Safety and Efficacy of Low-energy Small Incision Lenticule Extraction for the Correction of Myopia and Myopic Astigmatism: A Retrospective Analysis

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2023 Feb 2

PMID 36727343

Authors

N V Arulmozhi Varman

Aadithreya Varman

Dinesh Balakumar

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine the safety and efficacy of low-energy settings in small incision lenticule extraction (SMILE) for correcting myopia and myopic astigmatism.

Methods: We included patients aged ≥18 years with the myopia of -0.5 to -10 D and myopic astigmatism of -0.5 to -5 Dcyl in this retrospective case series performed at a private eye hospital in South India. All patients had preoperative best-corrected visual acuity of LogMar 0.0 ± 0, with stable refraction for 1 year and normal corneal topography. Ocular surface disease and other pathology cases were excluded. The repetition rate of the laser was 500 kHz, and the pulse energy was 110 nJ. The lenticule diameter was set at 6.5 mm, cap diameter was 7.20 mm, and intended cap thickness was 110-130 μ. The spot distance was 4.5 μm. All patients were evaluated immediately postoperation and on postoperative days 1, 8, and 30.

Results: Overall, 541 eyes were included. The mean patient age was 25.03 ± 4.1 years. The mean spherical error was -3.76 ± 1.84 Ds. The mean cylinder was -1.24 ± 0.91. The mean spherical equivalent of refraction was -4.22 ±1.94 D. The logMAR on postoperative day 1 was 0.0 ± 0. The mean spherical equivalent at 1 month was 0.28 ± 1.06 D. There was no loss of Snellen's lines after the procedure. The mean spherical equivalent of refraction to the target was 95% within ± 0.50 D. The postoperative astigmatism was within 0.5 Dycl. No intraoperative complications of SMILE including retained lenticule fragments, tears of incision, or improper dissection occurred.

Conclusion: Low-energy settings in SMILE are safe and effective in correcting myopia and myopic astigmatism including high cylinders (>3 Dcyl).

Citing Articles

Comparison of objective visual quality between SMILE and FS-LASIK in moderate-to-high myopia.

Zou H, Wei X, Li L, Wei D, Mao H, Huang Y Front Med (Lausanne). 2024; 11:1408516.

PMID: 39359915 PMC: 11446171. DOI: 10.3389/fmed.2024.1408516.

References

Ji Y, Kim M, Kang D, Reinstein D, Archer T, Choi J . Lower Laser Energy Levels Lead to Better Visual Recovery After Small-Incision Lenticule Extraction: Prospective Randomized Clinical Trial. Am J Ophthalmol. 2017; 179:159-170. DOI: 10.1016/j.ajo.2017.05.005. View

Tulu Aygun B, Cankaya K, Agca A, Yildirim Y, Kepez Yildiz B, Sucu M . Five-year outcomes of small-incision lenticule extraction vs femtosecond laser-assisted laser in situ keratomileusis: a contralateral eye study. J Cataract Refract Surg. 2020; 46(3):403-409. DOI: 10.1097/j.jcrs.0000000000000067. View

Hamilton D, Chen A, Khorrami R, Nutkiewicz M, Nejad M . Comparison of early visual outcomes after low-energy SMILE, high-energy SMILE, and LASIK for myopia and myopic astigmatism in the United States. J Cataract Refract Surg. 2020; 47(1):18-26. DOI: 10.1097/j.jcrs.0000000000000368. View

Kose B . Comparison of refractive and visual outcomes between image-guided system-assisted small-incision lenticule extraction and wavefront-optimized FS-LASIK in treatment of high astigmatism. J Cataract Refract Surg. 2021; 48(7):765-770. DOI: 10.1097/j.jcrs.0000000000000854. View

Sugar A, Rapuano C, Culbertson W, Huang D, Varley G, Agapitos P . Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002; 109(1):175-87. DOI: 10.1016/s0161-6420(01)00966-6. View

Yang L, Liu X, Mi S, Sun L, Chen M . Early visual function outcomes of topography-guided FS-LASIK and SMILE in treatment of myopia and myopic astigmatism. Int J Ophthalmol. 2021; 14(3):423-429. PMC: 7930544. DOI: 10.18240/ijo.2021.03.15. View

