RESUMEN
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.
RESUMEN
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.
RESUMEN
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&#x003E;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&#x003C;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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
AIM:To investigate the effectiveness of surgical simulator-based small-incision extracapsular cataract extraction training for young ophthalmologists.METHODS:Prospective and controlled study. A total of 48 young participants who had completed at least 3a standardized residency training or had obtained the attending certificate in the He Eye Specialist Hospital from 2020 to 2022 were enrolled. All the participants were randomly divided into simulator surgical operation training group(experimental group, n=24)and real animal eye operation training group(control group, n=24)after passing the theoretical training and assessment of small incision extracapsular cataract extraction. The participants in the experimental group and control group were trained with the surgical simulator and pig eyes respectively. After training, the overall effectiveness of training in both groups was rated using the simulator and pig eye operation was evaluated.RESULTS: The participants in the experimental group used less time than the participants in the control group on simulator assessment(all P<0.05). The scores of injecting viscoelastics during keratonyxis, nucleus delivery and hydrate the paracentesis site steps were not different on simulator assessment between the two groups(P>0.05). For the rest of the steps, the scores of experimental group were higher than those of the control group(all P<0.05). Participants in the experimental group had significantly higher scores than control group on pig eye operation assessment(all P<0.05). In the experimental group, the scores of the scleral groove dissection, tunnel dissection, continuous circular capsulorhexis, hydrodissection and hydro-prolapse and nucleus delivery steps had no significant difference between the surgical simulator and pig eye operation(P=0.068, 0.126, 0.960, 0.520, 0.206). The scores of injecting viscoelastics during keratonyxis, tunnel puncture into anterior chamber and hydrate the paracentesis site steps were significantly lower on simulator assessment than pig eye operation(P=0.007, 0.014, <0.01). The scores of the cortex removal and intraocular lens(IOL)implantation were significantly higher on simulator assessment than eye of real animal(P=0.035, <0.01).CONCLUSION:The application of surgical simulator on training small incision extracapsular cataract extraction skills for young ophthalmologists could significantly improve their skills in cataract surgery operation, providing a new mode and idea for the establishment of standardized cataract surgery training for young ophthalmologists.
RESUMEN
AIM: To analyze the effect of full-femtosecond small incision lenticule extraction(SMILE)on the treatment of high myopia based on propensity score matching.METHODS: A total of 48 cases(48 eyes)of high myopia patients who underwent SMILE surgery in our hospital from May 2019 to May 2021 were selected as the observation group, and 48 cases(48 eyes)of high myopia patients who underwent FS-LASIK surgery were matched using propensity score matching as the control group. Follow up for 6mo after surgery, the changes in cylindrical, central corneal thickness, uncorrected visual acuity(UCVA), corneal endothelial cell related indicators [percentage of hexagonal endothelial cells(6A), coefficient of variation(CV)of endothelial cell area, central corneal endothelial cell density(ECD)] and corneal biomechanical indicators [simulated Goldman intraocular pressure(IOPg), corneal hysteresis(CH), corneal resistance factor(CRF), corneal compensated intraocular pressure(IOPcc)] between the two groups were compared, and the incidence of complications in both groups of patients was recorded.RESULTS: Both groups of patients showed significant improvements in cylindrical and UCVA at 3 and 6mo after surgery, as well as decreased central corneal thickness, corneal endothelial cells, and corneal biomechanics related indicators. The changes in the observation group were more significant(all P<0.05). During the follow-up period, there was no significant difference in the incidence of complications between the observation group and the control group(8% vs. 17%, P>0.05).CONCLUSION: SMILE has a definite effect on patients with high myopia and is helpful to improve visual acuity.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
AIM: To compare the efficacy of and without small incision lenticule extraction(SMILE)with cyclotorsion compensation for astigmatism correction.METHODS: PubMed, Web of Science, EMBASE, Cochrane and CNKI, VIP, CBM, and Wan Fang Data were searched for clinically controlled studies from January 2010 to August 2022, including an experimental group with cyclotorsion compensation during SMILE and a control group without cyclotorsion compensation during SMILE. After literature screening, quality evaluation, and data extraction by two researchers independently, the Meta-analysis of uncorrected distance visual acuity(UDVA), residual astigmatism, vector analysis indicators for measuring the astigmatism correction including absolute value of angle of error(|AE|)and magnitude error(ME), and post-operative total higher order aberrations, spherical aberration and coma was carried out with Stata 16.0 software.RESULTS: Seven studies with a total of 846 eyes(442 in the experimental group, 404 in the control group)were finally included. The Meta-analysis showed that there were significant differences in the percentage of eyes with residual astigmatism ≥1.00D(OR=0.17, 95%CI: 0.06～0.49, P<0.01), |AE|(WMD=-1.56, 95%CI: -2.68～-0.45, P<0.01), the coma(WMD=0.06, 95%CI: -0.08～-0.04, P<0.01), and the total higher order aberrations(WMD=-0.04, 95%CI: -0.06～-0.02, P<0.01). However, there were no differences in the postoperative UDVA(WMD=0.00, 95%CI: -0.02～0.01, P=0.54), residual astigmatism(WMD=0.08, 95%CI: -0.02～0.18, P=0.10), ME(WMD=-0.01, 95%CI: -0.14～0.12, P=0.85), and the spherical aberration(WMD=0.03, 95%CI: -0.07～0.13, P=0.52).CONCLUSION: Cyclotorsion compensation in SMILE can reduce the angular error caused by eye rotation during astigmatism correction. It also decreases postoperative residual astigmatism. Overall, the SMILE with cyclotorsion compensation is superior in clinical efficacy of the precise correction of astigmatism.
