Higher-Order-Aberrations Following Hyperopia Treatment: Small Incision Lenticule Extraction, Laser-Assisted In Situ Keratomileusis and Lenticule Implantation

Abstract

PurposeTo compare the postoperative higher-order-aberrations (HOAs) after hyperopic small incision lenticule extraction (SMILE), hyperopic laser-assisted in situ keratomileusis (LASIK), and lenticule implantation for correction of hyperopia.MethodsEighteen monkeys were divided to six groups: +2.00 D and +4.00 D hyperopic SMILE, +2.00 D and +4.00 D hyperopic LASIK (n = 6 eyes for each), and lenticule implantation with a −2.00 D and −4.00 D lenticule (n = 3 eyes for each). The corneal HOAs were evaluated preoperatively and 3-month postoperatively.ResultsAt 3-month postoperatively, the spherical aberrations significantly increased toward negative direction in all +4.00 D groups (all P < 0.05). There was a significant change toward more negative values in the third-order vertical coma in the SMILE +4.00 D and LASIK +4.00 D groups (P = 0.026 and P = 0.036, respectively). There were also significant changes in the third-order horizontal trefoil (P = 0.034) and oblique secondary astigmatism (P = 0.012) in the LASIK +4.00 D group. In the eyes that underwent +4.00 D lenticule implantation, the fourth-order horizontal quatrefoil significantly increased (P = 0.029). In low hyperopia correction (+2.00 D), treatment with lenticule implantation tended to have less changes in HOAs, compared to the other two groups.ConclusionsIn hyperopic SMILE, hyperopic LASIK or lenticule implantation surgery, significant induction of third- and fourth-order HOAs were seen in moderate hyperopia correction but not in low hyperopia correction. In low hyperopia treatment, lenticule implantation might offer a favorable trend in the aspect of HOAs.Translational RelevanceThe results provided the knowledge of surgically induced HOAs and understanding of the effects of surgery in different types of hyperopic correction.

Corneal remodelling and topography following biological inlay implantation with combined crosslinking in a rabbit model

“…These results are, however, in agreement with previous studies of biological lenticule implantation ex vivo in human donor corneas and in vivo in non-human primates 47 , 48 . We observed an increase in the RMS of total HOA while the SA became more negative following biological implantation, consistent with previous reported higher-order aberrations after implantation of artificial 44 and biological inlays 49 .…”

Twelve-year global publications on small incision lenticule extraction: A bibliometric analysis

“…For correction of hyperopia, an important and attractive surgical correction is the transplantation of lenticules obtained from the SMILE procedure ( 55 ). Lenticule keratophakia and epikeratophakia are reversible in SMILE, and the visual quality offers unique advantages ( 56 , 57 ). Moreover, the discarded tissue was also reused as a bio-scaffold for stromal engineering, and an ocular drug delivery system of active molecules ( 58 , 59 ).…”

Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism

“…Convincing data about the accuracy and stability for a long period of the refractive correction has been obtained using SMILE for myopia [ 14 – 17 ]. Several studies have showed that corneal small incision intrastromal lenticule inlay can be used to correct hyperopic eye with good safety, effectiveness and predictability [ 3 – 10 ]. Meanwhile new treatments for hyperopia are emerging [ 18 ].…”

“…Other studies reported that the lenticule implantation was used for the hyperopic correction as implanting a crescentic convex-shaped lenticule obtained from a myopic SMILE procedure resulted in steeper central cornea [ 7 – 9 ]. Liu et al compared the postoperative higher-order-aberrations (HOAs) profiles after hyperopic SMILE, hyperopic LASIK, and lenticule implantation for correction of hyperopia, and found that lenticule implantation appeared to have less induction of HOAs in low hyperopia treatment [ 10 ]. However, to our knowledge, corneal small incision intrastromal lenticule inlay has not been explored in hyperopic eyes with astigmatism.…”