Clinical outcomes of epithelial basement membrane dystrophy after keratorefractive lenticule extraction.

PURPOSE: To determine the clinical outcomes of keratorefractive lenticule extraction (KLEx) in eyes with epithelial basement membrane dystrophy (EBMD) that developed after surgery. SETTING: Onnuri Smile Eye Clinic, Seoul, South Korea. DESIGN: Retrospective single-center study. METHODS: This study reviewed the medical records of 26 eyes of 16 patients who exhibited signs of EBMD after KLEx. Postoperatively, corneal findings and visual outcomes were evaluated. Statistical analyses were also performed on eyes without corneal complications after KLEx. RESULTS: Signs of EBMD were first observed within 1 week postoperatively in 22 eyes (84.6%): 6 eyes (23.1%) showed epithelial defects, 10 eyes (38.5%) showed subepithelial corneal opacity, 5 eyes (19.2%) showed diffuse lamellar keratitis, and 1 eye (3.9%) showed epithelial ingrowth. Symptoms such as pain, while corneal lesions were present, occurred in 21 eyes (80.8%). At 3 months postoperatively, 21 eyes (80.8%) showed no specific findings on slitlamp microscopy after medical treatment, 2 eyes (7.7%) showed subepithelial corneal opacity, 2 eyes (7.7%) showed corneal scar, and 1 eye (3.9%) showed epithelial ingrowth. Uncorrected distance visual acuity was 20/25 or better in 24 eyes (92.3%), and spherical equivalent was within ±1.0 D in 20 eyes (76.9%). The efficacy index of the EBMD group did not significantly differ from the control group, while the safety index was significantly lower. CONCLUSIONS: Manifestations of EBMD can occur after KLEx and can affect clinical outcomes. Most cases showed favorable results with appropriate nonsurgical treatment; however, some cases had long-term complications such as corneal scarring.

Comparison of Changes in Corneal Thickness and Curvature After Myopia Correction Between SMILE and FS-LASIK.

PURPOSE: To comparatively investigate the changes in corneal thickness and curvature between small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHODS: Data were collected preoperatively and postoperatively at 1 week, 1 month, and 3 months, including central corneal thickness (CCT), midperipheral corneal thickness (MPCT), peripheral corneal thickness (PCT), central keratometry (CK), midperipheral keratometry (MPK), and peripheral keratometry (PK), using a dual rotating Scheimpflug analyzer. RESULTS: At 1 week postoperatively, changes in CCT, MPCT, PCT, and PK were significantly greater in the SMILE group than in the FS-LASIK group (P = .003 for CCT and < .001 for MPCT, PCT, and PK), but no significant inter-group differences were found between changes in CK and MPK (P = .883 and .513, respectively). CCT, MPCT, and PK values showed a similar increase in both groups, but significantly more increase in PCT and significantly less increase in CK and MPK was observed in the SMILE group from 1 week to 3 months after surgery. At 3 months postoperatively, CCT and MPCT were significantly thinner in the SMILE group than in the FSLASIK group (P = .018 and .022, respectively), and there was no significant difference in PCT, CK, MPK, and PK between the two groups. CONCLUSIONS: SMILE caused significantly more corneal thinning at the center, midperiphery, and periphery, and more corneal flattening at the periphery, compared to FS-LASIK. A different pattern of corneal remodeling was observed between the two surgeries during the 3-month follow-up period. [J Refract Surg. 2023;39(1):15-22.].

Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles.

PURPOSE: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. SETTING: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. DESIGN: Retrospective case series. METHODS: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). RESULTS: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B (p < 0.001), and when ICL was horizontally and vertically implanted in group C (p = 0.021), respectively. And the mean SE was -0.11 ± 0.30, -0.34 ± 0.42, -0.3 ± 0.56 and -0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B (p = 0.039), and when the ICL was horizontally and vertically implanted in group C (p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. CONCLUSIONS: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for high astigmatism.

