SMILE Group Research Articles

SMILE and ICL implantation on the ocular surface and meibomian glands in patients with postoperative myopia

BackgroundObjectively compare the changes in ocular surface parameters in myopic patients who have undergone either SMILE or Implantable Collamer Lens (ICL V4c) surgery.MethodsThis prospective cohort study enrolled 32 patients (32 eyes) undergoing SMILE surgery and 35 patients (35 eyes) receiving ICL V4c intraocular lenses. Examinations were performed at preoperative, 1-week, 1-month, and 3-month postoperative time points. The assessments included Schirmer’s I Test (SIt), First Non-Invasive Break-Up Time (First-NIBUT), Average Non-Invasive Break-Up Time (Average-NIBUT), Tear Meniscus Height (TMH), Ocular Surface Disease Index (OSDI) score, conjunctival congestion score, meibomian gland loss score, lipid layer analysis score, lid margin opening detection score, and corneal fluorescein staining (CFS) score.ResultsRepeated measures ANOVA revealed that SIT, TMH, and First-NIBUT initially decreased and then increased. At three months, SIT levels in the SMILE group were significantly lower than those in the ICL group. From the first month onward, TMH levels in the SMILE group remained significantly lower than those in the ICL group (P < 0.05). OSDI scores initially rose and then fell, with the SMILE group consistently showing higher OSDI levels than the ICL group. Conjunctival congestion scores in the SMILE group fluctuated less, while the ICL group exhibited a clear downward trend, with significant differences starting from the first week (P < 0.05). Over time, scores for meibomian gland loss, lipid layer analysis, and lid margin opening detection were all higher in the SMILE group compared to the ICL group.ConclusionsSMILE surgery has a more pronounced and prolonged impact on the ocular surface and meibomian gland function compared to ICL implantation. Objective dry eye parameters in the ICL group recover more quickly than those in the SMILE group one month post-surgery.

Comparison of corneal consumption in correcting high with-the-rule astigmatism between refractive lenticule extraction and laser-assisted in situ keratomileusis.

To compare corneal thickness (CT) and corneal volume (CV) consumption after the refractive lenticule extraction and the femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) in myopic eyes with high with-the-rule (WTR) astigmatism. 70 myopic eyes (50 patients) with high WTR astigmatism (-2.00 to -3.25 D) received refractive lenticule extraction (35 eyes) or FS-LASIK (35 eyes) in this retrospective study. Predicted central corneal thickness (CCT) consumption was obtained from the corresponding laser platform software. The CT in different positions (thinnest location, center, around the thinnest location at 2mm, 4mm, 6mm rings and four different directions points in every ring), and CV in different areas (around the CCT at 3mm, 5mm, 7mm, and 10mm zone) were measured via corneal tomography before surgeries and at 1, 3, and 6-month follow-up. The results of the postoperative examination indicated that refractive lenticule extraction and FS-LASIK had proximate satisfaction, safety, accuracy, and stability. In SMILE group and FS-LASIK group, the predicted CCT consumption was 111.66 ± 13.08μm and 103.26 ± 12.79μm, respectively (P = 0.010). At the 6-month follow-up, the actual changes of CCT in two groups were 96.71 ± 12.88μm and 114.74 ± 16.42μm, respectively (P < 0.001). The reduction of CCT was overestimated by 14.94 ± 8.42μm (P < 0.001) in SMILE group, while it was underestimated by 11.34 ± 7.61μm (P < 0.001) in FS-LASIK group. The ΔCT (every area and each point) was significantly lower than in FS-LASIK group at 3 postoperative time points (1, 3, 6 months) in SMILE group. The data showed that ΔCV of all areas (3, 5, 7, 10-mm diameter area) in SMILE group was significantly fewer than FS-LASIK group in each follow-up. Refractive lenticule extraction had less consumption in CT and CV compared with FS-LASIK in equivalent refractive error. In refractive lenticule extraction, the CCT consumption has been overrated, whereas underrated in FS-LASIK. Compared with refractive lenticule extraction, the actual CCT changes of FS-LASIK approached the predicted value. What is known Corneal consumption is known as the important index in the treatment of refractive lenticule extraction and the femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for patients who suffer from myopia with astigmatism. What is new This study evaluated corneal thickness (CT) and corneal volume (CV) consumption of myopic patients with high with-the-rule (WTR) astigmatism before and after refractive lenticule extraction and FS-LASIK. There was less ΔCT and ΔCV consumption in SMILE group compared with FS-LASIK group in patients with high WTR astigmatism. The predictability of CCT consumption in FS-LASIK is better than in refractive lenticule extraction.

