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AIM: To evaluate the clinical outcomes of using the cross-positioning method for correcting low and moderate astigmatism during small incision lenticule extraction(SMILE)surgery with Alpins vector analysis.METHODS: A total of 50 patients(81 eyes)with low and moderate astigmatism with the rule ≤1.50 D who underwent SMILE surgery at the laser myopia treatment center of Xi'an No.1 Hospital from May 2022 to November 2022 were included in the prospective randomized controlled study, and they were divided into two groups according to the random table, with 25 case(41 eyes)in cross-positioning group and 25 cases(40 eyes)in control group. In the cross-positioning group, the patients' head position was adjusted based on the cross intersection lines before the standard SMILE procedure, aligning the lateral canthi with the horizontal line and the midpoint of the eyebrows and the nose bridge with the vertical line. Postoperative visual acuity and refractive results at 3 mo were observed in both groups, and astigmatic changes were analyzed and evaluated using the Alpins vector analysis method.RESULTS: During the follow-up period, 6 cases(11 eyes)in the cross-positioning group were lost to follow-up, while in the control group, 8 cases(14 eyes)were lost to follow-up, with 19 cases(30 eyes)and 17 cases(26 eyes)finally included in the cross-positioning group and the control group, respectively. At 3 mo postoperatively, the uncorrected visual acuity(UCVA)of both groups' operated eyes was ≥1.0, and no serious complications occurred, with no significant differences in UCVA, best corrected visual acuity(BCVA), spherical power, and spherical equivalent between the cross-positioning group and the control group(all P>0.05). The cylindrical power in the cross-positioning group was 0.00(0.00, 0.00)D, which was lower than -0.13(-0.50, 0.00)D in the control group(P=0.01). The vector analysis results showed that the difference vector(DV)in the cross-positioning group was lower than that in the control group [0.00(0.00, 0.00)vs 0.13(0.00, 0.50), P=0.01], and the index of success(IOS)was better than that of the control group [0.00(0.00, 0.00)vs 0.18(0.00, 0.77), P<0.01]. At 3 mo postoperatively, 26(87%)and 15(58%)eyes in the cross-positioning group and control groups achieved an angle of error(AE)within ±5°, respectively.CONCLUSION: The cross positioning method was used to calibrate the patients' head position during SMILE surgery, which reduced the axial position error and improved the accuracy of SMILE in correcting low and moderate astigmatism.
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AIM: To explore the clinical effect of small incision lenticule extraction(SMILE)on the treatment of myopic anisometropia.METHODS: Clinical data of 76 patients(146 eyes)with myopic anisometropia who received SMILE or femtosecond assisted laser in situ keratomileusis(FS-LASIK)in our hospital from January 2021 to December 2022 were retrospectively analyzed. The patients were divided into SMILE group(39 cases, 77 eyes)and FS-LASIK group(37 cases, 69 eyes)according to surgical methods. Uncorrected visual acuity(UCVA), diopter, anisometropia, corneal aberration and occurrence of postoperative complications were compared between the two groups at 1 wk, 1 and 3 mo after surgery.RESULTS: The UCVA of the two groups was improved after surgery compared with that before surgery, and the coma, trefoil, spherical aberration and total higher-order aberration were significantly increased compared to those before surgery(P<0.05), and the coma, trefoil, spherical aberration and total higher-order aberration in the FS-LASIK group were significantly higher than those in the SMILE group(P<0.05). After follow-up to 3 mo after surgery, the incidence of postoperative complications was significantly lower in the SMILE group than that in the FS-LASIK group(5.2% vs 15.9%, P<0.05).CONCLUSION: Both SMILE and FS-LASIK can effectively enhance the UCVA and improve the visual quality in patients with myopic anisometropia, but SMILE has lower corneal higher order aberrations, lower incidence of postoperative complications and better overall effect.
