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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.
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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.
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Objective:To evaluate the effectiveness and safety of transepithelial photorefractive keratectomy (TransPRK) assisted by smart pluse technology (SPT) for the correction of high myopia.Methods:An observational case series study was conducted.Sixty high myopic patients (107 eyes) with spherical equivalent (SE)≥-6.0 D who received TransPRK assisted by SPT from January to December 2016 in Eye Hospital of Wenzhou Medical University were enrolled.Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) of the patients were examined and recorded in logarithm of the minimum angle of resolution (LogMAR) units, and refraction was examined with a subjective refractometer.The healing of corneal epithelium and corneal haze was observed with a slit lamp.Intraocular pressure (IOP) was measured with the non-contact tonometer.Safety index (SI) and efficacy index (EI) were analyzed.The follow-up time was 12 months.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Eye Hospital of Wenzhou Medical University (No.2019-197-k-177). Written informed consent was obtained from each patient prior to any medical examination.Results:The mean epithelial healing time was (3.77±1.02) days.There were statistically significant differences in UCVA and BCVA between before and after surgery ( Z=380.812, 267.313; both at P<0.001). And the 7-day, 6-month, and 12-month postoperative BCVA were better than preoperative BCVA, showing statistically significant differences (all at P<0.05). Mean SI was 1.10±0.12, and mean EI was 1.05±0.17 at 12 months after surgery.There was no significant difference between the attempted SE before surgery (-8.02±1.36)D and the achieved SE at 12 months after surgery (-8.04±1.51)D ( P=0.523). SE in the predictive range within ±0.50 D accounted for 79% (85/107) and that within ±1.0 D accounted for 92% (98/107). The IOP was slightly increased in 3 eyes at 7 days and 7 eyes at 1 month after surgery, respectively, which returned to normal after the use of ophthalmic solution for lowing IOP.The incidence of haze severer than grade 1 was less than 1% (1 eye), and haze gradually disappeared after application of drugs. Conclusions:TransPRK assisted by SPT for high myopia shows good safety, effectiveness and predictability.It is an ideal corneal surface surgery to correct high myopia.
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@#AIM: To analyze changes in objective visual quality before and after femtosecond laser <i>in situ</i> keratomileusis(FS-LASIK)and smart pulse technology-assisted transepithelial photorefractive keratectomy(SMART).<p>METHODS: Prospective study. We collected 50 cases(100 eyes)treated with FS-LASIK(FS-LASIK group)and another 50 cases(100 eyes)treated with SMART(SMART group)from the Ophthalmology Department of our hospital between October 2018 and December 2018 using Optical Quality Analysis System(OQAS)to measure objective scatter index(OSI), modulation transfer function cut off frequency(MTF cut off), strehl ratio(SR)before and after surgery.<p>RESULTS: In the FS-LASIK and SMART groups, the OSI values were higher in the 1 and 3mo after surgery, whereas the MTF cut off and SR were lower in the 1 and 3mo after surgery(<i>P</i><0.05). There was no statistical difference between the two groups in the objective visual quality index before and after 1mo(<i>P</i>>0.05). However, after 3mo, the OSI value of the FS-LASIK group was higher than the SMART group(0.88±0.28 <i>vs</i> 0.70±0.27, <i>P</i><0.001), whereas the SR was lower than SMART group(0.21±0.05 <i>vs</i> 0.24±0.05, <i>P</i>=0.002).<p>CONCLUSION: Both FS-LASIK and SMART caused an increase in the intraocular scattering index and a decrease in objective visual quality. However, the visual quality of the SMART group was generally better than that of the FS-LASIK group, and long-term visual quality was more dominant.
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@#AIM: To observe the early clinical effects of smart pulse technology(SPT)-assisted transepithelial photorefractive keratectomy(TPRK).<p>METHODS: This was a retrospective non-randomized research. There were 260 patients(508 eyes)who were underwent SPT-assisted TPRK surgery. The best corrected visual acuity(BCVA)was recorded at 1 to 2wk before surgery. The uncorrected visual acuity(UCVA)was recorded at 1mo and 3mo after surgery. Corneal epithelial growth status and haze grade were recorded after surgery. Record the degree of pain within 3d after surgery and satisfaction surveys in all patients.<p>RESULTS: After 1mo and 3mo, UCVA(-0.080±0.0798, -0.108±0.089)achieved or even better than preoperative BCVA(-0.050±0.0561). Corneal epithelial wounds were completely repaired in all patients during 5d after operation. In the follow-up of 1mo and 3mo after operation, the corneas of most patients are clear except for 3 cases who had haze in 0-1 grade. Very satisfied patients accounted for 93.0%.<p>CONCLUSION: SPT-TPRK surgery is safe. The average postoperative UCVA can reach or even exceed the preoperative average BCVA.
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@#AIM: To evaluate the early postoperative efficacy of SMART for myopia and compare it with TransPRK.<p>METHODS: Retrospective non-randomized controlled study. Totally 120 eyes of 60 patients with myopia who underwent SMART and TransPRK in our hospital from January to August 2018 were selected respectively. The uncorrected visual acuity(UCVA), visual quality, pain score, corneal epithelial healing and subepithelial haze were compared between two groups.<p>RESULTS: There was no statistical differences between two groups regarding the proportion of UCVA reaching or exceeding 1.0 at 5d, 1mo and 3mo after operation(<i>P</i>>0.05), but the visual quality of SMART group was better than that of TransPRK group at 5d after operation(<i>P</i><0.05), and with the prolongation of time, the visual quality of the two groups gradually improved. There was a significant difference in pain scores between the TransPRK group and SMART group(3.56±0.96 <i>vs</i> 3.07±1.07; 1.22±0.61 <i>vs</i> 0.84±0.59)on the 1st day and 3rd day after operation(<i>P</i><0.01). 5d after operation, the complete recovery rate of corneal in TransPRK group was lower than that in SMART group(69.2% <i>vs</i> 83.3%, <i>P</i><0.05). At 1st and 3 mo after operation, there was no difference in haze between the two groups(5.0% <i>vs</i> 5.0% and 8.3% <i>vs</i> 10.0%; <i>P</i>>0.05).<p>CONCLUSION: There is no significant difference between SMART and TransPRK in the speed and stability of visual acuity recovery, but the early postoperative pain of SMART is lighter, the corneal epithelium is healed faster, and the visual quality is better.