Role of canine vertical position and gingival zenith level on smile aesthetics and qualitative evaluation of perception by orthodontists, general dentists and laypersons: A descriptive cross-sectional study

: Our objectives were to verify the impact of alterations in the vertical position of the maxillary canines in smile aesthetic perceptions and to determine whether exposure of the gingival margins directly affects laypersons' and orthodontists' perceptions.: To evaluate the impact of vertical position and gingival zenith level of maxillary canine on smile esthetics as judged by orthodontists, general dentist and laypersons: This is a qualitative, descriptive cross-sectional study aimed at studying the role of vertical position and gingival zenith level on the smile esthetic perception. A smiling photograph of a male subject with and without exposing the gingival zeniths was selected, and vertical positions and gingival zenith levels of canine were symmetrically modified in increments of 0.5 mm, creating two sets of 4 new modified images varying from 1.0 mm of intrusion to 1.0 mm of extrusion and 1.0 mm of increasing and decreasing the height with gingival exposure. The total of 15 images were evaluated by 40 orthodontists, 40 general dentists and 40 laypersons, who determined the level of attractiveness of each smile on a visual analog scale.: Both smile arc ( &amp;#60;0.05) and gingival display amount ( &amp;#60;0.001) had statistically significant influences on the perception of smile attractiveness. Smile attractiveness scores with reference to gingival display amount showed a statistically significant ( &amp;#60;0.001) difference between the rater groups. A significant ( &amp;#60;0.05) interaction between smile arc and gingival display amount was observed. No significant difference were noted with standard smiles and intrusion smiles. Also, with 0.5mm extrusion and intrusion images in low smile. The intra-evaluator groups showed no significant difference between intrusion and extrusion high as well as low smile images, (value&amp;#60;0.05 for all). significant difference was seen in extrusion and intrusion high smile at 0.5mm and low smile images at 1mm level, extrusion and intrusion low smile images at 0.5mm level, (value&amp;#62;0.05 for all), significantly higher intrusion and extrusion high smile images at 0.5mm level, (-value&amp;#60;0.05 for all). extrusion and intrusion high as well as low smile images at 1mm and 0.5mm levels, (-value&amp;#60;0.05 for all).: Orthodontists were more critical in their assessments. There were no differences in the esthetic evaluations of smiles with and without gingival margin exposure for both groups of evaluators. For all the three evaluator groups, the most attractive ones were the standard smile and smile with the intrusion of 0.5 in high smile, standard and extrusion of 0.5 mm in the low smile group 0.5 mm of increased gingival zenith level (GZL) as perceived by orthodontists and general dentists, while for laypeople it was the standard smile. The unattractive smiles have extrusion and intrusion of 1mm for all the three evaluator groups 1 mm followed of decreased GZL of canine, for orthodontists and general dentist with 1mm increased. Laypeople, orthodontists scored all the images more critically by giving lesser scores compared to the general dentists and laypeople.

Association of intensity and dominance of CEOs’ smiles with corporate performance

This study investigated whether the facial expressions of chief executive officers (CEOs) are associated with corporate performance. A photograph of the CEO or president of each company that appeared on the Fortune Global 500 list for 2018 was taken from the company’s official website. The smile intensity and action unit activation in each face were calculated using a pre-trained machine learning algorithm, FACET. The results revealed a positive association between smile intensity and company profit, even when controlling for the company’s geographic location (Western culture versus others) and the CEO’s gender. Furthermore, when the type of smile was examined with the activation of each action unit, this significant positive association was identified in the dominant smile but not in the reward and affiliative smiles. Relationships among the leader’s smile intensity, group strategy, and group performance are discussed.