Dong Z, Zhou X, Wu J, Zhang Z, Li T, Zhou Z . Small incision lenticule extraction (SMILE) and femtosecond laser LASIK: comparison of corneal wound healing and inflammation. Br J Ophthalmol. 2013; 98(2):263-9. PMC: 3913294. DOI: 10.1136/bjophthalmol-2013-303415. View

Denoyer A, Landman E, Trinh L, Faure J, Auclin F, Baudouin C . Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology. 2014; 122(4):669-76. DOI: 10.1016/j.ophtha.2014.10.004. View

Mohamed-Noriega K, Riau A, Lwin N, Chaurasia S, Tan D, Mehta J . Early corneal nerve damage and recovery following small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK). Invest Ophthalmol Vis Sci. 2014; 55(3):1823-34. DOI: 10.1167/iovs.13-13324. View

10.

Nicula C, Nicula D, Bolboaca S, Bulboaca A . One year outcomes after small incision lenticule extraction ReLEX in the correction of myopia and myopic astigmatism. BMC Ophthalmol. 2021; 21(1):423. PMC: 8656009. DOI: 10.1186/s12886-021-02195-9. View

11.

Moshirfar M, McCaughey M, Reinstein D, Shah R, Santiago-Caban L, Fenzl C . Small-incision lenticule extraction. J Cataract Refract Surg. 2015; 41(3):652-65. DOI: 10.1016/j.jcrs.2015.02.006. View

12.

Jun I, Kang D, Reinstein D, Arba-Mosquera S, Archer T, Seo K . Clinical Outcomes of SMILE With a Triple Centration Technique and Corneal Wavefront-Guided Transepithelial PRK in High Astigmatism. J Refract Surg. 2018; 34(3):156-163. DOI: 10.3928/1081597X-20180104-03. View

13.

Ganesh S, Brar S, Pawar A . Results of Intraoperative Manual Cyclotorsion Compensation for Myopic Astigmatism in Patients Undergoing Small Incision Lenticule Extraction (SMILE). J Refract Surg. 2017; 33(8):506-512. DOI: 10.3928/1081597X-20170328-01. View

14.

He M, Huang W, Zhong X . Central corneal sensitivity after small incision lenticule extraction versus femtosecond laser-assisted LASIK for myopia: a meta-analysis of comparative studies. BMC Ophthalmol. 2015; 15:141. PMC: 4619500. DOI: 10.1186/s12886-015-0129-5. View

15.

Sia R, Ryan D, Beydoun H, Eaddy J, Logan L, Rodgers S . Visual outcomes after SMILE from the first-year experience at a U.S. military refractive surgery center and comparison with PRK and LASIK outcomes. J Cataract Refract Surg. 2020; 46(7):995-1002. DOI: 10.1097/j.jcrs.0000000000000203. View

16.

Torky M, Alzafiri Y . Visual and refractive outcomes of small-incision lenticule extraction in mild, moderate, and high myopia: Six-month results. J Cataract Refract Surg. 2017; 43(4):459-465. DOI: 10.1016/j.jcrs.2017.01.015. View

17.

Liu T, Lu G, Chen K, Kan Q, Bai J . Visual and optical quality outcomes of SMILE and FS-LASIK for myopia in the very early phase after surgery. BMC Ophthalmol. 2019; 19(1):88. PMC: 6454732. DOI: 10.1186/s12886-019-1096-z. View

18.

Schallhorn S, Farjo A, Huang D, Boxer Wachler B, Trattler W, Tanzer D . Wavefront-guided LASIK for the correction of primary myopia and astigmatism a report by the American Academy of Ophthalmology. Ophthalmology. 2008; 115(7):1249-61. DOI: 10.1016/j.ophtha.2008.04.010. View

19.

Reinstein D, Carp G, Archer T, Lewis T, Gobbe M, Moore J . Long-term Visual and Refractive Outcomes After LASIK for High Myopia and Astigmatism From -8.00 to -14.25 D. J Refract Surg. 2016; 32(5):290-7. DOI: 10.3928/1081597X-20160310-01. View

20.

Sugar A . Ultrafast (femtosecond) laser refractive surgery. Curr Opin Ophthalmol. 2002; 13(4):246-9. DOI: 10.1097/00055735-200208000-00011. View