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AIM:To investigate the effect of small incision lenticule extraction(SMILE)on the treatment of myopia patients, and the impact on corneal biomechanics.METHODS:Retrospective study. A total of 120 myopic patients(240 eyes)who were scheduled to undergo corneal refractive surgery in Anyang Eye Hospital from January 2020 to December 2021 were selected. The patients were divided into SMILE group(64 patients, 128 eyes)and transepithelial photorefractive keratectomy(TransPRK)group(56 patients, 112 eyes)according to the surgical treatment method. The two groups were compared in terms of uncorrected visual acuity, corneal biomechanics, corneal endothelial cell count, posterior corneal surface height and corneal surface regularity index at 1, 7 d, 1, 3, 6 mo and 1 a after surgery, and surgical complications.RESULTS:The uncorrected visual acuity of the SMILE group at 1, 7 d and 1 mo after surgery was better than that of the TransPRK group(all P<0.001), but there was no statistically significant difference between the groups at 3, 6 mo and 1 a after surgery(all P>0.05). Compared with preoperative values, corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal resistance factor, and corneal hysteresis in both groups showed a first decreasing and then increasing trend after surgery. The corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal resistance factor, and corneal hysteresis in the SMILE group at 1, 7 d and 1 mo after surgery were higher than those in the TransPRK group(all P<0.05), but there was no statistically significant difference between the groups at 3, 6 mo and 1 a after surgery(all P>0.05). There were no significant changes of corneal endothelial cell count and corneal posterior surface height in the two groups after surgery(all P>0.05). Furthermore, corneal surface regularity index of the two groups showed a first increasing and then decreasing trend after surgery, with no statistically significant difference between the groups(P>0.05), and there was no statistically significant difference in the incidence of postoperative complications between the groups(P>0.05).CONCLUSION:Compared with TransPRK, SMILE has less influence on corneal biomechanics, and better visual recovery in the early stage. There is no difference in long-term visual acuity between the two surgeries, and both have good safety and effectiveness.
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Purpose: To study posterior capsular opacification (PCO) and neodymium?doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square?edged and non?square?edged intraocular lenses (IOLs) in manual small?incision cataract surgery (MSICS). Setting: Tertiary eye care center. Design: Prospective, comparative, and randomized controlled study. Methods: This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square?edged (S group) or non?square?edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit?lamp illumination. Results: A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (�2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best?corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (�10), 0.11 (�12), and 0.12 (�11), respectively, in the S group and 0.17 (�10), 0.17 (�12), and 0.20 (�17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow?up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd:YAG. Conclusion: Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360� square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square?edged IOL has a definite role in the prevention of PCO in MSICS.
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Purpose: To compare the visual outcomes in patients undergoing small?incision lenticule extraction (SMILE) for correction of myopic astigmatism (??1.50 D) with or without manual cyclotorsion compensation. Methods: A prospective, double?blinded, randomized, contralateral study was conducted in the refractive services of a tertiary eye care center. Eligible patients with bilateral high myopic astigmatism (?1.5 D) and intraoperative cyclotorsion (?5°) undergoing SMILE between June 2018 and May 2019 were included. Cyclotorsion compensation was performed using triple centration method before femtosecond laser delivery. Uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) measurement, manifest refraction, slit?lamp biomicroscopy, and corneal tomography were performed preoperatively and at 1 and 3 months’ postoperative visit. Astigmatic outcomes were analyzed using Alpins criteria. Results: A total of 30 patients (60 eyes) were included in this study. The patients underwent bilateral SMILE surgery, with manual cyclotorsion compensation in one eye (CC group, n = 30 eyes) and no cyclotorsion compensation in the other eye (NCC group, n = 30 eyes). Preoperative astigmatism and intraoperative cyclotorsion were ?2.0 D and 7.03° ± 1.06° (CC) and ?1.75 D and 7.24° ± 0.98° (NCC) (P = 0.472 and 0.240, respectively). No significant differences were noted in mean refractive spherical equivalent (MRSE), UDVA, CDVA, and refractive error between the two groups at 3 months’ postoperative visit. Astigmatic outcomes measured using Alpins criteria demonstrated no significant difference between the two cohorts. Conclusion: The cyclotorsion compensation technique provided no additional advantage in terms of astigmatic outcomes or postoperative visual quality, in eyes with high preoperative astigmatism and intraoperative cyclotorsion.