Comparison of Corneal Power Difference Maps with Achieved Myopic Correction Using Scheimpflug Tomography After LASIK, PRK, and SMILE.

To compare corneal power difference maps (∆maps) obtained from the Pentacam in patients with 1 year follow-up after LASIK, PRK, and SMILE with further stratification to low, moderate, and high myopia. This retrospective study was comprised of patients who had preoperative and 1-year postoperative power maps that were obtained-front sagittal (SagF), refractive power (RP), true net power (TNP), and total corneal refractive power (TCRP)-for evaluation. Measurements were recorded and compared at the 4mm, 5mm and 6mm pupil and apex zones. Comparisons were made between each specific power ∆map and the surgically induced refractive change (SIRC). Further analysis of the ∆maps was performed based on degree of myopia (high, moderate, and low). Correlation and agreement were also assessed with regression and limits of agreement (LoA). There were 172 eyes in the LASIK group, 187 eyes in the PRK group, and 46 eyes in the SMILE group. In the LASIK group, TNP ∆map at 5mm pupil zone had the least absolute mean difference with SIRC (0.007 ± 0.42D). In the PRK group, TNP ∆map at 5mm apex zone was most accurate compared to SIRC (0.066 ± 0.45D). In the SMILE group, TCRP ∆map at 4mm apex zone had the closest absolute value when compared to SIRC (0.011 ± 0.50D). There was good correlation and agreement for all three surgery groups, LASIK: r = 0.975, LoA -0.83D to +0.83D, PRK: r = 0.96, LoA -0.83D and +0.95D, and SMILE: r = 0.922, LoA -0.97 D to +0.99D. TNP ∆maps most accurately measured corneal power in the LASIK and PRK groups while TCRP ∆maps were most accurate in the SMILE group. The degree of myopia may change which ∆map is most accurate.

Histopathology of Corneal Lenticules Obtained from Small Incision Lenticule Extraction (SMILE) versus Microkeratome Excision.

To study the alterations on the lenticules extracted after femtosecond (Femto) small incision lenticule extraction (SMILE) versus the corneal free cap removed using a microkeratome. The visuMax (500 kHz; laser energy: 180 nJ) was used for small-incision lenticule extraction. Free caps from human cadaveric corneas were excised by microkeratome. The collected lenticules were examined with the light and transmission electron microscope (TEM) for histological analysis, DNA fragmentation was assessed by agarose gel electrophoresis, DNA damage was evaluated using comet assay, and corneal proteins secondary structure was assessed by Fourier transform infrared spectroscopy (FTIR). Light microscopic examination showed the presence of more edematous stroma under Femto SMILE than under free cap with a percentage change of 101.6%. In the Femto SMILE group, TEM examination showed pyknotic keratocytes, disruption, and cavitation of the collagen arrays stromal area under Femto SMILE. The DNA fragmentation for the Femto SMILE group revealed one undefined band with a size of 1.1 Kbp. The comet assay analysis indicated the presence of 3% and 8.0% tailed cells for the free cap and Femto SMILE groups, respectively. The tail lengths were 1.33 0.16 and 1.67 0.13 µm (P 0.01), the percentage of tail DNA was 1.41 0.18% (P 0.01) and 1.72 0.15%, and the tail moments were 1.88 0.12 AU and 2.87 0.14 AU (P 0.001) for the free cap and Femto SMILE groups, respectively. FTIR spectroscopy of the Femto smile group revealed disorders in the secondary and tertiary structure of the proteins. Femto SMILE technique induced more structural changes, DNA fragmentation, DNA damage, and corneal proteins secondary structure alteration than those induced by a microkeratome cutting. These changes may be attributed to the deep penetration of high energy levels to the corneal layer. These findings may highlight the potential impact of the Femto SMILE on the cornea and the necessity for managing the laser parameters used.

