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

Mohamed-Noriega, Karim; Riau, Andri K.; Lwin, Nyein Chan; Chaurasia, Shyam S.; Tan, Donald; Mehta, Jodhbir S.

doi:10.1167/iovs.13-13324

Cited by 107 publications

(66 citation statements)

References 29 publications

(40 reference statements)

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“…Although postoperative dry eye has decreased since the introduction of the femtosecond laser for flap creation, 23 it is still significant. In SMILE (a flapless procedure), the anterior stromal nerve plexus is disrupted significantly less than in FS-LASIK, 24 resulting in fewer dry eye symptoms postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism

Ganesh¹,

Gupta²

2014

J Refract Surg

190

147

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ASIK is the most popular refractive surgery for myopic laser correction to date. The use of femtosecond laser-assisted LASIK (FS-LASIK) offers the creation of more predictable flaps with regard to flap thickness, diameter, and hinge width. 1,2Even with high success rates, side effects such as increased postoperative dryness, reduced biomechanical corneal strength, induction of higher-order aberrations (HOAs), postoperative glare, halos, and flap-related complications remain. 3-5More recently developed is refractive lenticule extraction, which uses a femtosecond laser to create an intrastromal corneal lenticule (the removal of which alters the shape of the cornea), thereby correcting myopia. It encompasses two different techniques: femtosecond lenticule extraction (FLEX) and small-incision lenticule extraction (SMILE).SMILE is a more recent flapless subtype in which the lenticule is extracted through a small arcuate incision (2 to 4 mm). This allows for greater stability because most of the Bowman's layer remains intact.Studies have shown that SMILE is associated with lower topographic changes and less inflammation and keratocyte apopotosis than FS-LASIK, particularly for higher levels of correction of myopia. 6,7 Because the procedure is flapless, most flap-related complications are not observed with SMILE.The aim of the current study was to evaluate the efficacy and safety of SMILE compared with FS-LASIK. Our primary hypothesis (null hypothesis) states that SMILE is better or comparable to LASIK for correction of myopia in terms of refractive accuracy and quality of vision (ie, postoperative aberrations and contrast sensitivity). Primary outcome measures were refractive efficacy, predictability, and safety, postoperative contrast sensitivity wavefront aberrations, and tear film abnormalities. L ABSTRACT PURPOSE: To compare the visual and refractive outcomes of femtosecond laser-assisted LASIK with smallincision lenticule extraction (SMILE) in terms of visual acuity, contrast sensitivity, aberrations, and dry eye. METHODS:A single-center prospective randomized study in which patients diagnosed as having myopia presenting for refractive correction were allocated to either a LASIK or SMILE group. The primary outcome measures were refractive efficacy, predictability, and safety, postoperative contrast sensitivity, aberrations, and dry eye status. Patients were followed up at days 1 and 15 and 3 months; postoperative uncorrected visual acuity (UCVA), aberrations, dry eye, and contrast sensitivity were recorded and compared to preoperative data. Two postoperative subjective questionnaires were used to assess pain, pricking sensation, redness, glare, and overall patient satisfaction. RESULTS:At day 1 postoperatively, 48 (96%) of 50 eyes in the SMILE group achieved a UCVA of 20/20 compared with 46 (92%) of 50 eyes in the LASIK group. At day 15 postoperatively, contrast sensitivity was similar in the two groups (P = .15), but by 3 months, it was better in the SMILE group than the LASIK group at all spatial frequencies (...

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Section: Discussionmentioning

confidence: 99%

Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism

Ganesh¹,

Gupta²

2014

J Refract Surg

190

147

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“…16 ). In addition, there is minimal intervention into the innervation of the cornea and minimal risk of dry eye syndrome development after surgery [17][18][19][20][21][22] . It is essential to maintain the biomechanical stability of the cornea and decrease the risk of the development of postsurgical corneal ectasia due to preserving continuous frontal stroma across the cornea [23][24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficiency of femtoLASIK and ReLEx SMILE in terms of dioptric error reduction

Pavkova¹,

Kacerovská²,

Kacerovsky³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background and Aims. Refractive eye surgery is a rapidly expanding field of ophthalmology and corneal surgery is undergoing constant development leading to less invasive technologies. The goal of this study was to compare the most common femtoLASIK surgery with the newer ReLEx SMILE surgery which is gentler to the cornea. The comparison was made in terms of dioptric error reduction. Methods. The studied cohort of patients consisted of two major groups: 30 patients who underwent femtoLASIK surgery and 30 who underwent ReLEx SMILE surgery. -30 patients, 60 eyes. All patients were aged 18-45 years with moderate myopia or astigmatism ranging from -3.25 to -6.0 spherical diopters and from 0 to -1.0 cylindrical diopters. In all, the best corrected visual acuity measured prior to surgery was 1.0. Pachymetry was not comparable because each surgical method was performed at a different time point and the introduction of an innovative method into practice led to a change in selection criteria. Results. During postsurgical check-ups, the ReLEx SMILE method (0.74) led to lower values of non-corrected visual acuity compared to the femtoLASIK method (0.88), (P<0.001). However, the results changed at the one-year post-surgery check-up, when ReLEX SMILE patients achieved non-corrected visual acuity of 0.97 compared to femtoLASIK patients, who scored 0.83, (P=0.007). Based on data analysis from the automatic refractometer, the average spherical diopters of the femtoLASIK (-0.32 D) were higher than those of the ReLEx SMILE (-0.07 D), (P<0.001). The results for the cylindrical diopters were also significant, (P=0.021). When we compared the spherical equivalent one year after surgery, the difference between methods was significant. The FemtoLASIK method resulted in an average SE -0.55 D compared to -0.09 D for the ReLEx SMILE method, (P<0.001). Conclusion. This study showed that there was a significant difference in results between the two surgical methods of treatment of moderate myopia and astigmatism, in terms of regression of dioptric error, as well as in achievement and maintenance of visual acuity during the observed period. The ReLEx SMILE had better results.

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“…The rabbit cornea has been used extensively to understand disease pathogenesis, such as dry eye following corneal laser refractive surgery and infective keratitis, 23,24 and to investigate novel treatments, such as riboflavin application in a corneal pocket. 25 Corneal topography in rabbits has been used to describe the healthy rabbit cornea and to quantify the treatment effect of collagen-cross linking and corneal inlay implantation.…”

Section: Introductionmentioning

confidence: 99%

Repeatability and Reproducibility of Corneal Biometric Measurements Using the Visante Omni and a Rabbit Experimental Model of Post-Surgical Corneal Ectasia

Liu

Konstantopoulos

Riau

et al. 2015

Trans. Vis. Sci. Tech.

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

Abstract: Our findings suggest that SMILE results in less nerve damage and faster nerve recovery than LASIK.

Cited by 107 publications

References 29 publications

Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism

Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism

Comparison of the efficiency of femtoLASIK and ReLEx SMILE in terms of dioptric error reduction

Repeatability and Reproducibility of Corneal Biometric Measurements Using the Visante Omni and a Rabbit Experimental Model of Post-Surgical Corneal Ectasia

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