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Purpose: To evaluate the postoperative visual outcomes, that is, corneal higher?order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small?incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods: This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty?four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results: At 24 months postoperatively, the mean spherical equivalent (SE) refraction was ? 0.32 ± 0.40 and ? 0.31 ± 0.35 in the S?kappa group (kappa <0.3 mm) and the L?kappa group (kappa ?0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion: Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.
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Purpose: To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods: Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results: In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion: PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.
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Purpose: Pseudoexfoliation glaucoma (XFG) is often associated with a higher rate of intraoperative complications and failure. This study aims to compare the long?term clinical and surgical outcomes of cataract surgery alone versus combined surgery in XFG. This was a retrospective comparative case series. Methods: All patients with XFG who underwent either cataract surgery alone [group 1: either phacoemulsification, PHACO/small?incision cataract surgery (SICS), n = 35] or combined surgery (group 2: phacotrabeculectomy, PHACOT or SICS + trabeculectomy, n = 46) from 2013 to 2018 by a single trained surgeon were screened and recalled for a detailed clinical examination, including Humphrey visual field analysis at 3?monthly intervals for a minimum of 3 years. Surgical success (intraocular pressure, IOP, <21 mm Hg and >6 mm Hg with (qualified success) or without medicines, complete success, survival rates, visual field changes, and need for additional procedures/medicines for IOP control were compared between groups. Results: A total of 81 eyes of 68 patients with XFG were included in this study (groups 1–35 eyes and groups 2–46 eyes each). Both groups achieved 27–40% IOP reduction from preoperative IOP levels, P < 0.001. Surgical success rates were similar in both groups (complete success 66% vs 55%, P = 0.4), qualified success 17% vs 24%, P = 0.8, in groups 1 and 2). Kaplan–Meier analysis showed a marginally better survival rate for group 1, 75% (55–87%), than group 2, 66% (50–78%), at 3 and 5 years which was not significantly different. The number of eyes that progressed at 5 years after surgery (5–6%) was similar in both groups. Conclusion: Cataract surgery can be as effective as combined surgery in XFG eyes with regards to final visual acuity, long?term IOP profile, and visual field progression, and complications/survival rates are comparable between the two procedures.
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AIM: To observe and compare the changes in retinal peripheral refraction and aberrations after femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)versus small incision lenticule extraction(SMILE)for myopia correction.METHODS: A total of 71 patients(71 eyes)with myopia who underwent FS-LASIK from October 2022 to April 2023 in our hospital were selected as the FS-LASIK group, and 80 patients(80 eyes)with myopia who underwent SMILE were selected as the SMILE group. All patients underwent corneal wavefront aberration measurement and multispectral refractive topography preoperatively and 3mo postoperatively, as well as refraction difference value(RDV)in the range of 0°～10°, 10°～20°, 20°～30°, 30°～40°, and 40°～53° in the annulus of the retina, which were recorded as RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), and RDV-(40°～53°). The results of two groups of patients were compared.RESULTS: No significant differences were observed in RDV-(0°～10°), RDV-(10°～20°), RDV-(20°～30°), RDV-(30°～40°), RDV-(40°～53°)between the two groups at 3mo post-operation(all P>0.05). Furthermore, the RDV-(20°～30°), RDV-(30°～40°)and RDV-(40°～53°)of the two groups at 3mo postoperatively were all significantly lower than those preoperatively(all P<0.05). The changes in coma(horizontal)and spherical aberration(SA)at 3mo postoperatively were smaller in the SMILE group [0.106(0.056, 0.171)and 0.115(0.081, 0.182)μm] than in the FS-LASIK group [0.206(0.104, 0.355)and 0.197(0.128, 0.254)μm](Z=-4.170, -5.016, all P<0.05). A negative correlation was found between postoperative SA and postoperative RDV-(10°～53°)(rs=-0.205, -0.181, -0.226, -0.244, all P<0.05).CONCLUSION: Both FS-LASIK and SMILE reduced retinal hyperopic defocus in the peripapillary macular range of 20°～53° eccentricity, and the postoperative changes in coma(horizontal)and SA were smaller with SMILE than with FS-LASIK. There was a certain correlation between postoperative SA and postoperative retinal peripheral defocus.
