Unwanted Astigmatism and High-order Aberrations One Year after Excimer and Femtosecond Corneal Surgery.

SIGNIFICANCE: Small incision lenticule extraction (SMILE) is advanced as the most minimally invasive and least traumatic corneal procedure for correcting refractive errors using a single laser. Although SMILE obtains similar results to femtosecond laser in situ keratomileusis (LASIK) with spherical myopia, it has deficiencies in astigmatism correction. PURPOSE: The purpose of this study was to compare refractive outcomes and high-order aberrations (HOAs) between SMILE and femtosecond LASIK corneal procedures at 1 year post-operative. METHODS: Ninety-two patients (181 eyes) with myopia/myopic astigmatism underwent either SMILE (group 1) or femtosecond LASIK (group 2). The refractive target was to achieve emmetropia in all cases. Data were analyzed to determine significance of change in refraction and HOAs. Furthermore, astigmatism was subjected to vector analysis using the Thibos (calculation of change, Δ, in J0 and J45 values) and Alpins (calculation of difference, ΔC, between target-induced astigmatism [TIA] and surgically induced astigmatism) methods. RESULTS: Forty-five patients (89 eyes) from group 1 and 47 patients (92 eyes) from group 2 completed the study. The main significant (P ≤ .001) findings were as follows: (a) residual astigmatism was greater in group 1; (b) group 1, ΔJ0 = 1.015J0 + 0.040 (R = 0.861), ΔJ45 = 1.082J45 + 0.019 (R = 0.792), ΔC = 0.401TIA + 0.323 (R = 0.489), and mean spherical aberration increased from -0.003 (SD, ±0.059; 95% confidence interval [CI], -0.015 to 0.009) to 0.028 µm (SD, ±0.041; 95% CI, -0.037 to -0.020); and (c) group 2, ΔJ0 = 0.952J0 - 0.005 (R = 0.921), ΔJ45 = 0.962J45 - 0.002 (R = 0.923), ΔC = 0.187TIA + 0.101 (R = 0.272), mean coma reduced from 0.114 (SD, ±0.087; 95% CI, 0.096 to 0.132) to 0.077 µm (SD, ±0.059; 95% CI, 0.065 to 0.089), and trefoil from 0.089 (SD, ±0.049; 95% CI, 0.079 to 0.0990) to 0.056 µm (SD, ±0.047; 95% CI, 0.046 to 0.066). CONCLUSIONS: In comparison with SMILE, femtosecond LASIK offered better precision in the overall control of astigmatism and HOAs.

Apparent Corneal Ectasia After Bilateral Intrastromal Femtosecond Laser Treatment for Presbyopia.

PURPOSE: To report a case of apparent corneal ectasia after intrastromal femtosecond laser treatment for presbyopia (INTRACOR). METHODS: A healthy 56-year-old male with low hyperopia underwent an unremarkable bilateral INTRACOR procedure in March/April 2011. The patient was discharged after follow-up and returned 5 years later. RESULTS: Before discharge, the monocular logarithm of the minimal angle of resolution uncorrected distance visual acuity (UDVA) values were R, 0.0 and L, 0.10. In both eyes near (UNVA) visual acuities were 0.0. There were signs of slight posterior central corneal steepening without loss of corneal stability. Five years postop, monocular UDVA and UNVA values were 0.4 and 0.0, respectively. Ectasia was observed in both eyes, and the centrally placed 5 concentric rings after the INTRACOR procedure were visible under slit-lamp biomicroscopy. CONCLUSIONS: There is no clear reason to explain why the patient developed bilateral corneal steepening. It could be that the patient's corneal stromal fibers gradually weakened over this 5-year period.