Short-term Clinical Outcomes of Small Incision Lenticule Extraction for Correction of Myopia Patients with Corneal Opacity

PURPOSE: To evaluate the clinical outcomes of small incision lenticule extraction (SMILE) for the treatment of myopia with corneal opacity. METHODS: Thirteen eyes of 13 patients with corneal opacities who underwent SMILE were retrospectively studied. Uncorrected distance visual acuity, spherical equivalence, efficacy index, and safety index were noted at 3 months after the procedure. The density and area of the corneal opacities were measured and compared preoperatively and 3 months postoperatively. RESULTS: All eyes had preoperative corneal opacities within the lenticule formation areas. The mean area and density of corneal opacities were 0.72 ± 0.33 mm2 and 52.46 ± 15.74, respectively. All procedures were uneventful and no intraoperative complications were observed. At 3 months after the procedure, the efficacy and safety indices were 1.01 ± 0.15, and 1.05 ± 0.10, respectively, and the mean densities and areas of corneal opacities were 46.85 ± 14.56 (p = 0.038) and 0.70 ± 0.36 mm2 (p = 0.776), respectively. CONCLUSIONS: The SMILE procedure was effective and safe for the correction of myopic patients with corneal opacities.

Short-term Clinical Outcomes of Implantable Collamer Lens Implantation with Simultaneous Full Thickness Astigmatic Keratotomy

PURPOSE: To evaluate the clinical outcomes of implantable collamer lens (ICL) implantation with simultaneous full thickness astigmatic keratotomy (FTAK) for the correction of moderate to high myopic astigmatism. METHODS: Thirty-two eyes of 16 patients who had an ICL implantation with simultaneous FTAK were studied. Follow-up visits were at 1 week, 1 month, and 3 months. The outcome measures included the uncorrected distance visual acuity (UDVA), refractive error, efficacy, safety, and predictability. RESULTS: After the surgery, astigmatism was reduced by 74.83 ± 13.8%. The proportion of eyes with a spherical equivalent of 0.5 D or less was 87.5%, and all eyes had a spherical equivalent of 1.0 D or less at 3 months after the surgery. The proportion of eyes with a UDVA of 20/25 or better was 100%, and 20/20 or better was 81.25%. Reoperation was needed in one case (3.1%) because of undercorrection of the astigmatism, and no complications were observed. CONCLUSIONS: This study showed that ICL implantation with simultaneous FTAK is effective and safe for the correction of moderate to high myopic astigmatism.

Comparison of the Early Clinical Outcomes between Combined SMILE and Collagen Cross-linking versus SMILE

PURPOSE: To compare the clinical outcome of combined small incision lenticule extraction and collagen cross-linking (SMILE Xtra) with SMILE. METHODS: This study included 30 eyes from 15 patients who had undergone SMILE Xtra and a random sample of 30 eyes from 15 patients receiving SMILE alone during the same period. We obtained the following parameters from all patients: uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent (SE), efficacy and safety index, and corneal high-order aberrations. RESULTS: The SMILE Xtra group had higher preoperative SE and thinner central corneal and residual stromal bed thickness and optic zone diameter compared to the control group (p < 0.001). At 6 months, there was no significant difference in UDVA or CDVA between the two groups. The efficacy indices were 0.97 ± 0.16 and 1.05 ± 0.17 in the SMILE Xtra and control groups, respectively (p = 0.044), and there was no significant difference in safety index between the two groups during the follow-up period. Total corneal high-order aberrations numbered 2.59 ± 0.56 and 2.02 ± 0.41 in the SMILE Xtra and control groups, respectively (p < 0.001), and there was significant increase in spherical aberration and horizontal corneal aberration in both groups compared to preoperative results. Corneal haze was observed in 20% of eyes in the SMILE Xtra group, and no complication such as corneal ectasia was observed during the follow-up period. CONCLUSIONS: SMILE Xtra had good early clinical outcome compared to SMILE alone. It appears that SMILE Xtra can be a good modality when the cornea is thin or SE is high. However, postoperative corneal haze should be considered.

Comparison of the Early Clinical Outcomes between Combined SMILE and Collagen Cross-linking versus SMILE

PURPOSE: To compare the clinical outcome of combined small incision lenticule extraction and collagen cross-linking (SMILE Xtra) with SMILE. METHODS: This study included 30 eyes from 15 patients who had undergone SMILE Xtra and a random sample of 30 eyes from 15 patients receiving SMILE alone during the same period. We obtained the following parameters from all patients: uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical equivalent (SE), efficacy and safety index, and corneal high-order aberrations. RESULTS: The SMILE Xtra group had higher preoperative SE and thinner central corneal and residual stromal bed thickness and optic zone diameter compared to the control group (p < 0.001). At 6 months, there was no significant difference in UDVA or CDVA between the two groups. The efficacy indices were 0.97 ± 0.16 and 1.05 ± 0.17 in the SMILE Xtra and control groups, respectively (p = 0.044), and there was no significant difference in safety index between the two groups during the follow-up period. Total corneal high-order aberrations numbered 2.59 ± 0.56 and 2.02 ± 0.41 in the SMILE Xtra and control groups, respectively (p < 0.001), and there was significant increase in spherical aberration and horizontal corneal aberration in both groups compared to preoperative results. Corneal haze was observed in 20% of eyes in the SMILE Xtra group, and no complication such as corneal ectasia was observed during the follow-up period. CONCLUSIONS: SMILE Xtra had good early clinical outcome compared to SMILE alone. It appears that SMILE Xtra can be a good modality when the cornea is thin or SE is high. However, postoperative corneal haze should be considered.