<p>Outcomes of Small Incision Lenticule Extraction with Dual-Incisions in Myopic Patients</p>

Abstract

The study was conducted as a retrospective non-comparative analysis of the records of 105 eyes of 53 patients treated by the SMILE with a dualincisions technique for a mean spherical myopic error of −5.05 ± 1.93 D (range: −1.38 to −9.0 D) with or without astigmatism and the mean astigmatism of −0.90 ± 0.83 D. The mean LogMAR corrected distance visual acuity (CDVA) was −0.04 ± 0.07. Results: One month after surgery, the mean refractive error was −0.03 ± 0.56 D (range: 0.88 to −1.50 D), and the mean postoperative astigmatism was 0.20 ± 0.31 D. The mean LogMAR UDVA was 0.07 ± 0.18 in the last follow-up visit, 12 months after surgery. At the end of the follow-up period, approximately 91.43% of patients had unchanged CDVA or gained one or more lines, 8.57% lost one line of CDVA, and 0.0% lost 2 lines. Conclusion: SMILE with dual-incisions is effective and safe, with a stable and predictable outcome for correction of myopia and myopic astigmatism.

Comparison of Refractive Outcomes in Small-Incision Lenticule Extraction Performed with One or Two Incisions

“…Major previous research studies on the large number of patients receiving SMILE are summarized in Table 2. 1,4,6,8,[16][17][18][19][20] Our findings were compared, or slightly better than those in previous studies on safety and efficacy.…”

“…Recently, some refractive surgeons started creating SMILE with dual incisions in all cases, to allow draining the fluidics throughout the incision located at 270°. 8 Thus, the stromal pocket is no longer a closed space and the hydraulic current can get rid of the scrapped epithelial cells and pump them out through the draining incision instead of being trapped inside the closed space of the stromal pocket. The same thing happens when we irrigate the SMILE pocket in cases with intraoperative bleeding, SMILE XTRA (SMILE with corneal collagen cross-linkage) to wash out the Riboflavin, or with postoperative complications like inflammation.…”

“…In group two, dual side-cut incisions are produced; a primary main incision of 3.0 mm created at 120°, and a secondary incision (3.0 mm) created at 270°, in order to be positioned at the most lower location of the corneal pocket for better drainage of the fluidics (Figure 1) (Dr Abdelmonem Hamed technique). 8 The ReSMILE push-up technique 9,10 was then utilized to identify the lenticule edge; where an instrument with a Y-shaped tip; Bechert Nucleus Rotator (STORZ ® ophthalmic instrument, Product Number: E4937) was inserted through the small incision, which thus caught the edge of the lenticule between its two limbs. The caught edge of the lenticule is then pushed up from its bed so that it was easily recognizable in the pocket, the lenticule was then extracted after dissection.…”

Evaluation of Ocular Residual Astigmatism in Eyes with Myopia and Myopic Astigmatism and Its Interaction with Other Forms of Astigmatism

“…This makes it difficult to understand how the eyes astigmatism behaves as a whole from a clinical point of view. [61][62][63] In addition, many clinicians, especially those whose scope of practice does not encompass refractive surgery, remain unfamiliar with vector analysis, making literature utilizing such representations of astigmatism hard to digest. We could argue that vector analysis of astigmatism should be included in ophthalmology and optometry postgraduate training and teaching curricula.…”