RESUMEN
AIM: To investigate the effects of small incision extracapsular excision and phacoemulsification on the number of corneal endothelial cells, macular thickness and surgically induced corneal astigmatism in cataract patients.METHODS: Retrospective research. A total of 296 age-related cataract patients(296 eyes)admitted to our hospital from May 2019 to February 2023 were selected. They were divided into a small incision extracapsular excision group(144 eyes)and a phacoemulsification group(152 eyes)according to surgical method. The uncorrected visual acuity, best corrected visual acuity, numbers of corneal endothelial cells, macular thickness, surgically induced corneal astigmatism and postoperative complications between the two groups of patients at 7d, 1 and 3mo after surgery were compared.RESULTS: The uncorrected visual acuity and best corrected visual acuity of patients in the small incision extracapsular excision group after 7d of surgery were better than those of the phacoemulsification group, the number of corneal endothelial cells after 7d and 1, 3mo of surgery were higher than that of the phacoemulsification group, the macular thickness after 7d and 1mo of surgery was lower than that of the phacoemulsification group, and the incidence rate of postoperative corneal edema and incidence rate of total complications were lower than those of the phacoemulsification group(all P<0.05). Furthermore, there was no statistical significance in the values of surgically induced corneal astigmatism after 1, 7d and 1, 3mo of surgery compared with phacoemulsification group(P>0.05).CONCLUSION: Compared with phacoemulsification, the changes in the number of corneal endothelial cells and thickness of the macular area after small incision extracapsular excision are relatively small, visual recovery is faster, and the complications reduced.
RESUMEN
AIM:To observe the changes in corneal aberrations and the characteristics of visual quality after transepithelial photorefractive keratectomy(T-PRK)and femtosecond small incision lenticule extraction(SMILE)in the correction of low myopia.METHODS: Prospective cohort study. A total of 32 cases(32 eyes)with low myopia who underwent T-PRK surgery and 45 cases(45 eyes)of SMILE surgery at Weifang Eye Hospital from April 2021 to April 2022 were selected. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), spherical equivalent(SE), corneal higher-order aberrations(HOAs)and objective visual quality were compared between the two groups.RESULTS:All patients completed the surgery successfully without complications such as infection. At 3mo postoperatively, the safety index was 1.13±0.16 and 1.16±0.17(P=0.48)and the efficacy index was 1.10±0.20 and 1.15±0.18(P=0.27)in the T-PRK and SMILE groups, respectively. The percentage of UCVA(LogMAR)≤0 in the T-PRK and SMILE groups was 94% and 98%, respectively. The percentage of the residual SE within ±0.5D was 88% and 87% in the two groups, respectively. The HOAs and spherical aberration in both groups were significantly increased(P≤0.01), and the increase was not statistically significant between the two groups(P=0.31, 0.89). There was no significant change in horizontal coma, horizontal trefoil and vertical trefoil in both groups(P&#x003E;0.05). The vertical coma in SMILE group was significantly increased(P&#x003C;0.001), while there was no significant change in T-PRK group(P&#x003E;0.05), and the increase was significantly greater in SMILE group than in T-PRK group(P&#x003C;0.001). There was no significant difference in objective scattering index(OSI), modulation transfer function cut off frequency(MTFcut off), Strehl ratio(SR), visual acuity(VA)100%, VA20% and VA9% between the two groups(P&#x003E;0.05).CONCLUSION:Both T-PRK and SMILE showed good safety, efficacy, and visual quality in correcting low myopia, while SMILE induced more vertical coma than T-PRK.
