Inferior pseudo-hinge fulcrum technique and intraoperative complications of laser in situ keratomileusis retreatment after small-incision lenticule extraction

Reinstein, Dan Z.; Carp, Glenn I; Archer, Timothy J; Vida, Ryan S

doi:10.1016/j.jcrs.2018.07.051

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…In the largest study on the epidemiology of SMILE enhancement, Liu et al 7 reported an incidence of 2.1% and 2.9% after 1 and 2 years, respectively, resulting in an overall prevalence of 2.7%. These numbers have been recently confirmed by Siedlecki et al 8 reporting a prevalence of 2.3% in 2803 eyes, and Reinstein et al 6,15 , reporting a prevalence 4.4% in 2643 eyes. 71% of retreatments are performed within the first year with a mean latency of 10 to 11 months.…”

Section: Epidemiology and Risk Factors Of Smile Enhancementmentioning

confidence: 73%

“…These complications, however, mostly occurred in the early learning phase, and were greatly reduced by the introduction of the above mentioned bimanual inferior pseudo-hinge fulcrum technique. 6,15 At 1 year, the mean SEQ had improved to 0.19 ± 0.49 D. The number of eyes within 0.50 and 1.00 D from target refraction increased to 74% and 95%, respectively. An UDVA of 20/20 was achieved in 81% of eyes.…”

Section: Options Of Enhancement After Smilementioning

confidence: 96%

“…The first studies on the surgical technique and outcomes of thin-flap LASIK enhancement after myopic SMILE were recently published by Reinstein et al 6,15 . The choice between CIRCLE cap-to-flap conversion and thin-flap LASIK is mainly made by cap thickness, as thin caps of 100 to 120 μm make it nearly impossible to introduce another LASIK treatment plane above, and on the contrary, thick caps of ≥160 μm make it unreasonable to create a thick flap at the corresponding cap depth, as the biomechanical impact on the anterior stroma will be disproportionate in most cases (Fig.…”

Section: Options Of Enhancement After Smilementioning

confidence: 99%

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Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review

Luft

Priglinger

Dirisamer

2019

Asia-Pacific Journal of Ophthalmology

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Purpose:To provide an overview of the currently available retreatment methods after myopic small-incision lenticule extraction (SMILE).Design:Systematic literature review.Methods:The PubMed library was searched for articles containing the terms “small-incision lenticule extraction” and “enhancement” or “retreatment”. The last search was performed on May 1, 2019.Results:In contrast to laser in-situ keratomileusis (LASIK), which can be retreated by a flap relift, repeat SMILE retreatment is currently not approved and only seldomly performed. As substitutes, surface ablation, cap-to-flap conversion using the CIRCLE program in the VisuMax platform, and thin-flap LASIK have been recently established. While all options offer safety and efficacy comparable to LASIK retreatments, each has its patient-specific advantages and disadvantages. While surface ablation preserves the flap-free approach of the primary procedure, the aspect of pain and a slow visual recovery might render it less attractive as compared with CIRCLE and thin-flap LASIK which offer quick recovery, however at the price of flap creation. Besides, each retreatment method generates specific tissue responses and has a different impact on corneal biomechanics, which is strongly dependent on the previous SMILE parameters, especially the cap thickness.Conclusions:Refractive enhancement after SMILE is currently mostly performed by surface ablation, CIRCLE cap-to-flap conversion or thin-flap LASIK, which all offer safety and efficacy comparable to LASIK retreatments. In this review, a detailed overview over each method, its technical aspects, and specific advantages and disadvantages is given.

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Section: Epidemiology and Risk Factors Of Smile Enhancementmentioning

confidence: 73%

Section: Options Of Enhancement After Smilementioning

confidence: 96%

Section: Options Of Enhancement After Smilementioning

confidence: 99%

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Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review

Luft

Priglinger

Dirisamer

2019

Asia-Pacific Journal of Ophthalmology

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“…Between the first published trials of SMILE in 2011 and June 2022, 9 we identified twelve studies in the literature that present cases of enhancement following SMILE (Table 3). 5,8,[10][11][12][13][14][15][16][17][18] Of these, eight identified rates of enhancement following SMILE. In a 2017 study in Singapore, Liu et al found a prevalence, 1-year incidence, and 2-year incidence of enhancement of 2.7%, 2.1%, and 2.9%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Photorefractive Keratectomy Enhancement (PRK) After Small-Incision Lenticule Extraction (SMILE)

