Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study

Sekundo, Walter; Kunert, Kathleen S.; Blum, Marcus

doi:10.1136/bjo.2009.174284

Cited by 726 publications

(453 citation statements)

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“…This shows that both procedures affected regular corneal morphology and visual quality, especially in highly spherical patients. Consistent with other studies, greater high order wavefront aberrations increased the relative risk of symptoms [18][19].…”

Section: Discussionsupporting

confidence: 91%

Corneal aberrations after small-incision lenticule extraction versus Q-value-guided laser-assisted in situ keratomileusis

Zhang¹,

Li²,

Zhao³

et al. 2018

New Front Ophthalmol

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Aim: To compare the changes in anterior corneal surface aberration characteristics after small-incision lenticule extraction (SMILE) versus Q-value-guided femtosecond laser-assisted in situ keratomileusis (Q-FS-LASIK) Methods:In this prospective comparative study, 102 patients with myopia and myopic astigmatism were divided between the SMILE and Q-FS-LASIK groups, consisting of 51 patients each. High order aberration (HOA), primary spherical aberration (PSA), and primary coma aberration (PCA) of the central 6 mm region of the anterior corneal surface were quantitatively assessed using pre-and post-operative Sirius scanning, and then statistical analysis with repeated measures analysis of variance.Results: Both types of surgery were associated with statistically significant increases in post-operative HOA, PSA, and PCA (both groups P <0.01). In the SMILE group, the variations in HOA, PSA, and PCA were not statistically significant starting at post-operative week 2 (P >0.05). In the Q-FS-LASIK group, the variations in HOA and PCA were not statistically significant starting at post-operative day 1 (P >0.05). Conclusion:Both SMILE and Q-FS-LASIK resulted in an increase in HOA, PSA, and PCA at post-operative day 1. However, Q-FS-LASIK introduced lower HOA and showed better stability. Spherical measurement is highly related to PSA.

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Section: Discussionsupporting

confidence: 91%

Corneal aberrations after small-incision lenticule extraction versus Q-value-guided laser-assisted in situ keratomileusis

Zhang¹,

Li²,

Zhao³

et al. 2018

New Front Ophthalmol

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“…In the largest report to date on SMILE in 670 myopic eyes 3 months after surgery (preoperative SE refraction was -7.2 D) the mean error in SE refraction was -0.25±0.44 D, with 80 % of eyes within ± 0.50 D and 94 % within ± 1.0 D. 6 We recently extended this evaluation to the first 1,574 eyes 3 months after SMILE and found a similar mean error of -0.15±0.50 D with 77 % of eyes within ± 0.50 D and 95 % within ± 1.0 D. 7 Other reports on SMILE 3,4,8,9 and 500 kHz FLEx 10-14 have found similar refractive outcomes in smaller numbers of patients. Most studies have included patients with moderate and high myopia, while the refractive predictability in treatment of low myopia (less than 2 D) has not been evaluated thoroughly or compared with results after FS-LASIK or photorefractive keratectomy (PRK).…”

Section: Refractive Outcomementioning

confidence: 87%

“…2,3,[8][9][10][11][12][13][14] In one study on 279 eyes after SMILE, 0.4 % of eyes were reported to have a loss of two or more lines. 3 By contrast, a 2.4 % risk for a two-line loss was found in 670 eyes by Hjortdal et al 6 However, in the same study, a safety index (CDVA before/CDVA after surgery) of 1.07±0.22 was found, indicating that CDVA on average increased after surgery, as would be expected because of the image magnification of myopic keratorefractive procedures.…”

Section: Safetymentioning

confidence: 99%

New Developments in the Lenticule Extraction Procedure

Hjortdal¹,

Ivarsen²

2014

European Ophthalmic Review

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31Over the last few years, surgical extraction of a refractive lenticule, or ReLEx ® , has evolved as a new treatment in the field of keratorefractive surgery. Currently, the VisuMax ® femtosecond (FS) laser (Carl Zeiss Meditec, Jena, Germany) is the only platform to offer this treatment.The 500 kHz VisuMax laser generates very fast pulses (10 -15 s range) in the near-infrared spectrum. Depending on the specific laser settings, each pulse conveys approximately 150 nJ, which causes localised photodisruption at the focal point. The generated plasma expands, creating a cavitation bubble, and, as individual cavitation bubbles fuse, the stroma is cut with a minimum of collateral damage. The VisuMax FS laser uses a high numerical aperture and a concave contact glass to focus the laser pulses with very high precision. Thus, laser spots of approximately 1 μm diameter are placed with a defined distance of 2-5 μm in a spiral pattern. To ensure centration on the visual axis, the patient fixates on a blinking light and suction is applied at the limbus to maintain stability of the eye. Initially, the posterior refractive surface of the lenticule is cut, followed by creation of the plano anterior surface, which is slightly enlarged in diameter to facilitate surgical manipulation.This review article reviews the current state of the technique, updated clinical results, 1 experimental studies and, finally, presents some of the challenges that need to be addressed by new technologies.Depending on the method used to access the lenticule, ReLEx can be split into FLEx, in which a laser-assisted in situ keratomileusis ( In contrast to LASIK, ReLEx is a one-laser approach, where the critical laser treatment is performed on the intact cornea rather than on exposed corneal stroma. Consequently, the potential variability associated with the excimer laser photoablation is avoided.In addition, the minimally invasive SMILE treatment has several theoretical advantages over flap-based treatments, including little trauma to the corneal surface, less corneal denervation and better biomechanical strength due to an almost intact anterior stroma. Since AbstractFor the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia and astigmatism.Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient and safe procedure for correction of myopia and astigmatism. Technological developments related to further improved cutting quality, hyperopic and individualise...

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“…It involves lenticule dissection and extraction from a small curved bow-like incision (2.5-3 mm) positioned superiorly. 52,53 In a prospective, randomized clinical trial (contralateral-eye study), 28 patients with myopia or myopic astigmatism in both eyes were enrolled. One eye of each patient was treated by SMILE, and the fellow eye was treated by F-LASIK.…”

mentioning

confidence: 99%

Recent Perspectives on Corneal Nerves: A Short Review

Sarkar¹

2017

Ophthalmol Open J

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This mini-review provides an overview of recent trends in our understanding of the general structure of the cornea, the importance of corneal nerves, their function and distribution in the different layers of the cornea based on reports obtained by imaging techniques such as in vivo confocal microscopy (IVCM) and immunohistochemistry (IHC) analysis. Recent data on corneal nerve status in conditions such as Dry Eye Disease (DED) and Diabetes is also discussed. There is additional emphasis on corneal nerve damage due to injury especially during surgical interventions and underlying disease states as well as translational research on corneal nerve regeneration. Information on recent clinical studies on the effect of laser corneal surgery and its impact on corneal nerves is also presented.

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Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study

Abstract: SMILE is a promising new flapless minimally invasive refractive procedure to correct myopia.

Cited by 726 publications

References 9 publications

Corneal aberrations after small-incision lenticule extraction versus Q-value-guided laser-assisted in situ keratomileusis

Corneal aberrations after small-incision lenticule extraction versus Q-value-guided laser-assisted in situ keratomileusis

New Developments in the Lenticule Extraction Procedure

Recent Perspectives on Corneal Nerves: A Short Review

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