The effect of thin lenticule versus thick lenticule (a cut-off value of 55 micrometer) on the outcome of SMILE in low myopia
DOI:
https://doi.org/10.22317/jcms.v6i5.860Abstract
Objectives: In the current study, the aim was to evaluate the effect difference in lenticule thickness SMILE cases (≤ 55 µm versus > 55 µm) on the visual outcome in a cohort of 61 patients with low myopia (≤3.0 diopters)
Methods: The current prospective cohort study included 61 patients undergoing SMILE refractive procedure during the period extending from November the 14th 2019 through June the 14th 2020, a total of 99 eyes. The study was conducted in Ibsar ophthalmology surgery centre "private medical centre" in the wholly Najaf city, mid-Euphrates region of Iraq. The cases enrolled in the study were all operated on by the same ophthalmologist. According to lenticule thickness, eyes were classified into two groups, (≤ 55 µm versus > 55 µm). The main outcome variable was visual acuity postoperative within two short period of time, one week and 3 months.
Results: Comparison of visual acuity between patients with lenticule thickness of ≤ 55 µm and patients with lenticule thickness of > 55 µm was shown in table 6. There was no significant difference in UCVA (uncorrected visual acuity) (P = 1.000), significant difference in BCVA (best corrected visual acuity) (better with lenticule thickness of ≤ 55 µm) (P = 0.037), no significant difference in VAAS (visual acuity after surgery) (P = 0.065) and no significant difference in VA3M (visual acuity 3 months after surgery) (P = 0.599).
Conclusion: Thin lenticule of less than or equal 55 micrometer to as low as 41 micrometer can be chosen for SMILE with efficacy and safety comparable to that of thicker lenticule provided that the operation is done by well trained and skilled refractive surgeon.
References
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23. Ang M, Mehta JS, Chan C, et al. Refractive lenticule extraction: transition and comparison of 3 surgical techniques. J Cataract Refract Surg. 2014;40(9):1415–1424.
24. Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology. 2014;121(4):822–828.
25. Ramirez-Miranda A, Ramirez-Luquin T, Navas A, Graue-Hernandez EO. Refractive Lenticule Extraction Complications. Cornea. 2015;34(Suppl 10):S65–S67.
26. R. Shetty, R. Shroff, L. Kaweri, C. Jayadev, M. K. Kummelil, and A. Sinha Roy, “Intra-operative cap repositioning in small incision lenticule extraction (SMILE) for enhanced visual recovery,†Current Eye Research, vol. 41, pp. 1532–1538, 2016.
27. M. He, W. Wang, H. Ding, and X. Zhong, “Comparison of two cap thickness in small incision lenticule extraction: 100 μm versus 160 μm,†PLoSOne, vol. 11, article e0163259, 2016.
28. Y. W. Ji, M. Kim, D. S. Y. Kang et al., “Lower laser energy levels lead to better visual recovery after small-incision lenticule extraction: prospective, randomized clinical trial,†American Journal of Ophthalmology, vol. 179, pp. 159–170, 2017.
29. D. Donate and R. Thaëron, “Lower energy levels improve visual recovery in small incision lenticule extraction (SMILE),†Journal of Refractive Surgery, vol. 32, pp. 636–642, 2016.
30. Acar B. T. and Acar S. Effect of Cap-Lenticule Diameter Difference on the Visual Outcome and Higher-Order Aberrations in SMILE: 0.4 mm versus 1.0 mm. Journal of Ophthalmology. 2017; (2017): 8259546.
31. Moshirfar M, McCaughey MV, Reinstein DZ, Shah R, Santiago-Caban L, Fenzl CR. Small-incision lenticule extraction. J Cataract Refract Surg. 2015 Mar;41(3):652-65.
32. Miruna N, Andrei F, Vasile FM, Rotaru E. Smile--the next generation of laser vision correction. Rom J Ophthalmol. 2016;60(1):6-8.
33. Moshirfar M, Albarracin JC, Desautels JD, Birdsong OC, Linn SH, Hoopes PC. Ectasia following small-incision lenticule extraction (SMILE): a review of the literature. ClinOphthalmol. 2017;11:1683-1688.
