Effect of corneal stromal pocket irrigation in small-incision lenticule extraction

Abstract

Objectives To investigate the effect of corneal stromal pocket irrigation after small-incision lenticule extraction (SMILE) on visual acuity, intraocular pressure (IOP), corneal parameters and complications after surgery. Methods A total of 242 eyes of 121 patients undergoing SMILE were enrolled in this prospective controlled study, and it was designed for one eye to randomly undergo SMILE with balanced salt solution irrigation of the corneal stromal pocket, while the other eye was not. The uncorrected distance visual acuity (UDVA) and slit lamp examination were recorded at 1 hour, 1 day, 1 week, and 1 month. Postoperative corneal density, corneal biomechanical, corneal endothelial cell number, and anterior OCT images were compared at 1 day, 1 week, and 1 month. Results Compared with the nonirrigation group, the irrigation group showed significantly higher UDVA at 1 day postoperatively (P < 0.05), but there was no significant difference during the rest of the postoperative period (1 hour, 1 week, and 1 month). In addition, no significant differences were found in IOP, corneal density, corneal biomechanics, corneal endothelial cells, and corneal morphology. No visual decline or severe postoperative complications were found in the patients in this study. Conclusions Interlamellar irrigation did not affect IOP, corneal parameters, morphology, complications, or UDVA at 1 hour, 1 week, and 1 month after the operation, but it may promote UDVA 1 day after the operation.

Visual Outcome with Irrigation of the Interface in Small-Incision Lenticule Extraction

“…UCVA is key for patients, as it is a marker for how well they will see without the use of spectacles or contacts. Therefore, it is possible that irrigating the eyes of patients during the SMILE procedure may be beneficial in terms of achieving a better UCVA, with regards to the concern that it can reduce patients' post-operative UCVA due to stromal edema [6,7].…”

“…By irrigating the stroma, surgeons can wash out inflammatory cytokines, minimize the risk of infection by flushing out contaminants, and decrease epithelial ingrowth. However, stromal irrigation can lead to early post-operative stromal edema and reduced postoperative uncorrected visual acuity (UCVA) [6,7]. If stromal irrigation is found to be efficacious for patients undergoing SMILE by this proposed study, it can be adopted by refractive surgeons for improved refractive and visual outcomes.…”