Direct assessment of changes in biomechanical properties of the cornea after ReLEx SMILE and FemtoLASIK surgeries

The SMILE group comprised 23 patients (46 eyes) with spherical refraction -3.8±1.8 diopters (D), the FemtoLASIK group included 18 patients (36 eyes) with spherical refraction -3.5±1.3 D. Analysis of the biomechanical properties of the cornea was carried out using the CORVIS ST device (Oculus, Germany) before and seven days after corneal refractive surgery. In the SMILE group, with intraoperative decrease in corneal thickness of 91.43±19.43 µm, a significant increase in the following parameters was observed: deformation coefficient (DA ratio; p=0.0001), peak distance (PD; p=0.02) and inverse concave radius (ICR; p=0.003); a decrease in the stiffness parameter at first applanation (SP-A1; p=0.0001), Corvis biomechanical index (CBI; p=0.0001), intraocular pressure (IOP; p=0.001). In the FemtoLASIK group, with intraoperative decrease in corneal thickness of 75.33±32.3 µm, we observed a significant increase in DA ratio (p=0.0002), PD (p=0.04), ICR (p=0.0002), a decrease in SP-A1 (p<0.0001), IOP values (p=0.0003). In comparison with the FemtoLASIK group, the deformation amplitude DA changed significantly less in the SMILE group (p=0.04). In the FemtoLASIK group, in comparison with the SMILE group, the DA ratio (p=0.0009) and SP-A1 (p=0.0003) significantly increased. Intraoperative corneal thickness change correlates with ICR both in SMILE (R=0.52) and in FemtoLASIK (R=0.65). Corneal biomechanical properties determined with CORVIS ST in eyes with mild to moderate myopia change to a lesser extent after ReLEx SMILE compared to FemtoLASIK.

The Modern Technologies of Refractive Lenticular Extraction: Comparative Analysis of Clinical and Functional Results

Relevance. Today, keratorefractive surgery is a high-tech branch of ophthalmology and provides a predictable, high-precision, stable and safe refractive result in patients with a wide range of refractive disorders.Purpose. To evaluate the clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers.Materials and methods. Within the framework of this work, 160 patients (160 eyes) with inpatient myopia of medium and high degree were examined and operated, with average keratometry parameters (43.0–45.0 dptr), aged from 18 to 36 years. The follow-up period was 1 month after the operation. The SMILE group was formed: a group of patients who underwent surgery using refractive lenticular extraction technology using a femtosecond VisuMax 500 laser (80 eyes); and the CLEAR group: a group of patients who underwent surgery using refractive lenticular extraction technology using femtosecond laser Femto LDV Z8 (80 eyes).Results and discussion. Operations with SMILE and CLEAR technology were performed in the Department of refractive laser surgery of the FSAU NMIC MNTC “Eye Microsurgery” named after S.N. Fedorov of the Ministry of Health of Russia (Moscow) according to standard protocols. No intraoperative complications were recorded. The analysis of comparable clinical and functional results of myopia correction using the technology of fractional lenticular extraction performed using femtosecond VisuMax and LDV Z8 lasers was carried out.Conclusion. Thus, the analysis of the clinical and functional results of correction of myopia of medium and high degree by the technology of refractive extraction of the lenticle performed using femtosecond lasers VisuMax and LDV Z8 showed their high comparability in terms of efficiency, safety, predictability and stability. A new technology of fractional lenticular extraction using a comprehensive assessment of the condition of the ocular surface at the preoperative stage, which allows to identify and eliminate the changes that have occurred, can be recommended for widespread clinical implementation.