34. Moshirfar M, Bruner CD, Skanchy DF, Shah T. Hyperopic small-incision lenticule extraction. CurrOpinOphthalmol. 2019 Jul;30(4):229-235.
35. Siedlecki J, Luft N, Keidel L, et al. Variation of Lenticule Thickness for SMILE in Low Myopia. J Refract Surg. 2018;34(7):453-459.
2. Wu PC, Huang HM, Yu HJ, Fang PC, Chen CT. Epidemiology of Myopia. Asia Pac J Ophthalmol (Phila). 2016;5(6):386-393.
3. Foster PJ, Jiang Y. Epidemiology of myopia. Eye (Lond). 2014;28(2):202-208.
4. G. L. Ehlke and R. R. Krueger, “Laser vision correction in treating myopia,†Asia-Pacific Journal of Ophthalmology, vol. 5, pp. 434–437, 2016.
5. A. Agca, A. Demirok, Y. Yıldırım et al., “Refractive lenticule extraction (ReLEx) through a small incision (SMILE) for correction of myopia and myopic astigmatism: current perspectives,†Clinical Ophthalmology, vol. 10, pp. 1905–1912, 2016.
6. Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy (LASEK) versus laser-assisted in-situ keratomileusis (LASIK) for correcting myopia. Cochrane Database Syst Rev. 2017; 2(2):CD011080.
7. Ganesh S, Brar S, Arra RR. Refractive lenticule extraction small incision lenticule extraction: A new refractive surgery paradigm. Indian J Ophthalmol. 2018;66(1):10-19.
8. Sekundo W, Kunert K, Russmann C, et al. First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia: six-month results. J Cataract Refract Surg. 2008;34(9):1513–1520.
9. Titiyal JS, Kaur M, Shaikh F, Gagrani M, Brar AS, Rathi A. Small incision lenticule extraction (SMILE) techniques: patient selection and perspectives. ClinOphthalmol. 2018;12:1685-1699.
10. Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2011;95(3):335–339.
11. Shah R, Shah S, Sengupta S. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 2011;37(1):127–137.
12. M. Liu, Y. Chen, D. Wang et al., “Clinical outcomes after SMILE and femtosecond laser-assisted LASIK for myopia and myopic astigmatism: a prospective randomized comparative study,†Cornea, vol. 35, pp. 210–216, 2016.
13. E. Chansue, M. Tanehsakdi, S. Swasdibutra, and C. McAlinden, “Efficacy, predictability and safety of small incision lenticule extraction (SMILE),†Eye and Vision, vol. 2, p. 14, 2015.
14. D. Z. Reinstein, T. J. Archer, and M. Gobbe, “Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes,†Eye and Vision, vol. 1, p. 3, 2014.
15. Y. Zhang, Q. Shen, Y. Jia, D. Zhou, and J. Zhou, “Clinical outcomes of SMILE and FS-LASIK used to treat myopia: a meta-analysis,†Journal of Refractive Surgery, vol. 32, pp. 256–265, 2016.
16. M. J. Ye, C. Y. Liu, R. F. Liao, G. ZY, B. Y. Zhao, and Y. Liao, “SMILE and wavefront-guided LASIK out-compete other refractive surgeries in ameliorating the induction of high-order aberrations in anterior corneal surface,†Journal of Ophthalmology, vol. 2016, Article ID 8702162, 7 pages, 2016.
17. W. T. Cai, Q. Y. Liu, C. D. Ren et al., “Dry eye and corneal sensitivity after small incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis: a meta-analysis,†International Journal of Ophthalmology, vol. 10, pp. 632–638, 2017.
18. R. Shah and S. Shah, “Effect of scanning patterns on the results of femtosecond laser lenticule extraction refractive surgery,†Journal of Cataract and Refractive Surgery, vol. 37, pp. 1636–1647, 2011.
19. A. Vestergaard, A. Ivarsen, S. Asp, and J. Q. Hqjortdal, “Femtosecond (FS) laser vision correction procedure for moderate to high myopia: a prospective study of ReLex® flex and comparison with a retrospective study of FS-laser in situ keratomileusis,†ActaOphthalmologica, vol. 91, pp. 335–362, 2013.