Moshirfar¹,

Parsons²,

Chartrand³

et al. 2022

OPTH

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To determine rates of enhancement and visual prognosis following photorefractive keratectomy (PRK) enhancement of small-incision lenticule extraction (SMILE). Patients and Methods: This retrospective, single-site study reviewed all cases of primary SMILE at Hoopes Vision in Draper, Utah between March 14, 2017 and April 8, 2022 to identify any cases that required follow-up enhancement. Primary SMILE was performed using Visumax 500 kHz femtosecond laser (Carl Zeiss Meditec, Jena, Germany). All enhancements were performed with alcoholassisted PRK, using a WaveLight EX500 excimer laser (Alcon Laboratories, Inc., Fort Worth, TX). Results: Four hundred and five eyes underwent primary SMILE, of which 15 later underwent PRK enhancement (enhancement rate of 3.7%). No significant difference in pre-SMILE data was identified between the enhancement and non-enhancement groups. The average age of those who underwent PRK enhancement was 33.8±6.3 years old and ranged from 25 to 45. Following primary SMILE, 13 eyes (87%) had an uncorrected distance visual acuity (UDVA) of 20/40 or better, and none had a UDVA of 20/20 or better. After one year of post-enhancement follow-up, all eyes had a UDVA of 20/40 or better, and 13 eyes (87%) had a UDVA of 20/20 or better (Figure 1). All were within one diopter of target spherical equivalent (SEQ), 13 (87%) were within 0.50 D, and 10 (67%) were within 0.25 D. Of those with 12-month follow-up data, none had UDVA worse than corrected distance visual acuity (CDVA), and none had lost lines of CDVA. Efficacy and safety indices were 1.03 and 0.99, respectively. Conclusion: Following SMILE, ophthalmologists may anticipate an enhancement rate of one to seven percent. In these cases, PRK is a safe and effective procedure for enhancement of SMILE.

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“…The retreatment rate of 3.5% reported in this study is in tandem with previous studies. Siedlecki et al [ 22 ] reported 2.3% at the 3rd month postoperative, and Liu et al [ 23 ] reported an incidence of 2.1% and 2.9% after 1 and 2 years, respectively, while Reinstein et al [ 24 , 25 ] reported an incidence of 4.4% in 2643 eyes after a 2-year study. In this study, there were grade 1 and grade 2 corneal haze in some cases but it was not clinically significant in terms of visual acuity, which is most likely because of the prophylactic use of MMC.…”

Section: Discussionmentioning

confidence: 99%

SmartSurfACE transepithelial photorefractive keratectomy with mitomycin C enhancement after small incision lenticule extraction

Gab-Alla

2021

Eye and Vis

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Background To evaluate predictability, stability, efficacy, and safety of transepithelial photorefractive keratectomy (TPRK) using smart pulse technology (SPT) (SmartSurface procedure) of Schwind Amaris with mitomycin C for correction of post small incision lenticule extraction (SMILE) myopic residual refractive errors. Method This study is a prospective, non-comparative case series conducted at a private eye centre in Ismailia, Egypt, on eyes with post-SMILE myopic residual refractive errors because of undercorrection or suction loss (suction loss occurred after the posterior lenticular cut and the creation of side-cuts; redocking was attempted, and the treatment was completed in the same session with the same parameters) with myopia or myopic astigmatism. The patients were followed up post-SMILE for six months before the SmartSurface procedure, and then they were followed up for one year after that. TPRK were performed using Amaris excimer laser at 500 kHz. The main outcomes included refractive predictability, stability, efficacy, safety and any reported complications. Results This study included 68 eyes of 40 patients out of 1920 total eyes (3.5%) with post-SMILE technique myopic residual refractive errors. The average duration between the SMILE surgery and TPRK was 6.7 ± 0.4 months (range 6 to 8 months). The mean refractive spherical equivalent (SE) was within ± 0.50 D of plano correction in 100% of the eyes at 12 months post-TPRK. Astigmatism of < 0.50 D was achieved in 100% of the eyes. The mean of the residual SE error showed statistically significant improvement from preoperative − 1.42 ± 0.52 D to 0.23 ± 0.10 D (P < 0.0001). Uncorrected distance visual acuity (UDVA) (measured by Snellen's chart and averaged in logMAR units) was improved significantly to 0.1 ± 0.07 (P < 0.0001). UDVA was 0.2 logMAR or better in 100% of the eyes, 0.1 logMAR or better in 91.2% of the eyes, and 0.0 logMAR in 20.6% of the eyes. Corrected distance visual acuity (CDVA) remained unchanged in 79.4% of eyes. 14.7% of eyes gained one line of CDVA (Snellen). 5.9% of eyes gained two lines of CDVA (Snellen). Conclusion Transepithelial photorefractive keratectomy using smart pulse technology with mitomycin C enhancement after SMILE is a safe, predictable, stable, and effective technique.

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Inferior pseudo-hinge fulcrum technique and intraoperative complications of laser in situ keratomileusis retreatment after small-incision lenticule extraction

Cited by 7 publications

References 32 publications

Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review

Enhancement Options After Myopic Small-Incision Lenticule Extraction (SMILE): A Review

Photorefractive Keratectomy Enhancement (PRK) After Small-Incision Lenticule Extraction (SMILE)

SmartSurfACE transepithelial photorefractive keratectomy with mitomycin C enhancement after small incision lenticule extraction

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