Efficacy and Safety of a Pegasparaginase-Based Chemotherapy Regimen vs an L-asparaginase–Based Chemotherapy Regimen for Newly Diagnosed Advanced Extranodal Natural Killer/T-Cell Lymphoma

The L-asparaginase-based SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) chemotherapy regimen has shown higher response rates and survival benefit over an anthracycline-containing regimen. However, the safety profile was not satisfied. A well-tolerated regimen with promising efficacy is lacking. To compare the efficacy and safety of the DDGP (dexamethasone, cisplatin, gemcitabine, and pegaspargase) regimen with the SMILE regimen in newly diagnosed advanced-stage (III/IV) extranodal natural killer/T-cell lymphoma (ENKL). This was an open-label, multicenter, randomized clinical trial that took place across 12 participating hospitals in China from January 2011 to February 2019. Patients were eligible if they were 14 to 70 years old with newly diagnosed ENKL in stages III/IV and had an Eastern Cooperative Oncology Group performance status of 0 to 2. Eligible patients were evenly randomized to either the DDGP or SMILE group. Patients in each group were treated with the assigned regimen every 21 days for 6 cycles. The primary end point was progression-free survival (PFS), and secondary end points included overall response rate and overall survival (OS). The adverse events between the DDGP and SMILE groups were compared. Among the 87 randomized patients, 80 received treatment (40 in the DDGP group and 40 in the SMILE group); the median (IQR) age was 43 (12) years, and 51 (64%) were male. The baseline characteristics were similar between the groups. At a median follow-up of 41.5 months, the median PFS was not reached in the DDGP group vs 6.8 months in the SMILE group (HR, 0.42; 95% CI, 0.23-0.77; P = .004), and the median OS was not reached in the DDGP group vs 75.2 months in the SMILE group (HR, 0.41; 95% CI, 0.19-0.89, P = .02). The PFS rate at 3 years and OS rate at 5 years were higher in the DDGP group vs the SMILE group (3-year PFS, 56.6% vs 41.8%; 5-year OS, 74.3% vs 51.7%). The overall response rate was higher in the DDGP group than in the SMILE group (90.0% vs 60.0%; P = .002). Grade 3 and 4 hematologic toxic effects were more frequently reported in the SMILE group vs the DDGP group (leukopenia, 85.0% vs 62.5%; neutropenia, 85.0% vs 65.0%). In this randomized clinical trial, the DDGP regimen showed promising preliminary results for patients with newly diagnosed local advanced ENKL. A confirmation trial based on larger population is warranted. ClinicalTrials.gov Identifier: NCT01501149.

Effect of dimensions on function: A 2-dimensional sonographic assessment to correlate facial muscle and smile type

The aim of this study was to measure the dimensions of the select facial muscles and correlate them with different types of smiles. The study group included 30 South Asian adults (17 men and 13 women) aged between 24 and 30 years divided into 3 groups of 10 subjects each according to Rubin's classification of smile. The zygomaticus major, levator labii superioris, depressor anguli oris, and mentalis muscles were ultrasonographically evaluated. The length and thickness of the muscles were measured bilaterally. The data obtained were analyzed statistically. The maximum mean value thickness of the zygomaticus major was found in the canine smile group. The maximum mean value thickness of the depressor anguli oris and mentalis was seen in the full denture smile group. However, the thickness of the levator labii superioris muscle was similar between the different smile groups. There was no significant difference in the measurements of the length of the muscles between the right and the left sides. This study did not find any statistically significant correlation between the type of smiles described in Rubin's classification and the dimensions of the associated facial muscle.

Comparison of Long-Term Outcomes and Refractive Stability following SMILE versus SMILE Combined with Accelerated Cross-Linking (SMILE XTRA).

Purpose To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures. Methods This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months. Results At the end of follow-up, the mean sphere, cylinder, and SE reduced to −0.03, −0.09, and −0.08 D in the SMILE group and −0.06, −0.15, and −0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error. Conclusion Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline.