20. K. Kamiya, K. Shimizu, A. Igarashi, and H. Kobashi, “Effect of femtosecond laser setting on visual performance after small incision lenticule extraction for myopia,†The British Journal of Ophthalmology, vol. 99, pp. 1381–1387, 2015.
21. Titiyal JS, Kaur M, Rathi A, et al. Learning Curve of Small Incision Lenticule Extraction: Challenges and Complications. Cornea. 2017;36(11):1377–1382.
22. Pradhan K, Reinstein D, Carp G, et al. Learning curve for small incision lenticule extraction (SMILE) of a novice corneal laser refractive surgeon evaluated by procedure time for consecutive cases. European Society of Cataract & Refractive Surgeons. 2013. ESCRS website. Available from: http://escrs.org/amsterdam2013/programme/free-papers-details.asp?id=15825&day=0.
23. Ang M, Mehta JS, Chan C, et al. Refractive lenticule extraction: transition and comparison of 3 surgical techniques. J Cataract Refract Surg. 2014;40(9):1415–1424.
24. Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology. 2014;121(4):822–828.
25. Ramirez-Miranda A, Ramirez-Luquin T, Navas A, Graue-Hernandez EO. Refractive Lenticule Extraction Complications. Cornea. 2015;34(Suppl 10):S65–S67.
26. R. Shetty, R. Shroff, L. Kaweri, C. Jayadev, M. K. Kummelil, and A. Sinha Roy, “Intra-operative cap repositioning in small incision lenticule extraction (SMILE) for enhanced visual recovery,†Current Eye Research, vol. 41, pp. 1532–1538, 2016.
27. M. He, W. Wang, H. Ding, and X. Zhong, “Comparison of two cap thickness in small incision lenticule extraction: 100 μm versus 160 μm,†PLoSOne, vol. 11, article e0163259, 2016.
28. Y. W. Ji, M. Kim, D. S. Y. Kang et al., “Lower laser energy levels lead to better visual recovery after small-incision lenticule extraction: prospective, randomized clinical trial,†American Journal of Ophthalmology, vol. 179, pp. 159–170, 2017.
29. D. Donate and R. Thaëron, “Lower energy levels improve visual recovery in small incision lenticule extraction (SMILE),†Journal of Refractive Surgery, vol. 32, pp. 636–642, 2016.
30. Acar B. T. and Acar S. Effect of Cap-Lenticule Diameter Difference on the Visual Outcome and Higher-Order Aberrations in SMILE: 0.4 mm versus 1.0 mm. Journal of Ophthalmology. 2017; (2017): 8259546.
31. Moshirfar M, McCaughey MV, Reinstein DZ, Shah R, Santiago-Caban L, Fenzl CR. Small-incision lenticule extraction. J Cataract Refract Surg. 2015 Mar;41(3):652-65.
32. Miruna N, Andrei F, Vasile FM, Rotaru E. Smile--the next generation of laser vision correction. Rom J Ophthalmol. 2016;60(1):6-8.
33. Moshirfar M, Albarracin JC, Desautels JD, Birdsong OC, Linn SH, Hoopes PC. Ectasia following small-incision lenticule extraction (SMILE): a review of the literature. ClinOphthalmol. 2017;11:1683-1688.
34. Moshirfar M, Bruner CD, Skanchy DF, Shah T. Hyperopic small-incision lenticule extraction. CurrOpinOphthalmol. 2019 Jul;30(4):229-235.
35. Siedlecki J, Luft N, Keidel L, et al. Variation of Lenticule Thickness for SMILE in Low Myopia. J Refract Surg. 2018;34(7):453-459.
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Published
2020-10-30
How to Cite
Shukur, Z. Y. . H. (2020). The effect of thin lenticule versus thick lenticule (a cut-off value of 55 micrometer) on the outcome of SMILE in low myopia. Journal of Contemporary Medical Sciences, 6(5), 223–228. https://doi.org/10.22317/jcms.v6i5.860
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