Short-term and long-term effects of small incision lenticule extraction (SMILE) on corneal endothelial cells

Zhang, Hui; Wang, Yan; Xie, Shiyong; Wu, Di; Wu, Wenjing; Xu, Lulu

doi:10.1016/j.clae.2015.03.011

Cited by 15 publications

(15 citation statements)

References 35 publications

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“…Previous studies concerning the effect of FS-LASIK, and FS-SMILE on the corneal endothelial cells reported no statistically significant differences 11,12,14 and no significant impairment of the corneal endothelium in short and longterm follow-up periods of the studies [4][5][6][11][12][13][14][15][16][17][18][19] In our study, although we reported statistically significant changes in ECD, CV, and HEX in both FS-LASIK and FS-SMILE groups, with more affection in the FS-SMILE group, the Notes: The main effect of time is statistically significant (Greenhouse-Geisser F=154.823, p<0.001). The main effect of the type of operation is statistically insignificant (F=0.612, p=0.436).…”

Section: Discussionmentioning

confidence: 99%

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<p>Comparison Between the Effect of Femtosecond Laser in situ Keratomileusis (FS-LASIK) and Femtosecond Small Incision Lenticule Extraction (FS-SMILE) on the Corneal Endothelium</p>

Shaaban¹,

Badran²

2020

OPTH

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Purpose: To compare the effect of FS-LASIK and FS-SMILE on the corneal endothelial cell density (ECD) and morphology. Patients and Methods: This is a prospective, cohort observational study that included 80 eyes of two equal groups of patients. Forty eyes were subjected to the FS-LASIK, and 40 eyes were subjected to the FS-SMILE. In both groups, patients, age ranged between 19 and 37 years with myopia ranges from −0.75 to −9.00 diopters (D) and astigmatism up to −3.00D. The ECD, coefficient of variation (CV), and hexagonality (HEX) in both groups were compared over six months. Specular microscopy was used to evaluate the corneal endothelium throughout the study. Results: In both groups, ECD showed a statistically significant decrease while CV showed a statistically significant increase in the first month postoperatively. The FS-SMILE had more impact on both ECD and CV until the third and six months, respectively. Hexagonality showed a significant decrease in both groups throughout the whole study. In both groups, no vision-threatening complications occurred, and no eyes developed any corneal complications over a six-month follow-up period. Conclusion: Although the ECD, CV, HEX are statistically affected in both FS-LASIK and FS-SMILE groups, both procedures have no significant adverse effects on the ECD and morphology. The impact of the FS-SMILE group may be due to the deeper penetration of the femto laser in the corneal tissue compared to the FS-LASIK. The closer the femto laser to the endothelium, the more exposure to the shock waves and heat energy, although minimal but it can cause collateral damage to this layer. The effects of FS-SMILE surgery on corneal endothelial cells and morphology need further investigations.

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Section: Discussionmentioning

confidence: 99%

“…Zhang et al 17 investigated the corneal endothelial changes one day, and one year after the SMILE procedure. They studied a total of 56 eyes of 30 patients with myopia ranging from −3.25 to −8.25 D and cylinder up to −3.50D who were treated by SMILE.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison Between the Effect of Femtosecond Laser in situ Keratomileusis (FS-LASIK) and Femtosecond Small Incision Lenticule Extraction (FS-SMILE) on the Corneal Endothelium</p>

Shaaban¹,

Badran²

2020

OPTH

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“…The strengthening effects of SMILE Xtra have been supported by an ex vivo study on human cornea by Kanellopoulos et al, which showed that combining cross-linking with refractive lenticule (5 mm diameter and 80 μ m thickness at 140 μ m depth) extraction resulted in significantly increased biomechanical properties compared with control non-cross-linked eyes [ 32 ]. We did not routinely check the endothelial cell count either, as it has already been shown that there was no significant change in the endothelial cell count before and after SMILE [ 33 ] or in SMILE Xtra [ 28 ]. Other limitations of this study included small sample size and a relatively short follow-up.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Early Clinical Outcomes between Combined Small-Incision Lenticule Extraction and Collagen Cross-Linking versus SMILE for Myopia