Femtosecond Small Incision Lenticular Extraction in comparison to Femtosecond Laser In situ Keratomileusis Regarding Dry Eye Disease

Abstract&#x0D; Objective: Comparison of femtosecond small incision lenticule extraction (FS-SMILE) versus Femtosecond laser Insitu keratomileusis (FS-LASIK) regarding dry eye disease (DED) and corneal sensitivity (CS) after those refractive surgeries.&#x0D; Methods: A comparative prospective study conducted for a period of 2 years; from March 2017 until February, 2019. Enrolled patients were diagnosed with myopia. Fifty patients (100 eyes) were scheduled for bilateral FS-SMILE and the other 50 patients (100 eyes) had been scheduled for bilateral FS-LASIK. Both groups were followed for six months after surgery. The age, gender, and preoperative refraction for both groups were matched. Complete evaluation of dry eye disease had been performed for the intervals of one week pre-operatively, one and six months postoperatively. The evaluation included history of symptoms according to scoring systems, investigations and clinical examination.&#x0D; Results: One month postoperatively and in both groups, there was significant DED (P &lt; .01), although the incidence was lower in femtosecond SMILE group, overall severity score (0-4): 0.3 ± 0.3 (FS-SMILE) vs. 1.4 ± 0.9 (LASIK). One month postoperatively, CS was lower in FS- LASIK more than FS-SMILE eyes (2.3 ± 2.2 vs 3.6 ± 1.8, respectively, P &lt; .01) and then return to not statistically significant sensitivities at six-month duration. DED was negatively correlated with CS (P &lt; 0.01).&#x0D; Conclusions: The FS-LASIK surgery had a more pronounced effect on the CS and DED compared with FS-SMILE, with higher incidence of DED postrefractive surgery.

Comparison of the Clinical Outcomes between Combined Femtosecond Laser-Assisted In Situ Keratomileusis and Corneal Cross Linking versus Combined Small-Incision Lenticule Extraction and Corneal Cross Linking.

Purpose The purpose of this study was to compare femtosecond laser-assisted in situ keratomileusis with prophylactic cross linking (FS-LASIK Xtra) and small-incision lenticule extraction with prophylactic cross linking (SMILE Xtra) in terms of their postoperative clinical outcomes. Methods In this retrospective study, 24 patients (48 eyes) with myopia and myopia astigmatism were recruited from 2017 to 2018. All patients underwent comprehensive ophthalmic examinations preoperatively and follow-up visits at one and three months. Four patients (eight eyes) in each group were followed up for 12 months. The following were assessed at each visit: uncorrected distance visual acuity (UDVA), manifest refractive spherical equivalent (MRSE), keratometry values, biomechanical properties, anterior and posterior curvature, and corneal pachymetry. Results The FS-LASIK Xtra and SMILE Xtra groups both included 24 eyes of 12 patients. At 1, 3, and 12 months after surgery, a UDVA of 20/20 or better was achieved for 91.7%, 91.7%, and 87.5% of individuals, respectively, in the FS-LASIK group and 95.8%, 100%, and 100% in the SMILE group, respectively. For 75% of eyes in the FS-LASIK Xtra group and 100% of eyes in the SMILE Xtra group, the achieved MRSE was within ±1.00D of attempted correction. The LASIK Xtra group had a significantly higher mean MRSE than the SMILE Xtra group at 3 and 12 months after surgery (P=0.006, 0.01), and the SMILE Xtra group had significantly higher K1 and K2 values than the FS-LASIK group at one month after surgery (P=0.024, 0.023). Corneal thickness decreased significantly at one month postoperatively and started to increase over the next 12 months in both groups (P=0.001). The biomechanical properties showed no significant intergroup differences at the 12-month follow-up. Conclusions FS-LASIK Xtra and SMILE Xtra are safe and effective in the correction of myopia and myopia astigmatism, and both procedures have the same effect on postoperative corneal morphology and biomechanics.

Comparison of Corneal Biomechanics in Post-SMILE, Post-LASEK, and Keratoconic Eyes.