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AIM: To investigate the effect of different preoperative corneal curvature on the size of optical deformation area after femtosecond laser small incision lens extraction(SMILE).METHODS:A prospective study was conducted on 108 consecutive patients who underwent SMILE surgery in our hospital from February 2021 to January 2022. Considering the association between both eyes, only the left eye of each patient was studied. According to the average anterior corneal surface curvature in preoperative, the patients were divided into three groups: Km<42.0D group(n=30), Km>47.0D group(n=26)and conventional corneal curvature group(n=52)with 42.0D≤Km≤47.0D. All patients underwent standardized SMILE surgery, and the laser ablation diameter was 6.5mm. The diameters of optical deformation areas in the three groups were compared at 6mo after operation.RESULTS:There was no significant difference in preoperative data among the three groups except for the mean curvature of the anterior corneal surface(all P>0.05), and there was no significant difference in uncorrected distance visual acuity(UDVA)and subjective refraction at 6mo after operation(all P>0.05). The diameters of the optical deformation zone in the Km<42.0D group, Km>47.0D group and the conventional corneal curvature group were 6.54±0.14, 6.32±0.13, 6.45±0.15mm respectively(F=19.238, P<0.05). The optical area diameter of the group with flat corneal curvature was larger than that of the group with conventional corneal curvature and the group with steeper corneal curvature(P<0.05). The diameter of optical zone in the conventional curvature group was larger than that in the Km>47.0D group(P<0.05).CONCLUSION: When the preset laser cutting diameter is the same, the steeper the corneal curvature before operation, the smaller the diameter of the optical deformation area after operation.
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AIM: To compare the changes in corneal densitometry after small incision lenticule extraction(SMILE)and femtosecond laser in situ keratomileusis(FS-LASIK)and investigate the effect of corneal interface haze on vision after SMILE.METHODS: Prospective cohort study. A total of 93 patients(186 eyes)who were scheduled to undergo refractive surgery at the Ophthalmic Refractive Surgery Center of the Affiliated Hospital of Nantong University from May 2020 to October 2021 were included in the study, and there were 48 patients(96 eyes)in the SMILE group and 45 patients(90 eyes)in the FS-LASIK group. The changes in corneal densitometry, spherical equivalent(SE), and uncorrected visual acuity(UCVA)were observed and compared between the two groups before and at 1d, 1wk, 1, 3 and 6mo after surgery.RESULTS: The 93 patients all successfully completed the surgery, and there were no related complications during and after the surgery, and there were no lost cases. The UCVA of FS-LASIK group was 0.044±0.064 and -0.001±0.065 respectively at 1d and 1wk after surgery, which was better than that of SMILE group(0.102±0.077 and 0.023±0.064; all P<0.05). There was no statistical difference in the SE between the two groups at the postoperative follow-ups(P>0.05). The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1d postoperatively in the FS-LASIK group were 18.0(17.5, 18.6), 16.2(15.6, 16.7)and 16.7(16.1, 17.3), which were lower than those of SMILE group [18.6(18.1, 19.3), 16.8(16.4, 17.4), 17.2(16.6, 17.8)](all P<0.05); The corneal densitometry values at 0-2 and 2-6 mm from corneal vertex and total corneal densitometry at 1wk postoperatively in the FS-LASIK group were 17.2(16.7, 17.6), 15.5(15.0, 15.9)and 15.9(15.3, 16.7), which were lower than those of SMILE group [17.6(17.1, 18.3), 16.0(15.6, 16.5), 16.6(15.9, 17.1)](all P<0.05).CONCLUSIONS: The transient interface haze after SMILE is responsible for the early higher corneal densitometry than FS-LASIK. The presence of interface haze is probably a factor for the quality of vision.
