

confidence: 99%

Impact of Treatment Decentration on Higher-Order Aberrations after SMILE

Zhang

Cheng

et al. 2017

Journal of Ophthalmology

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Purpose. To evaluate decentration following femtosecond laser small incision lenticule extraction (SMILE) and sub-Bowman keratomileusis (SBK) and its impact on higher-order aberrations (HOAs). Methods. Prospective, nonrandom, and comparison study. There were 96 eyes of 52 patients who received SMILE and 96 eyes of 49 patients who received SBK in this study. Decentration was calculated 6 months after surgery with Pentacam. HOAs and visual acuity after the surgery were examined for patients in both groups before and 6 months after surgery. Results. The mean decentration displacement in SMILE group was significantly less than SBK group (P = 0.020). 89 eyes were decentered within 0.50 mm after SMILE and SBK. The association between vertical decentration and the induced spherical aberration was insignificant in SMILE group (P = 0.035). There was an association between decentration and safety index, efficacy index, vertical coma, spherical aberration, and HOAs in root mean square (RMS, μm) after SBK (all P < 0.05). No difference was found in uncorrected and corrected distance visual acuity, safety index, efficacy index, and wavefront aberrations between the two subgroups at any delimited value after SMILE (all P > 0.05). Decentration exceeding 0.37 mm affected vertical coma and RMSh of SBK eyes (P = 0.002, 0.005). Conclusion. SMILE surgery achieved more accurate centration than SBK surgery. Vertical decentration is associated with the induced spherical aberration in SMILE.

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