Abstract
BackgroundTo evaluate the refractive outcomes for the correction of low to moderate astigmatism up to 1 year following small incision lenticule extraction (SMILE) surgery.MethodsThis retrospective study enrolled 98 eyes from 98 patients who underwent SMILE surgery for the correction of myopia and astigmatism. Only right eyes were included in this study to avoid the bias of orientation errors. The vector method was used to analyze the outcomes of astigmatism at 1 month, 6 months and 12 months after the procedure, including the double-angle plots, correction index (CI), index of success (IOS), angle of error (AofE) and magnitude of error (MofE). The effectiveness, safety, stability and predictability were also investigated during the 12-month follow-up.ResultsThe preoperative cylinder ranged from -2.75 D to -0.25 D (average of -0.90 ± 0.68 D), and the mean postoperative cylinder values were -0.24 ± 0.29 D, -0.24 ± 0.29 D, and -0.20 ± 0.27 D at 1 month, 6 months, and 12 months, respectively. The mean astigmatism in vector form was -0.14 D × 27.19° at 1 month, -0.13 D × 27.29° at 6 months, and -0.10 D × 28.63° at 12 months after surgery. The CI was 1.00 ± 0.32 and IOS was 0.29 ± 0.44 at the 12-month follow-up. Significant negative correlations were found between the CI and absolute target induced astigmatism (TIA) value, and positive correlations were found between the IOS and absolute AofE value (P < 0.05). The MofE was limited within ±1.00 D at the 12-month follow-up. Fifty-six eyes (57.1%) gained one line in corrected distance visual acuity (CDVA) and five eyes (5.1%) gained two lines. There were no significant differences observed in the refractive outcomes among time points.ConclusionsSMILE surgery was effective and safe in correcting low to moderate astigmatism, and stable refractive outcomes were observed at the long-term follow-up. The undercorrection of astigmatism could possibly be influenced by attempted astigmatism correction preoperatively, the axis rotation during the surgery or wound healing postoperatively. This study suggested that nomograms should be adjusted in correcting astigmatism with SMILE surgery.
Highlights
To evaluate the refractive outcomes for the correction of low to moderate astigmatism up to 1 year following small incision lenticule extraction (SMILE) surgery
Compared to the previous laser insitu keratomileusis (LASIK) procedure, the lenticule of SMILE surgery is created by the femtosecond laser without eye-tracking, instead of photoablation performed by excimer laser, and the accuracy of the axis correction is highly influenced by the alignment between the center of the ablated zone and the center of the pupil
The mean astigmatism in vector form was −0.63 D × 6.68° preoperatively and −0.14 D × 27.19° at 1 month, −0.13 D × 27.29° at 6 months, and −0.10 D × 28.63° at 12 months after surgery. These results indicated a reduction in the cylinder value and the axis of astigmatism toward counterclockwise with long-term observation
Summary
To evaluate the refractive outcomes for the correction of low to moderate astigmatism up to 1 year following small incision lenticule extraction (SMILE) surgery. Since small incision lenticule extraction (SMILE) surgery was first published in 2011 by Shah [1] and Sekundo [2], it has gained great interest among refractive surgeons for its flapless feature and all-in-one femtosecond laser procedure. Refractive results have previously been analyzed in several studies [1,2,3,4,5,6]; few have focused on correcting astigmatism, especially in the vector method. A study on correcting astigmatism following femtosecond lenticule extraction (FLEx) was investigated by Kunert et al [7] in vector form, which had a promising result. The vector analysis of SMILE surgery might play an important role in the evaluation of astigmatism
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