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AIM:To compare the curative effect of different surgical methods combined with Toric intraocular lens(IOL)implantation on age-related hard nuclear cataract.METHODS:According to retrospective study, 104 patients(104 eyes)with age-related hard nuclear cataract confirmed in the hospital between January 2020 and December 2021 were enrolled. They were divided into phacoemulsification group(52 eyes, phacoemulsification combined with Toric IOL implantation)and small-incision group(52 eyes, small-incision split nuclear technique in horizontal space combined with Toric IOL implantation)according to different surgical methods. The best corrected distance visual acuity(BCDVA), corneal astigmatism, number of corneal endothelial cells, proportion of normal hexagonal cells, tear film function and complications were compared between the two groups.RESULTS:There was no significant difference in BCDVA(LogMAR)between the two groups before and at 3mo after surgery(all P>0.05), while BCDVA(LogMAR)was better in small-incision group than phacoemulsification group at 1wk after surgery(0.15±0.04 vs. 0.20±0.05, P<0.001). The corneal astigmatism of the patients in both groups was lower at 1wk and 3mo after surgery than that before surgery, and it was lower at 3mo than 1wk after surgery(all P<0.05), while there was no significant difference in corneal astigmatism between the two groups before and after surgery(all P>0.05). At 1wk and 3mo after surgery, number of corneal endothelial cells in small-incision group was more than that in phacoemulsification group(1wk after surgery: 2363.8±315.3 vs. 2231.4±326.4 cells/mm2, P<0.05; 3mo after surgery: 2414.6±245.7 vs. 2322.9±221.0 cells/mm2, P<0.05). Before and at 1wk after surgery, there was no significant difference in the proportion of normal hexagonal cells between the two groups(all P>0.05). At 3mo after surgery, proportion of normal hexagonal cells in small-incision group was higher than that in phacoemulsification group(21.77%±1.91% vs. 20.59%±1.65%, P<0.001). Before and at 3mo after surgery, there was no difference in break up time(BUT)or ocular surface disease index(OSDI)score between the two groups(P>0.05). At 1wk after surgery, BUT in small-incision group was longer than that in phacoemulsification group(6.8±0.8 vs. 5.9±1.0s, P<0.001)and OSDI score was lower than that in phacoemulsification group(17.62±5.47 vs. 20.34±6.18 points, P<0.05). The incidence of postoperative complications in small-incision group was lower than that in phacoemulsification group(3.9% vs. 17.3%, P<0.05).CONCLUSION: Small-incision split nuclear technique in horizontal space combined with Toric IOL implantation can significantly improve visual acuity and astigmatism in patients with age-related cataract, with slight damage to corneal endothelium and tear film function.
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Femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)are the mainstream corneal refractive surgeries at present. Despite efficacy, safety and predictability they have showed in refractive error correction, there are still complications relating to femtosecond laser, such as suction loss and opaque bubble layer(OBL), due to that the production of corneal flap or lenticule is dependent on the femtosecond laser. OBL is a complication that is unique to femtosecond laser surgery and the bubbles are generated from photo-disruptive effect towards corneal tissues which consisted of water vapor and carbon dioxide, and OBL gradually formed when the bubbles are trapped in the stroma. The bubbles can influence the intraoperative manipulation and postoperative visual quality. This review discusses the mechanism, grading, classification, and influencing factors of OBL and its effects on intraoperative manipulations and postoperative recovery, in the hope of providing reference and basis for further clinical studies.