Significance: Our study found that SP-A1 (stiffness parameter at time of first applanation) was statistically different between post-laser-assisted subepithelial keratomileusis (LASEK) and post-small incision lenticule extraction (SMILE) eyes. The stiffness of keratoconus was lower than that of post-refractive surgery corneas.Purpose: To compare corneal biomechanics among post-SMILE, post-LASEK, and keratoconic eyes.Methods: In this retrospective study, 36 eyes of 36 patients after SMILE, 36 eyes of 36 patients after LASEK, and 36 eyes of 36 patients with keratoconus with matching (±5 μm) central corneal thickness (CCT) were examined using Scheimpflug corneal topography (Pentacam HR) and dynamic Scheimpflug analyzer (CorVis ST). Mixed linear model analysis with Bonferroni-adjusted post-hoc comparisons was performed to compare the differences in corneal biomechanics and topographic parameters among the three groups with the CCT and the bIOP (intraocular pressure with biomechanical correction) as the random factor.Results: All groups had comparable CCT at baseline. The bIOPs between the three groups were comparable. The mean values of the Belin/Ambrósio Deviation (BAD-D) in the keratoconus group were significantly higher than those of the SMILE (post hoc p < 0.001) and LASEK groups (post hoc p < 0.001). The SP-A1 in the keratoconus group was the lowest when compared with those of the SMILE (post hoc p = 0.003) and LASEK groups (post hoc p < 0.001). The SMILE group SP-A1 values were slightly lower than those of the LASEK group (post hoc p = 0.044).Conclusions: Keratoconus eyes were significantly softer when compared to post-refractive surgery corneas with comparable corneal thickness in terms of SP-A1 and BAD-D values, while the LASEK group may have the greatest stiffness. Post-SMILE and post-LASEK corneas showed significant differences in SP-A1.

The Clinical Features and Survival Outcome of 107 Newly Diagnosed Advanced Stage Extranodal NK/T-Cell Lymphoma Cases: A Triple-Center Study.

ObjectiveAdvanced stage extranodal natural killer/T-cell lymphoma (ENKTL) is a distinct type of non-Hodgkin lymphoma and the prognosis of ENKTL is poor with current treatment. This study aimed to investigate the clinical features, treatment strategy and survival outcome in patients with advanced stage ENKTL.Patients and MethodsA total of 107 patients with newly diagnosed advanced stage ENKTL between January 2010 and December 2014 were reviewed from three cancer centers. Survival probability was calculated using Kaplan-Meier and the survival curves were compared by Log rank test. Cox regression analyses was performed to investigate the prognostic factors in ENKTL.ResultsThe median patient age in our cohort was 42.0 years, with a male to female ratio of around 2.3:1. Over half of the patients had B symptoms (n = 61), high IPI scores (≥ 2, n = 60) and high Prognostic Index of Natural Killer Lymphoma (PINK) scores (≥ 3, n = 69). Elevated LDH level was present in around half of the patients (44/91). Most patients (n = 88) in our cohort originated in upper aerodigestive tract and the remaining 19 cases presented with non-upper aerodigestive tract involvement at first diagnosis. Chemotherapy regimens used in our study mainly include CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) (n = 26), L-asparaginase (L-asp) containing chemotherapy (GELOXD (gemcitabine, l-asparaginase, oxaliplatin and dexamethasone) and SMILE (L-asparaginase, methotrexate, ifosfamide, etoposide, and dexamethasone)) (n = 66). No significant difference between the baseline clinical characteristics was found between the L-asp and CHOP group. The CR rate after treatment was 39.3% (42/107) for the whole cohort. The 3-year progression-free survival (PFS) and 3-year overall survival (OS) rate was 41.0% and 41.5%, respectively. The 3-year PFS (49.2% vs 26.5%, P = 0.048) and 3-year OS (49.4% vs 26.0%, P = 0.030) was significantly higher in the L-asp group than the CHOP group. Patient CR status and PINK score were proved to be significant independent factors affecting OS and PFS by multivariate analysis. The grade 3/4 hematologic toxicity (P = 0.0003) and non-hematologic toxicity (P = 0.0002) occurred more frequently in the SMILE group than the GELOXD group.ConclusionOur results demonstrated that L-asp containing chemotherapy could provide favorable survival outcomes in patients with advanced stage ENKTL.

