Yong Woo Ji1, Minseo Kim2, David Sung Yong Kang3, Dan Z Reinstein4, Timothy J Archer5, Jin Young Choi3, Eung Kweon Kim1, Hyung Keun Lee1, Kyoung Yul Seo1, Tae-Im Kim6. 1. Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea; Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. 2. Hankuk Academy of Foreign Studies, Yongin, South Korea. 3. Eyereum Eye Clinic, Seoul, South Korea. 4. London Vision Clinic, London, United Kingdom; Department of Ophthalmology, Columbia University Medical Center, New York, New York; Centre Hospitalier National d'Ophtalmologie, Paris, France; Biomedical Science Research Institute, University of Ulster, Coleraine, United Kingdom. 5. London Vision Clinic, London, United Kingdom; Biomedical Science Research Institute, University of Ulster, Coleraine, United Kingdom. 6. Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea; Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: tikim@yuhs.ac.
Abstract
PURPOSE: To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE). DESIGN: Prospective randomized clinical trial. METHODS: A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively. RESULTS:Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001). CONCLUSIONS: SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.
RCT Entities:
PURPOSE: To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE). DESIGN: Prospective randomized clinical trial. METHODS: A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively. RESULTS: Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001). CONCLUSIONS: SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.
Authors: Marcus Ang; Damien Gatinel; Dan Z Reinstein; Erik Mertens; Jorge L Alió Del Barrio; Jorge L Alió Journal: Eye (Lond) Date: 2020-07-24 Impact factor: 3.775
Authors: Majid Moshirfar; Michael S Murri; Tirth J Shah; Steven H Linn; Yasmyne Ronquillo; Orry C Birdsong; Phillips C Hoopes Journal: Ophthalmol Ther Date: 2018-06-29