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AIM:To evaluate the changes in corneal biomechanics of patients with moderate refractive error after receiving small-incision lenticule extraction(SMILE)and femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)using the corneal visualization Scheimpflug technology(Corvis ST).METHODS:Prospective cohort study. A total of 65 moderate myopia patients(65 eyes)who were scheduled to undergo refractive surgery at the Ophthalmic Refractive Surgery Center of the Ningxia Eye Hospital from November 2020 to November 2021 were included in the study, and there were 30 eyes in the SMILE group and 35 eyes in the FS-LASIK group. The changes in corneal biomechanical parameters, including integrated radius(IR), inverse concave radius(ICR), deformation amplitude ratio 2mm(DAR2), stiffness parameter at first applanation(SP-A1), ambrosio relational thickness(ARTh)and the central curvature radius at highest concavity(HC-Radius)were observed by Corvis ST between both groups preoperatively and 1 and 3mo postoperatively.RESULTS: There were no statistical significance in biomechanical parameters between two groups of patients 1 and 3mo postoperatively(P&#x003E;0.05). IR, ICR and DAR2 of each groups of patients 1 and 3mo postoperatively were significantly increased than those preoperatively, and SP-A1, ARTh and HC-Radius were significantly decreased than those preoperatively(all P&#x003C;0.05). The biomechanical parameters at 1mo and 3mo postoperatively showed no statistical significance(P&#x003E;0.05). In addition, a positive correlation was found between central corneal thickness(CCT)and ARTh and SP-A1 of the two groups of patients at 3mo postoperatively(FS-LASIK group: r=0.727, 0.819, SMLIE group: r=0.683, 0.434, all P&#x003C;0.05), while a negative correlation was found between CCT and IR and ICR at 3mo postoperatively.(FS-LASIK group: r=-0.697, -0.622, SMLIE group: r=-0.447, -0.491, all P&#x003C;0.05).CONCLUSION:For patients with moderate myopia, both SMILE and FS-LASIK can reduce corneal biomechanical stability. Both surgeries showed no significant differences in the effect on biomechanical, and the biomechanical has been stabilized at 1mo postoperatively. A correlation was found between postoperative CCT and ARTh, SP-A1, IR and ICR.
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@#Objective To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement. Methods The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared. Results There were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05). Conclusion The aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.
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Objective:To analyze the clinical effect of small incision approach conjoint fascial sheath (CFS) suspension in the treatment of congenital severe blepharoptosis, and to discuss its advantages and disadvantages compared with conventional CSF suspension.Methods:From February 2020 to August 2022, 42 cases of severe blepharoptosis in the Department of Burn, Plastic and Cosmetic Surgery, Shaanxi Provincial People's Hospital were divided into the observation group (23 cases, 39 eyes) and the control group (19 cases, 37 eyes). The observation group was treated with small incision CFS suspension surgery, while the control group was treated with conventional CFS suspension surgery. The correction effect, complications, recovery time and other conditions between the two groups at different times after surgery were compared.Results:During postoperative follow-up at 1 week, 1 month, 3 months, and 6 months, there was no significant difference in the corrective effect between the two surgical methods at each time point (all P>0.05). The incidence of complications in the observation group at each time point that was 26.3%, 15.7%, 10.5%, and 5.2%, respectively, while the incidence of complications in the control group was 60.0%, 20.0%, 14.2%, and 8.6%, with statistical differences in the first week after surgery (χ 2=8.74, P=0.011). The average postoperative swelling time in the observation group was 4.2 days, which was less than 5.8 days in the control group. During a 6-month follow-up, it was found that there was a decrease in scar hyperplasia in the observation group of 9.1% (2/22) compared to the control group of 16.7% (3/18) (χ 2=0.023, P=0.878). The difference was of no statistical significance. Conclusions:CFS suspension with small incision in the treatment of moderate and severe blepharoptosis has the advantages of ideal correction effect, small damage range, and few postoperative complications, but the operation area is small, the operation is difficult, and the surgeon has higher requirements.
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Objective:To study the effect of cardiac rehabilitation program on recovery of patients after small incision aortic valve replacement.Methods:600 patients who underwent small incision aortic valve replacement in our hospital from January 2015 to January 2020 were retrospectively collected and divided into Cardiac rehabilitation group(CR) and control group by propensity matching analysis. Clinical data of CR group and control group were collected 6 months and 12 months after the beginning of Cardiac rehabilitation program. The primary outcome measures were the peak oxygen uptake(VO 2 Peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialty in tertiary hospitals after the rehabilitation program began. The secondary outcome measures were 6-minute Walk test(6-MWT), psychological evaluation, and assessment of cardiovascular disease risk factors. Results:After 6 months and 12 months of cardiac rehabilitation program, the VO2 peak in CR group was statistically significant compared with the control group, and the 6-MWT index after 12 months was statistically significant.The cardiovascular specialist visits in tertiary hospitals in the two groups were statistically significant. The comparison of psychological self-rating scale and cardiovascular disease risk factors between the two groups was statistically significant after propensity matching analysis.Conclusion:Cardiac rehabilitation has a positive effect on postoperative recovery after small incision aortic valve replacement, and can improve patients’ motor ability.