BACKGROUND: To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism. METHODS: This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method. RESULTS: Twenty-four months after the combined procedure, the average spherical equivalent was reduced from - 6.56 ± 2.38 D to - 0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to - 0.02 ± 0.09 and from - 0.03 ± 0.07 D to - 0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was - 5.48 ± 1.17 D, which was reduced to - 2.27 ± 0.97 D and - 0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p < 0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. CONCLUSION: Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.

Comparison of clinical outcomes of implantable collamer lens implantation with and without use of an ophthalmic viscosurgical device.

PURPOSE: To compare the clinical efficacy of posterior chamber phakic implantable collamer lens (ICL) implantation with and without the use of an ophthalmic viscosurgical device (OVD). SETTING: Onnuri Eye Hospital, Jeonju, Jeollabuk-do, South Korea. DESIGN: Retrospective case series. METHODS: Included were patients who underwent ICL implantation with the use of an OVD (OVD group) and patients who underwent ICL implantation without the use of an OVD (hydro group). Refractive error, endothelial cell density (ECD), intraocular pressure (IOP), vault, and adverse events were evaluated at 1 day, 1 week, 1 month, and 3 months postoperatively. The IOP and vault were checked 1 hour postoperatively, and the surgical time was recorded. RESULTS: The OVD group comprised 54 eyes of 27 patients and the hydro group 49 eyes of 25 patients. There were no significant preoperative differences between the 2 groups. At 1 hour postoperatively, the IOP was significantly higher in the OVD group (P < .001); however, there was no significant difference in IOP between the 2 groups at other follow-up timepoints. Surgical time was significantly shorter for the hydro group (P = .032). There was no statistically significant difference in vault, ECD, or refractive error between the 2 groups during the 3-month follow-up period. No adverse events were observed. CONCLUSIONS: ICL implantation without the use of an OVD was safe and effective. The advantages of this technique included a short surgical time, prevention of early postoperative IOP spikes, and cost savings due to OVD elimination.

Small Incision Lenticule Extraction (SMILE) in Patients with Corneal Guttae.

PURPOSE: To report 12-month results of small incision lenticule extraction (SMILE) in the treatment of myopia with corneal guttae (CG). METHODS: We conducted a retrospective analysis of 12 eyes from six patients who had preoperative CG without clinical sign of Fuchs' endothelial corneal dystrophy (FECD) and had SMILE for correction of myopia. Preoperative and 12-month postoperative measurements included uncorrected distance visual acuity (UDVA), spherical equivalent (SE), endothelial cell density (ECD), the coefficient of variation (CV), the percentage of hexagonal cells (HEX), and central corneal thickness (CCT). The changes in ECD, CV, HEX, and CCT after SMILE were subjected to statistical analysis. RESULTS: Twelve months postoperatively, the mean SE was -0.10 ± 0.32 D and all eyes had a UDVA of 0 logMAR or better. No eyes developed corneal edema or other complication during the follow-up period. There were no significant changes in the ECD, CV, or HEX at 12 months (all p>0.05). CONCLUSION: SMILE yielded improvement in visual acuity and no adverse effects to corneal endothelial cells were found when correcting myopia or myopic astigmatism in patients with CG. However, studies with a greater number of patients and longer follow-up periods are needed to establish the long-term outcomes and safety.

Comparison of anterior segment changes after femtosecond laser LASIK and SMILE using a dual rotating Scheimpflug analyzer.

BACKGROUND: To compare the changes in the anterior segment after femtosecond laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) using a dual rotating Scheimpflug (DRS) analyzer (Galilei®; Ziemer Ophthalmology, Port, Switzerland). METHODS: A total of 218 eyes of 109 patients who underwent FS-LASIK or SMILE for myopic correction were retrospectively studied. Ninety-eight eyes of 49 patients who underwent FS-LASIK were compared to 120 eyes of 60 patients treated with SMILE. A DRS analyzer was used for preoperative and 6-month postoperative anterior segment analyses. Measured variables included the central corneal thickness (CCT), anterior chamber depth (ACD), anterior and posterior keratometry (K), anterior and posterior best-fit sphere radius, and maximum posterior elevation (MPE). RESULTS: After the procedure, the amount of CCT decrease was higher in the SMILE group than in the FS-LASIK group, but it was not statistically significant. The MPE was significantly increased after both procedures (p < 0.001 and p = 0.001 in the FS-LASIK and SMILE groups, respectively), with the amount of elevation being higher after FS-LASIK than after SMILE even though it was not statistically significant. And there was a significant change in the steep and average posterior K in the FS-LASIK group (p = 0.006 and 0.001, respectively), but not in the SMILE group. CONCLUSIONS: Regarding changes in the MPE and posterior K, changes in the posterior corneal surface were greater after FS-LASIK than after SMILE. TRIAL REGISTRATION: The trial registration number: KCT0003628. Date of registration: 15 March 2019.

