Unilateral ectasia after small-incision lenticule extraction

Pazo, Emmanuel Eric; McNeely, Richard N.; Arba-Mosquera, Samuel; Palme, Christoph; Moore, Jonathan E.

doi:10.1016/j.jcrs.2018.10.018

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…1). SMILE-Search results for post-SMILE ectasia resulted in 4366 articles, of which 4356 were excluded, yielding 10 articles [161][162][163][164][165][166][167][168][169][170]. In total, 19 eyes were reported to have ectasia related to SMILE.…”

Section: Literature Reviewmentioning

confidence: 99%

Ectasia After Corneal Refractive Surgery: A Systematic Review

et al. 2021

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Section: Literature Reviewmentioning

confidence: 99%

Ectasia After Corneal Refractive Surgery: A Systematic Review

et al. 2021

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“…Over the years, and with more cases of iatrogenic ectasia reported ( Ambrósio, 2019 ), there was a search for procedures that would have a low impact on corneal biomechanics—this search led to an increased use of surface ablation surgeries including transepithelial photorefractive keratectomy (tPRK) and the introduction of the small-incision lenticule extraction (SMILE) surgery. However, recent case reports of iatrogenic ectasia post-SMILE have highlighted the need to carefully evaluate the biomechanical advantage of this procedure over laser-assisted in-situ keratomileusis (LASIK) ( El-Naggar, 2015 ; Wang et al, 2015 ; Mattila and Holopainen, 2016 ; Voulgari et al, 2018 ; Pazo et al, 2019 ; Shetty et al, 2019 ). Even though there is experimental and numerical evidence of the reduced biomechanical effect of SMILE compared to LASIK ( Seven et al, 2017 ; Spiru et al, 2018 ), this expected reduced effect was not evident in clinical studies ( Guo et al, 2019 ; Raevdal et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Effects of tPRK, FS-LASIK, and SMILE on the Cornea

Yue

Lopes

Wang

et al. 2022

Front. Bioeng. Biotechnol.

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Purpose: The objective of this study is to evaluate the in vivo corneal biomechanical response to three laser refractive surgeries.Methods: Two hundred and twenty-seven patients who submitted to transepithelial photorefractive keratectomy (tPRK), femtosecond laser-assisted in-situ keratomileusis (FS-LASIK), or small-incision lenticule extraction (SMILE) were included in this study. All cases were examined with the Corvis ST preoperatively (up to 3 months) and postoperatively at 1, 3, and 6 months, and the differences in the main device parameters were assessed. The three groups were matched in age, gender ratio, corneal thickness, refractive error corrections, optical zone diameter, and intraocular pressure. They were also matched in the preoperative biomechanical metrics provided by the Corvis ST including stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), and deformation amplitude 2 mm away from apex and the apical deformation (DARatio2mm).Results: The results demonstrated a significant decrease post-operation in SP-A1 and significant increases in IIR, DA, and DARatio2mm (p < 0.05), all of which indicated reductions in overall corneal stiffness. Inter-procedure comparisons provided evidence that the smallest overall stiffness reduction was in the tPRK group, followed by the SMILE, and then the FS-LASIK group (p < 0.05). These results remained valid after correction for the change in CCT between pre and 6 months post-operation and for the percentage tissue altered. In all three surgery groups, higher degrees of refractive correction resulted in larger overall stiffness losses based on most of the biomechanical metrics.Conclusion: The corneal biomechanical response to the three surgery procedures varied significantly. With similar corneal thickness loss, the reductions in overall corneal stiffness were the highest in FS-LASIK and the lowest in tPRK.

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“…[3][4][5][6][7][8] Some cases of post-SMILE ectasia have been reported in patients with forme fruste keratoconus or mild keratoconus. 3,5,6,8 However, others occurred without any predisposing risk factors. 4,7 These reports are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only six cases of ectasia after SMILE have been reported. 3 – 8 This case report is on an unusual case of post-SMILE bilateral corneal ectasia, as the corneal pathology developed with pregnancy.…”

mentioning

confidence: 99%

Case Report: Bilateral Corneal Ectasia Developed during Pregnancy after Small-incision Lenticule Extraction

Huang

Huang²

2022

Optom Vis Sci

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SIGNIFICANCEThis case highlights that hormonal changes during pregnancy could affect the biomechanical stability of the cornea and lead to corneal ectasia during pregnancy after corneal refractive surgery.PURPOSEWe report an unusual case of bilateral corneal ectasia after small-incision lenticule extraction that developed during pregnancy.CASE REPORTA 27-year-old woman experienced post–small-incision lenticule extraction corneal ectasia. Her pre-operative corneal topography was normal, with a minimum central corneal thickness of 538 μm in the right eye and 530 μm in the left eye. The manifest refraction was −7.75 −0.25 × 180 and −7.50 −0.75 × 10, and the lenticule thickness was 140 and 139 μm in the right and left eyes, respectively. After 11 months, in her first trimester, the patient began to experience gradually deteriorating blurred vision. Two years post-operatively, corneal ectasia was diagnosed based on topographic data. The automatic optometer examination was −7.25 −2.50 × 42 in the right eye and −11.00 −5.00 × 140 in the left eye. Later, the patient underwent corneal collagen cross-linking to control further progression and was recommended to wear rigid gas-permeable contact lenses.CONCLUSIONSSurgeons should be alert for cornea ectasia after refractive surgery in pregnant patients, as hormonal changes during pregnancy may affect corneal biomechanical stability.

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Unilateral ectasia after small-incision lenticule extraction

Cited by 13 publications

References 12 publications

Ectasia After Corneal Refractive Surgery: A Systematic Review

Ectasia After Corneal Refractive Surgery: A Systematic Review

Biomechanical Effects of tPRK, FS-LASIK, and SMILE on the Cornea

Case Report: Bilateral Corneal Ectasia Developed during Pregnancy after Small-incision Lenticule Extraction

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