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Objective:To evaluate the efficacy and safety of small incision surgery combined with multi-point skin fixation in the treatment of axillary osmidrosis.Methods:104 patients with axillary osmidrosis who were treated in the dermatology department of the Third Hospital of Changsha from January 2017 to December 2020 were retrospectively analyzed. They were divided into the observation group (56 cases) and the control group (48 cases). Both groups were treated with small incision pruning combined with porous drainage. On this basis, the observation group was treated with multi-point skin fixation gauze compression bandage, while the control group was treated with conventional gauze stacking compression bandage. The efficacy, satisfaction, postoperative wound healing time and complication rate of the two groups were compared.Results:The effective rate of the observation group and the control group were 96.43%(54/56) and 95.83%(46/48) respectively, with no significant difference ( P>0.05). Compared with preoperative, the Visual Analogue Scale (VAS) score of patients in the two groups was significantly lower after operation, and the difference was statistically significant (both P<0.05). The satisfaction of patients in the observation group was higher than that in the control group [(4.05±1.15)points vs (3.19±1.00)points], and the difference was statistically significant ( t=4.10, P<0.05). The wound healing time in the observation group was shorter than that in the control group, and the incidence of complications was lower than that in the control group, with statistically significant difference (all P<0.05). Conclusions:Small incision surgery combined with multi-point skin fixation for the treatment of axillary osmidrosis has good curative effect, short postoperative wound healing time and fewer complications, and improved patient satisfaction, which can be popularized in clinical application.
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Objective:To compare the changes in functional optical zone (FOZ) and corneal morphology in myopes between femtosecond small incision laser lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK).Methods:A cohort study was performed.A total of 94 patients (94 eyes) who underwent FS-LASIK or SMILE at Eye Hospital, Wenzhou Medical University from March to December 2021 were enrolled.The selected patients were divided into a SMILE group (46 cases, 46 eyes) and an FS-LASIK group (48 cases, 48 eyes) according to the surgical procedure, and the follow-up period was 6 months.The primary outcome measures were postoperative changes in corneal FOZ and Q-value, and the secondary outcome measures were changes in central corneal thickness (CCT) and mean corneal curvature (Km). Corneal Q-value, horizontal and vertical FOZ diameters, CCT, and Km were recorded before surgery and at 1 day, 1 week, 1 month, and 6 months after surgery using the Pentacam anterior segment analysis system, and the differences in each parameter and the trends of changes between the two groups were compared.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Eye Hospital, Wenzhou Medical University (No.2021-034-k-27). Written informed consent was obtained from each subject.Results:There were statistically significant overall differences in the postoperative horizontal and vertical FOZ diameters between the two groups (horizontal diameter: Fgroup=7.06, P<0.001; Ftime=64.18, P=0.001; vertical diameter: Fgroup=11.08, P<0.001; Ftime=77.14, P<0.001). The horizontal and vertical FOZ diameters were significantly larger in SMILE group than in FS-LASIK group at various postoperative time points, and the differences were statistically significant (all at P<0.001). In the two groups, the postoperative 1-week, 1-month and 6-month horizontal FOZ diameters and the postoperative 1-week and 1-month vertical FOZ diameters were smaller than the postoperative 1-day ones, and the differences were statistically significant (all at P<0.05). There were significant overall differences in Q-values at different postoperative time points between the two groups ( Fgrouup=53.11, P=0.019; Ftime=29.18, P<0.001). The postoperative 1-day, 1-week, and 1-month Q-values of FS-LASIK group were significantly higher than those of SMILE group (all at P<0.05). The postoperative 1-week Q-value was significantly larger than the postoperative 1-day value in SMILE group ( P<0.001). The postoperative Q-values gradually decreased with time in FS-LASIK group, with significant pairwise differences at all adjacent time points (all at P<0.001). There were significant differences in CCT at various postoperative time points between the two groups ( Ftime=21.43, P<0.01). In FS-LASIK group, the CCT was decreased at 1 week than 1 day after surgery and was increased at 6 months than 1 week after surgery, and the differences were statistically significant (all at P<0.05). In SMILE group, the postoperative 1-week, 1-month and 6-month CCT was increased in comparison with the postoperative 1-day value, and the differences were statistically significant (all at P<0.05). There was no significant overall difference in the Km between the two groups ( Fgroup=27.29, P=0.41). There were significant pairwise differences in the Km at different postoperative time points between the two groups (all at P<0.001). The postoperative 6-month Km was smaller than the postoperative 1-day value in SMILE group, and the postoperative 6-month Km was greater than the postoperative 1-day value in FS-LASIK group (both at P<0.05). Conclusions:The FOZ shows a trend of gradual reduction within a month after SMILE and FS-LASIK.The FOZ is larger after SMILE than after FS-LASIK.The morphologic stability of corneal FOZ is better after SMILE than after FS-LASIK.