Inverted internal limiting membrane flap technique and an autologous platelet concentrate to treat an Nd: YAG laser-induced macular hole: A case report.

RATIONALE: Nd:YAG laser-induced macular holes (MHs) feature more extensive anatomical defects and worse functional outcomes than idiopathic MHs. Although new treatment options for large refractory MHs have been suggested, the current literature on Nd:YAG laser-induced MHs suggests only conventional pars plana vitrectomy combined with internal limiting membrane (ILM) peeling, which is the same treatment as for idiopathic MHs. PATIENT CONCERNS: A 40-year-old dermatologist was referred to us because of a sudden decrease in visual acuity following exposure to a floor-tile-reflected single-shot Nd:YAG laser beam while not wearing protective goggles. DIAGNOSES: An Nd:YAG laser-induced MH was diagnosed based on fundoscopy and optical coherence tomography (OCT). INTERVENTIONS: Pars plana vitrectomy using an inverted ILM flap technique and autologous platelet concentrate (APC) was performed. OUTCOMES: Postoperative spectral domain OCT and en-face OCT showed "U-shaped" closure of the MH and a decreased ellipsoid zone defect, while the best-corrected visual acuity improved from 20/500 to 20/25. LESSONS: The inverted ILM flap technique combined with APC is an effective option to achieve successful MH closure and visual improvement in patients with an Nd:YAG laser-induced MH.

One-handed revolving technique for soft cataract extraction.

This study describes a new one-handed revolving technique for soft cataract extraction. Following hydrodissection, the endonucleus is removed piecemeal while the lens is rotated using a phaco tip. A peripheral groove is created in the 6 o'clock direction and, after lens rotation through 180° using the phaco tip, another 6 o'clock groove is created. After a further 90° of lens rotation, the residual plate is readily flipped over and emulsified. The entire procedure requires only a phaco tip; it is not necessary to create a corneal side port or use any instrument.

Reversible cataract after exposure to distilled water: a case report.

BACKGROUND: To report a case of a reversible cataract after intracameral infusion of distilled water during full-thickness astigmatic keratotomy. CASE PRESENTATION: A 20-year-old male whose bilateral anterior chambers were exposed to distilled water during astigmatic keratotomy developed bilateral corneal edema, inflammation of the anterior chambers, and an anterior subcapsular cataract in the right eye. After 1 month of topical administration of 0.1% prednisolone acetate and 5% NaCl, the bilateral inflammation of the cornea and anterior chambers cleared; endothelial cell density decreased by 41.1% in the right eye and 12.7% in the left eye. The cataract in the right eye decreased centripetally. Small incision lenticule extraction surgery was performed at 2 months after the astigmatic keratotomy; the patient's uncorrected distance visual acuity 3 months later was 20/25 in both eyes. CONCLUSIONS: This case suggests that a cataract that develops as a result of instantaneous intracameral exposure to distilled water is reversible.

Management of incision failure during small incision lenticule extraction because of conjunctivochalasis.

PURPOSE: We report a case of incision failure during small incision lenticule extraction (SMILE) and its management. OBSERVATIONS: The incision could not be made using the femtosecond laser because of a redundant conjunctiva, so it was instead done manually using a diamond knife. The lenticule was successfully separated and extracted. Three months after the procedure, the uncorrected distance visual acuity was 20/20 and no complication was observed. CONCLUSIONS AND IMPORTANCE: This case demonstrates that the conjunctiva should be carefully examined before SMILE. If a complication occurs because of conjunctivochalasis, it can be resolved with proper management without compromising the patient's visual acuity.