RESUMEN
AIM: To investigate the short-term visual quality outcomes after femtosecond laser small incision lenticule extraction(SMILE)and evolution implantable collamer lens(EVO-ICL)implantation for the correction of moderate myopia.METHODS: Prospective control study. A total of 51 cases(51 eyes)with moderate myopia who underwent SMILE or EVO-ICL implantation surgery at Weifang Eye Hospital from April 2021 to February 2022 were selected. They were divided into SMILE group(30 patients, 30 eyes)and EVO-ICL group(21 patients, 21 eyes)according to the surgical methods. The changes of visual acuity [uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA)], diopter [spherical equivalent(SE)] and related parameters of optical quality analysis system(OQAS Ⅱ)were observed before surgery and at 1wk, 1 and 3mo after surgery, and the quality of vision(QoV)questionnaire was completed.RESULTS: At 3mo after surgery, the safety index(postoperative CDVA/preoperative CDVA)of SMILE gruop and EVO-ICL group were 1.20(1.00, 1.20)and 1.20(1.00, 1.38), respectively, the efficacy index(postoperative UDVA/preoperative CDVA)were 1.00(1.00, 1.20)and 1.00(1.00, 1.20), respectively, and the percentage of SE within ±0.50D was 87% and 100%, respectively. In SMILE group, the objective scattering index(OSI)was increased after surgery, while modulation transfer function cutoff frequency(MTF cutoff), contrast visual acuity(VA)100%, and VA20% at 1wk and 1mo after surgery, and Strehl ratio(SR)and VA9% at each time point after surgery were all decreased compared with those before surgery(all P&#x003C;0.05). The OSI, MTF cutoff, SR and VA of EVO-ICL group showed no difference at each time point after surgery compared with those before surgery(all P&#x003E;0.05). The most common visual symptoms after SMILE and EVO-ICL implantation were visual haze and halos, respectively.CONCLUSION: Both SMILE and EVO-ICL implantation have good safety, efficacy and predictability in the short term after the correction of moderate myopia. Both groups had visual symptoms after surgery, but the overall satisfaction of patients was high. Furthermore, EVO-ICL implantation has better objective visual quality performance.
RESUMEN
AIM: To compare the visual quality between smart pulse technology-assisted(SPT)transepithelial photorefractive keratectomy(TransPRK)of 1 050Hz ablation frequency and small incision lenticule extraction(SMILE)for myopia and astigmatism.METHODS: A total of 138 cases(248 eyes)who received corneal refractive surgery in the Eye Hospital of Chengdu University of TCM were enrolled from July 2020 to January 2021. The patients were divided into TransPRK group(64 cases, 123 eyes)and SMILE group(74 cases, 125 eyes)according to the surgical method. The follow-up duration was 6mo. Strehl ratio(SR)and high-order aberration at 6mm pupil diameter measured by Sirius anterior segment integrated analyzer and LogMAR visual acuity were recorded at different preoperative and postoperative time points.RESULTS: The uncorrected visual acuity(UCVA)of TransPRK group was worse than SMILE group at 1wk and 1mo after surgery(all P<0.05), but UCVA was better in TransPRK group at 6mo after surgery(P<0.05). SR in TransPRK group was lower than that in SMILE group at 1wk and 1mo after surgery(all P<0.05). There was no significant difference in SR between the two groups at 3 and 6mo after surgery(P=0.968, 0.433). At 1wk after surgery, there was no significant difference in coma between the two groups(P=0.554). At 1, 3, and 6mo after surgery, coma in the TransPRK group was lower than that in SMILE group(all P<0.05). At 1wk, 1 and 3mo after surgery, the trefoil aberration in TransPRK group was higher than that in SMILE group(all P<0.05). At 6mo after surgery, there was no significant difference in trefoil aberration between the two groups(P=0.167). At 6mo after surgery, UCVA of TransPRK group and SMILE group were -0.13±0.05 and -0.11±0.08, respectively, which were better than the best corrected visual acuity(BCVA)before surgery(-0.07±0.05 and -0.07±0.05; all P<0.05). Furthermore, the SR of both groups was higher than that before surgery(all P<0.05).CONCLUSION: Both SPT-assisted TransPRK of 1 050Hz ablation frequency and SMILE can achieve better visual acuity after refractive surgery, while SMILE has better visual quality at 1wk and 1mo after surgery. However, SPT-assisted TransPRK of 1 050Hz ablation frequency has better visual acuity at 6mo after surgery than SMILE, and the coma is smaller.
RESUMEN
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.
RESUMEN
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.