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Objective:To investigate the differences and changes in early postoperative visual quality after small incision lenticule extraction (SMILE) and smart pulse technology-assisted transepithelial photorefractive keratectomy (SPT-TransPRK).Methods:A cohort study was performed.A total of 92 patients (92 eyes) who underwent corneal laser refractive surgery were enrolled in Dalian Third People's Hospital Affiliated to Dalian Medical University from February 2021 to May 2021.The data from the right eye were collected for analysis.The patients were divided into SMILE group (40 patients, 40 eyes) and SPT-TransPRK group (52 patients, 52 eyes). Preoperative, 1- and 3-month postoperative visual acuity were measured to calculate the effectiveness, which was defined as the ratio of postoperative uncorrected visual acuity (UCVA) to preoperative best corrected visual acuity.Refraction was measured by an AR-1 autorefractor.Corneal higher-order aberration (HOA) including total HOA, spherical aberration and coma was measured by Sirius corneal topographer.Objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), simulated contrast visual acuity VA100 (day), VA20 (dusk) and VA9 (night) were measured via OQAS II visual quality analysis system.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Dalian Third People's Hospital Affiliated to Dalian Medical University (No.2019-KT-010). Written informed consent was obtained from each subject.Results:There was no significant difference in 3-month postoperative UCVA and effectiveness between the two groups ( Z=0.880, P=0.380; t=0.920, P=0.058). Patients in SPT-TransPRK group showed mild hyperopia 3 months after surgery.Preoperative, 1- and 3-month postoperative total corneal HOA was (0.47±0.18), (0.70±0.22) and (0.74±0.19)μm in SMILE group, and (0.40±0.14), (0.98±0.35) and (0.94±0.22)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=13.851, P=0.001; Ftime=29.960, P<0.001). Preoperative, 1- and 3-month postoperative spherical aberration was (-0.20±0.09), (-0.44±0.14) and (-0.44±0.15)μm in SMILE group, and (-0.20±0.10), (-0.71±0.23) and (-0.75±0.20)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=31.037, P<0.001; Ftime=48.005, P<0.001). The postoperative total corneal HOA and spherical aberration were increased in both groups compared with before surgery, with statistically significant differences (all at P<0.05). The 1- and 3-month postoperative total corneal HOA and spherical aberrations were smaller in SMILE group than in SPT-TransPRK group, and the differences were statistically significant (all at P<0.05). The 1- and 3-month postoperative coma were increased in both groups compared with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, and VA9 were lower than those before surgery, and 3-month postoperative OSI was higher and 3-month postoperative SR and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). In SPT-TransPRK group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, VA100, VA20, and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). There was no significant difference in OSI, MTF cut-off, SR, VA100, VA20, and VA9 between 3 months postoperatively and before surgery in the SPT-TransPRK group (all at P>0.05). There was no significant difference in coma, OSI, MTF cut-off, SR, VA100, VA20, and VA9 between two groups (all at P>0.05). Conclusions:Both SMILE and SPT-TransPRK are effective methods for correcting myopia and they have comparable visual quality.Compared with SPT-TransPRK, corneal total HOA and spherical aberration are smaller after SMILE.