Small-incision lenticule extraction in a patient with congenital nystagmus.

We report a case of a 23-year-old woman with congenital nystagmus who had small-incision lenticule extraction (SMILE) procedure to correct refractive errors. The manifest refraction was -5.50 -1.75 × 180 in the right eye, -5.0 -2.50 × 180 in the left eye, and the patient presented with horizontal pendular nystagmus with an amplitude range of 5 to 10 degrees. Uneventful simultaneous bilateral small-incision lenticule extraction was performed. Six months postoperatively, the uncorrected distance visual acuity was 20/18 with -0.25, -0.25 × 80 in the right eye, and 20/20 with +0.25 -0.5 × 50 in the left eye. The case suggests that small-incision lenticule extraction can be an effective alternative for correcting myopic astigmatism in patients with nystagmus.

Bilateral Small Incision Lenticule Extraction (SMILE) After Penetrating Keratoplasty.

PURPOSE: To report a case of successful bilateral small incision lenticule extraction (SMILE) performed on a patient who had penetrating keratoplasty and astigmatic keratotomy in the right eye and penetrating keratoplasty in the left eye. METHODS: Case report. RESULTS: Astigmatic keratotomy was used to reduce astigmatism of the right eye because astigmatism was higher than the maximum correction limitation of SMILE. Bilateral SMILE was performed afterward. Although there were no difficulties during lenticule separation and removal of the right eye, wound dehiscence occurred during lenticule separation of the left eye. Two sutures were used at both ends of the incision, and the remainder of the procedure was successfully completed. Visual acuity improved to 20/50 in both eyes without correction, and the corrected distance visual acuities were 20/50 and 20/30 in the right and left eyes, respectively, at the 6-month postoperative visit. CONCLUSIONS: SMILE is a potentially effective alternative in correcting refractive errors in patients following penetrating keratoplasty. However, studies with a larger patient population with longer follow-up periods are needed to confirm these initial findings. [J Refract Surg. 2016;32(9):644-647.].

Chung's swing technique: a new technique for small-incision lenticule extraction.

BACKGROUND: To introduce the Chung's swing technique for small-incision lenticule extraction (SMILE). METHODS: A total of 112 eyes of 56 patients were included in this study. Patients were divided into two groups: 52 eyes of 26 patients were treated with SMILE using a traditional method (traditional group) and 60 eyes of 30 patients were treated with SMILE using the Chung's swing technique (swing group). RESULTS: At 1 month postoperatively, all eyes in both groups had an uncorrected distance visual acuity of 20/20 or better. The efficacy indices were 1.09 ± 0.17 and 1.02 ± 0.11 (p = 0.492), and the safety indices were 1.12 ± 0.14 and 1.09 ± 0.15 (p = 0.537), for the traditional and swing group, respectively. All eyes in both groups underwent successful lenticule extraction; all lenticules were intact and complete. The mean lenticule extraction times were 48.67 ± 4.9 and 39.8 ± 5.53 s, for the traditional and swing group, respectively (p < 0.001). CONCLUSIONS: The Chung's swing technique is efficient for lenticule separation and extraction. Our study results showed good clinical outcomes. TRIAL REGISTRATION NUMBER: KCT0001978 . Registered 22 July 2016. Retrospectively registered.

Full-Thickness Astigmatic Keratotomy Combined With Small-Incision Lenticule Extraction to Treat High-Level and Mixed Astigmatism.

