ABSTRACT
A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.
ABSTRACT
The purpose of the study is to report the feasibility of implantation of a new design of anterior capsule-fixated intraocular lens (IOL). The new IOL design is a foldable, hydrophilic, open-loop posterior chamber IOL with two extra polymethyl methacrylate swivel haptics created on the optic surface to capture the anterior capsulotomy after the IOL is implanted in the bag. In the pilot phase, the new IOL was implanted in 10 eyes of 10 patients of which 8 eyes underwent phacoemulsification and 2 eyes had laser cataract surgery. The mean spherical equivalent changed from *1.75 D to ?0.75 D at 6 months. Postoperatively, from 1 week to 6 months, all eyes showed stable refraction and anterior chamber depth with no evidence of decentration. Subjective questionnaire revealed high patient satisfaction with no complaints of dysphotopsia. No intra- or postoperative complications such as swivel haptic breakage, iris chafing, pigment dispersion, postoperative uveitis, or endophthalmitis occurred in any of the eyes necessitating explantation of the IOL. The new IOL design was feasible to implant and provided satisfactory outcomes in terms of no dysphotopsias and stable effective lens position.
ABSTRACT
Purpose: To study the time course of interface healing and its correlation with visual acuity, modulation transfer function (MTF), and aberrations after myopic small-incision lenticule extraction (SMILE) correction. Methods: Seventy-eight eyes of 78 patients (1 eye per patient) with a mean age of 25.7 years and mean spherical equivalent (SE) of ?3.74D, undergoing bilateral SMILE procedure, were included in this study. On postoperative day 1, 2 weeks, and 3 months, dilated retroillumination photographs were taken and morphology of corneal interface was graded by comparing them with 5 standard templates representing 5 grades of interface roughness (IRG): IRG � 0 (clear), IRG � 1 (mild), IRG � 2 (moderate), IRG � 3 (severe), and IRG � 4 (severe IRG with Bowman's folds in visual axis). Pearson's correlations were computed to study correlation associations, and Wilcoxon signed-rank test was used for intragroup comparison of means. P ? 0.05 was considered statistically significant. Results: At 3 months, 90.70% eyes were Grade 0 while 9.30% eyes still had Grade 2 interface granularity. Mean IRG significantly improved from 2.47 � 0.57 at day 1 to 0.62 � 0.53 at 3 months (P = 0.00). At day 1, pre-SE showed a significant positive correlation with IRG; however, mean postoperative corrected distant visual acuity (CDVA, in decimal), corneal Strehl ratio (SR), and MTF showed weak but significant negative correlation with IRG (r2 = 0.28 for SE, ?0.052 for CDVA, ?0.017 for SR, and ?0.39 for MTF, respectively, P < 0.05 for all correlations). At 2 weeks and 3 months, corneal MTF continued to show a significant negative correlation, whereas other parameters did not show any correlation with IRG. Conclusion: Visual quality and corneal MTF may be significantly affected by the IRG in the immediate postoperative period after SMILE and may take 3 months or more for complete recovery.
ABSTRACT
Small incision lenticule extraction (SMILE), a variant of refractive lenticule extraction technology is becoming increasingly popular, as a flapless and minimally invasive form of laser vision correction (LVC) for the treatment of myopia and myopic astigmatism. This review aims at summarizing the principles, surgical technique, and clinical outcomes in terms of visual and refractive results, safety, efficacy, postoperative dry eye, aberrations, and biomechanics of SMILE and its comparison with other conventional techniques of LVC, such as laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Recent advancements in the laser frequency and energy delivery patterns, instrumentation, and surgical techniques have shown significant improvement in the visual recovery and outcomes after SMILE, compared to the initial results published by Sekundo and Shah et al. Most of the recently published literature on long-term outcomes of SMILE shows excellent stability of the procedure, especially for higher myopia. In terms of the postoperative dry eye, SMILE shows a clear advantage over LASIK as numerous studies have shown significant differences about the Schirmer's, Tear film break up time, corneal sensitivity, and corneal nerve regeneration to be better following SMILE compared to LASIK. There is some evidence that since the Bowman's membrane (BM) and the anterior lamellae remain intact after SMILE, this may be a potential advantage for corneal biomechanics over LASIK and PRK where the BM is either severed or ablated, respectively, however, the data on biomechanics are inconclusive at present. Overall, this procedure has proved to be promising, delivering equivalent, or better visual and refractive results to LASIK and providing clear advantage in terms of being a flapless, minimally invasive procedure with minimal pain and postoperative discomfort thus offering high patient satisfaction.