Hassan Hashemi1, Mohammadreza Aghamirsalim2, Saied Shahhoseini3, Alireza Moghaddasi3, Soheila Asgari3. 1. Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran. research@norc.ac.ir. 2. Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 3. Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
Abstract
PURPOSE: To determine the two-year results of small incision lenticule extraction (SMILE) for correcting post-keratoplasty myopia and myopic astigmatism. METHODS: In this case-series study, 10 eyes of 10 patients with a 6- to 10-year history of successful deep lamellar keratoplasty (DALK) underwent SMILE using the VisuMax laser platform. Ophthalmologic examinations and visual acuity and refraction measurement were taken pre- and 1, 3, 6, 12, and 24 months postoperatively. The Pentacam and Sirius imaging were done in the first and last follow-up sessions. RESULTS: The mean age of the patients was 39.60 ± 7.86 years. Six subjects were male. Two years after SMILE, the mean improvement in UDVA and CDVA was 3.60 ± 1.84 (P < 0.001) and 1.60 ± 2.91 (P = 0.231) LogMAR, respectively. The mean decrease in spherical equivalent, spherical error, and cylinder power was 1.92 ± 1.96 diopter (D) (P = 0.013), 0.70 ± 3.05D (P = 0.213), and 2.42 ± 2.91D (P = 0.024), respectively. The vector mean target-induced astigmatism, surgical-induced astigmatism, and difference vector were 1.30D@44˚, 1.11D@24˚, and 0.86D@73˚, respectively. Two years after SMILE, vertical coma, horizontal coma, and spherical aberration increased by 0.44 ± 0.51, 0.23 ± 0.32, and 0.02 ± 0.16 µm, respectively, (all P > 0.05) while trefoil reduced by 0.29 ± 0.75 µm (P = 0.428). CONCLUSION: SMILE can be an effective procedure for reducing refraction and astigmatism after DALK in patients with moderate myopia and moderate to severe astigmatism and improves the visual acuity in these patients. Axis rotation during surgery may result in under-correction of astigmatism. Refinement of SMILE treatment nomogram for post-DALK cases seems necessary.
PURPOSE: To determine the two-year results of small incision lenticule extraction (SMILE) for correcting post-keratoplasty myopia and myopic astigmatism. METHODS: In this case-series study, 10 eyes of 10 patients with a 6- to 10-year history of successful deep lamellar keratoplasty (DALK) underwent SMILE using the VisuMax laser platform. Ophthalmologic examinations and visual acuity and refraction measurement were taken pre- and 1, 3, 6, 12, and 24 months postoperatively. The Pentacam and Sirius imaging were done in the first and last follow-up sessions. RESULTS: The mean age of the patients was 39.60 ± 7.86 years. Six subjects were male. Two years after SMILE, the mean improvement in UDVA and CDVA was 3.60 ± 1.84 (P < 0.001) and 1.60 ± 2.91 (P = 0.231) LogMAR, respectively. The mean decrease in spherical equivalent, spherical error, and cylinder power was 1.92 ± 1.96 diopter (D) (P = 0.013), 0.70 ± 3.05D (P = 0.213), and 2.42 ± 2.91D (P = 0.024), respectively. The vector mean target-induced astigmatism, surgical-induced astigmatism, and difference vector were 1.30D@44˚, 1.11D@24˚, and 0.86D@73˚, respectively. Two years after SMILE, vertical coma, horizontal coma, and spherical aberration increased by 0.44 ± 0.51, 0.23 ± 0.32, and 0.02 ± 0.16 µm, respectively, (all P > 0.05) while trefoil reduced by 0.29 ± 0.75 µm (P = 0.428). CONCLUSION: SMILE can be an effective procedure for reducing refraction and astigmatism after DALK in patients with moderate myopia and moderate to severe astigmatism and improves the visual acuity in these patients. Axis rotation during surgery may result in under-correction of astigmatism. Refinement of SMILE treatment nomogram for post-DALK cases seems necessary.