PURPOSE: To explore the clinical effects of combined full-thickness astigmatic keratotomy and small-incision lenticule extraction (SMILE) in patients who are inoperable using SMILE alone. METHODS: We included 13 eyes of 9 patients with high-level or mixed astigmatism who underwent full-thickness astigmatic keratotomy followed by SMILE (secondarily) to correct the residual refractive error. RESULTS: Six months after SMILE, the spherical equivalent was reduced from -4.83 ± 3.26 D to -0.17 ± 0.38 D (P < 0.001), and the astigmatism was reduced from 5.12 ± 0.96 D to 0.21 ± 0.22 D (P < 0.001). The uncorrected and corrected (CDVA) distance visual acuities improved from 1.07 ± 0.62 to 0.02 ± 0.13 (P < 0.001) and from 0.08 ± 0.14 to -0.01 ± 0.14 (P = 0.002), respectively. The CDVA improved by 1 or 2 Snellen lines in 8 cases (61.5%), and there was no loss in CDVA. All procedures were completed without intraoperative or postoperative complications. CONCLUSIONS: This combined procedure was effective and safe for the treatment of high-level or mixed astigmatism.

One-year outcomes of small-incision lenticule extraction (SMILE): mild to moderate myopia vs. high myopia.

BACKGROUND: The purpose of this study was to compare the refractive outcomes of small incision lenticule extraction (SMILE) in high-myopic patients with those of mild- to moderate-myopic patients. METHODS: This study included 183 eyes of 92 myopic patients treated with SMILE using a VisuMax 500-kHz femtosecond laser. Treated eyes were divided into two groups, according to the preoperative spherical equivalent (SE): mild to moderate myopia (A group, <-6.0 D) and high myopia (B group, ≥ - 6.0 D). Follow-up visits were at 1 day, 1 week, and 1, 3, 6, and 12 months. The outcome measures included uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index, and predictability. RESULTS: Preoperative SE was -5.05 ± 0.71 D in the A group and -7.67 ± 1.01 D in the B group. No differences were observed between -0.13 ± 0.38 D in the A group and -0.24 ± 0.35 D in the B group 12 months postoperatively (p = 0.18). At 12 months postoperatively, 93.1 % and 76.8 % had an UDVA of 20/20 or better in the A and B groups, respectively. In the A group, 87.9 % and 96.6 % were within ± 0.5 D and ± 1.0 D, respectively, of the intended correction; in the B group, 88.0 % and 97.6 % were within ± 0.5 D and ± 1.0 D, respectively. The efficacy index was 1.04 ± 0.19 in the A group and 0.99 ± 0.19 in the B group. The safety index was 1.27 ± 0.17 for the A group and 1.24 ± 0.17 for the B group. The efficacy and safety index were not significantly different between the two groups 12 months postoperatively (p = 0.141 and p = 0.307, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia, as well as mild to moderate myopia.

Efficacy, predictability, and safety of small incision lenticule extraction: 6-months prospective cohort study.

BACKGROUND: To report our experience with small incision lenticule extraction ("SMILE") for myopia treatment. METHODS: In this prospective clinical study, we evaluated 447 eyes from 224 patients with myopia, with and without astigmatism. We followed the patients for 6 months after SMILE. RESULTS: The mean (±standard deviation, SD) spherical equivalent was -6.75 ± 1.65 diopters (D) preoperatively and -0.21 ± 0.37 D at 6 months postoperatively. Our data showed that 97.9% of eyes were within ±1.0 D and 86.1% were within ±0.5 D of the intended correction. Furthermore, 79.8% had an uncorrected distance visual acuity (UDVA) of 0 logMAR or less (20/20 or better in the Snellen equivalent) 6 months after surgery. Additionally, 48.5% remained unchanged, 41% gained one line of corrected distance visual acuity (CDVA), 7.2% gained two lines of CDVA, 3.3% lost one line of CDVA, and 0.3% lost two or more lines of CDVA. Age was the only predictor for worsening UDVA at 6 months postoperatively in linear regression analyses (0.07 decrease logMAR per increased 10 years of age; P < 0.05). No predictor showed an association with error in spherical equivalent refraction at 6 months postoperatively. CONCLUSIONS: SMILE is an effective and safe refractive surgery. Age was the only predictor that influenced visual outcome, but its effect appeared clinically insignificant. Faster visual recovery is also expected with improved surgical technique.