Dry Eye after Small Incision Lenticule Extraction (SMILE) versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis.

Zeren Shen,Ke Yao,Xiaohui Song,Yanan Zhu,Jie Yan,Wei Li

doi:10.1371/journal.pone.0168081

Zeren Shen, Ke Yao + Show 4 more

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https://doi.org/10.1371/journal.pone.0168081

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Journal: PloS one	Publication Date: Dec 16, 2016
Citations: 35	License type: CC BY 4.0

Affiliation: Second Affiliated Hospital of Zhejiang University

Abstract

PurposeTo compare dry eye after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK) for correcting myopia.MethodsCENTRAL, Embase and PubMed were searched in November 2016. All randomized controlled trials (RCTs) and prospective cohorts that compared dry eye after SMILE with FS-LASIK were selected.ResultsFive cohorts and one RCT were identified for comparing dry eye after SMILE (291 eyes) and FS-LASIK (277 eyes). The pooled results revealed that the SMILE and FS-LASIK groups did not differ significantly in terms of Schirmer’s I test (SIT) and tear film osmolarity (TFO) at any postoperative visits. By contrast, tear break up time (TBUT; p = 0.04 for one month, p < 0.001 for three months, and p = 0.02 for six months) and ocular surface disease index (OSDI; p < 0.001 for one month and three months, and p = 0.006 for six months) were significantly worse in the FS-LASIK group than in the SMILE group at follow-up. At six months postoperatively, TBUT and TFO values in both the SMILE and FS-LASIK groups and OSDI scores in the SMILE group returned to preoperative levels, but SIT values in both groups (p = 0.02 for the SMILE group and p < 0.001 for the FS-LASIK group) and OSDI in the FS-LASIK group (p < 0.001) were still statistically impaired.ConclusionDry eye after both SMILE and FS-LASIK usually occurs transiently. SMILE does not show obvious superiority over FS-LASIK by exhibiting similar and acceptable objective parameters, and SMILE may have milder subjective symptoms.

Highlights

Refractive surgery, such as laser-assisted in situ keratomileusis (LASIK), allows people to reduce their dependence on glasses
Five cohorts and one randomized controlled trials (RCTs) were identified for comparing dry eye after small incision lenticule extraction (SMILE) (291 eyes) and FS-LASIK (277 eyes)
The pooled results revealed that the SMILE and FS-LASIK groups did not differ significantly in terms of Schirmer’s I test (SIT) and tear film osmolarity (TFO) at any postoperative visits

Summary

Introduction

Refractive surgery, such as laser-assisted in situ keratomileusis (LASIK), allows people to reduce their dependence on glasses. High satisfaction is reported, dry eye remains the most common complication after LASIK; the incidence varies among patients [1,2,3,4,5]. Some patients experienced transient dry eye, while others reported severe symptoms over the long term, with incidence ranging from 20% to 40% [2]. Total amputation of the corneal nerves due to flap creation and photoablation is a likely cause of post-LASIK dry eye [2,7]. Femtosecond laser-assisted LASIK (FS-LASIK) generates more consistent and predictable flap diameters, thicknesses, and hinge widths than microkeratomes [9]. The control and optimization of corneal features may reduce flap-related complications such as reduced corneal nerve injury and encourage faster recovery from dry eye [9,10,11]

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