Asli Kirmaci Kabakci1, Burcin Kepez Yildiz2, Yusuf Yildirim3, Alper Agca4, Fevziye Ondes Yilmaz2, Gokhan Demir5, Beril Tulu Aygun2, Ahmet Demirok6. 1. Department of Ophthalmology, University of Health Sciences Okmeydani Training and Research Hospital, Istanbul, Turkey. 2. University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. 3. University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. yusufyldrm82@gmail.com. 4. Atakoy Dunya Goz Hospital, Bakirkoy, Istanbul, Turkey. 5. Department of Ophthalmology, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. 6. Department of Ophthalmology, Istanbul Medeniyet University, Istanbul, Turkey.
Abstract
OBJECTIVES: To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy. SETTING: Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case series. METHODS: The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated. RESULTS: The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time. CONCLUSION: SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.
OBJECTIVES: To report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy. SETTING: Refractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case series. METHODS: The pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated. RESULTS: The study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time. CONCLUSION: SMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.
Authors: Jesper Ø Hjortdal; Anders H Vestergaard; Anders Ivarsen; Suganiah Ragunathan; Sven Asp Journal: J Refract Surg Date: 2012-12 Impact factor: 3.573