Chan

Cheng

et al. 2016

Journal of Ophthalmology

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Background. To compare the early outcome of combined SMILE and collagen crosslinking (SMILE Xtra) with SMILE. Method. Prospective, comparative interventional study of 21 eyes receiving SMILE Xtra using a low energy protocol and 32 control eyes receiving SMILE only. The outcomes were compared at 1, 3, and 6 months postoperatively. Results. Both groups had myopia with spherical equivalent refraction (SEQ) > 4.00 D. The SMILE Xtra group had thinner preoperative central corneal thickness and residual stromal bed thickness (p < 0.021). At 6 months, no eyes lost more than 1 line in corrected distance visual acuity. The safety index was 0.96 ± 0.06 and 1.00 ± 0.00 in SMILE Xtra and control, respectively (p < 0.001). 89% and 94% of eyes were within ±0.50 D of target refraction, respectively, with the mean error in SEQ correction being −0.17 ± 0.26 D for SMILE Xtra and +0.03 ± 0.25 D for control (p = 0.021). The efficacy index was 0.88 ± 0.13 and 0.97 ± 0.06, respectively (p = 0.005). Conclusion. SMILE Xtra had good overall safety profile and predictability at 6 months. However, when compared with control, the safety index and efficacy index were statistically significantly lower in the early postoperative period.

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“…This was consistent with a previous report showing no change of ECD at 1 day or 1 year after SMILE. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Cap Thickness in Small Incision Lenticule Extraction: 100μm versus 160μm

Wang

Ding

et al. 2016

PLoS ONE

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PurposeTo compare the changes of biomechanical properties, endothelial cell density (ECD), and posterior corneal elevation (PCE) after femtosecond small incision lenticule extractions (SMILEs) with 100μm versus 160μm cap thicknesses.MethodsA total of 12 rabbits were randomly assigned into two groups of 6 each. SMILE was performed at a depth of either 160μm (160-cap group) or 100μm (100-cap group). Corneal biomechanics, PCE, ECD were evaluated pre-operatively, 1week, 1 month, 2 months, 3 months, and 4 months post-operatively by Pentacam, Corvis ST, in vivo confocal microscopy (IVCM) respectively. The Young’s modulus was obtained by strip-extensometry test 4 months after surgery.ResultsAt each time point, the second applanation time (A2T) was similar between the groups with the exception of 4 months after surgery (22.66±0.16 ms in the 160-cap group versus 21.75±0.29 ms in the 100-cap group, p = 0.004). Neither deformation amplitude (DA) nor the first applanationtime (A1T) were significantly different between the two groups. The postoperative posterior surface did not shift forward, the changes of PCE and ECD were not significantly different between the two groups at any observation time. Young’s modulus was higher in the 160-cap group than that in the 100-cap group with no statistical significance (P>0.05). Regression analyses showed that the PCE changes and Young’s modulus were not affected by cap thickness (CT) or residual stromal bed thickness (RBT) (All P>0.05).ConclusionsThe differences of corneal biomechanics, posterior surface elevation, or ECD changes were quite small when using 100μm or 160μm cap thicknesses in SMILE.

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Short-term and long-term effects of small incision lenticule extraction (SMILE) on corneal endothelial cells

Cited by 15 publications

References 35 publications

<p>Comparison Between the Effect of Femtosecond Laser in situ Keratomileusis (FS-LASIK) and Femtosecond Small Incision Lenticule Extraction (FS-SMILE) on the Corneal Endothelium</p>

<p>Comparison Between the Effect of Femtosecond Laser in situ Keratomileusis (FS-LASIK) and Femtosecond Small Incision Lenticule Extraction (FS-SMILE) on the Corneal Endothelium</p>

Comparison of the Early Clinical Outcomes between Combined Small-Incision Lenticule Extraction and Collagen Cross-Linking versus SMILE for Myopia

Comparison of Two Cap Thickness in Small Incision Lenticule Extraction: 100μm versus 160μm

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