Evaluation of the Effects of Myopic Astigmatism Correction and Anterior Corneal Curvature on Functional Optical Zone After SMILE.

Abstract

To evaluate the influence of different degrees of myopic astigmatism correction and preoperative anterior corneal curvature on the functional optical zone (FOZ) following small incision lenticule extraction (SMILE). In this retrospective study, 68 patients (106 eyes) treated with SMILE were grouped according to myopic astigmatism correction: control (0.00 diopters [D]), moderate astigmatism (-0.50 to -2.00 D), and high astigmatism (> -2.00 D). The FOZ was measured and compared between the three groups for 3 months. Correlations between attempted correction, anterior corneal curvature, corneal aberrations, and the FOZ were analyzed. The preoperative mean treatment spherical equivalent was comparable among the three groups. The average FOZ was 5.06 ± 0.24 mm in the control group, 5.19 ± 0.25 mm in the moderate astigmatism group, and 5.35 ± 0.20 mm in the high astigmatism group The FOZ showed statistically significant differences among the three groups (P < .001), particularly between the high astigmatism group and the other two groups (P < .001 and .018). Correlation analysis showed that the total higher order aberrations, coma, and spherical aberration change were correlated with the FOZ (P < .001). Preoperative steep keratometry, average keratometry, and corneal astigmatism were significantly correlated with the FOZ (P < .05). The correlation remained after excluding the influence of attempted correction on the FOZ (P < .05). After adjusting for other risk factors using multiple linear regression analysis, there was still a significant positive association between preoperative steep keratometry and the FOZ (P < .001). Patients with higher myopic astigmatism achieved a larger FOZ and less induced horizontal coma than the control and moderate astigmatism groups. A larger FOZ after SMILE can be achieved in eyes with steeper keratometry. [J Refract Surg. 2023;39(2):135-141.].