Can a spontaneous smile invalidate facial identification by photo-anthropometry?

PurposeUsing images in the facial image comparison process poses a challenge for forensic experts due to limitations such as the presence of facial expressions. The aims of this study were to analyze how morphometric changes in the face during a spontaneous smile influence the facial image comparison process and to evaluate the reproducibility of measurements obtained by digital stereophotogrammetry in these situations.Materials and MethodsThree examiners used digital stereophotogrammetry to obtain 3-dimensional images of the faces of 10 female participants (aged between 23 and 45 years). Photographs of the participants' faces were captured with their faces at rest (group 1) and with a spontaneous smile (group 2), resulting in a total of 60 3-dimensional images. The digital stereophotogrammetry device obtained the images with a 3.5-ms capture time, which prevented undesirable movements of the participants. Linear measurements between facial landmarks were made, in units of millimeters, and the data were subjected to multivariate and univariate statistical analyses using Pirouette® version 4.5 (InfoMetrix Inc., Woodinville, WA, USA) and Microsoft Excel® (Microsoft Corp., Redmond, WA, USA), respectively.ResultsThe measurements that most strongly influenced the separation of the groups were related to the labial/buccal region. In general, the data showed low standard deviations, which differed by less than 10% from the measured mean values, demonstrating that the digital stereophotogrammetry technique was reproducible.ConclusionThe impact of spontaneous smiles on the facial image comparison process should be considered, and digital stereophotogrammetry provided good reproducibility.

Quality of life impact of refractive correction (QIRC) results three years after SMILE and FS-LASIK

BackgroundThis study aimed to compare long-term postoperative quality of life and satisfaction differences between SMILE and FS-LASIK for myopia correction.MethodsThis cross-sectional study enrolled patients under the age of 39 years, who chose to undergo SMILE or FS-LASIK surgery to both eyes 3 years previously. Patients completed a common vision test and Quality of Life Impact of Refractive Correction (QIRC) questionnaire, together with the surgical satisfaction, adverse symptoms subjective survey. Patients with preoperative corrected distance visual acuity and postoperative uncorrected distance visual acuity of 20/20 or greater were included. Propensity score matching (PSM) was used to match the preoperative and postoperative spherical equivalent, age, and designed optical zones of the left and right eyes between the two groups.ResultsForty-nine patients were included in each group after PSM from 188 patients. No significant difference in the total QIRC score was found between the SMILE and FS-LASIK groups (45.89 ± 5.91 vs 45.09 ± 5.65, p = 0.492). There were no differences in surgical satisfaction between the groups (p = 0.178). Compared to the SMILE group, the FS-LASIK group had more glare (2.12 ± 2.25 vs 3.22 ± 2.54, p = 0.026) and severe dryness (1.80 ± 1.98 vs 2.79 ± 2.19, p = 0.021).ConclusionPostoperative quality of life is similar after SMILE or FS-LASIK. Dry eye symptoms and glare were milder in the SMILE group than in the FS-LASIK group.

Extranodal NK/T-cell lymphoma-nasal type: Experience from a regional cancer center in India

Introduction: Extranodal natural killer/T-cell lymphoma-nasal type (ENKTL-NT) is an aggressive rare non-Hodgkin's lymphoma (NHL) subtype. It presents with involvement of the nasal and upper aerodigestive region causing extensive destruction of these midline structures. It has a predilection for the Asian population. Most cases present in the early-stage disease. Treatment outcomes are usually poor, and no consensus for optimal treatment strategy exists. Patients and Methods: This is a retrospective analysis of ENKTL-NT, diagnosed in a regional cancer center in India during the period of 2013–2018. The demographic and clinical features, laboratory parameters, radiological, histopathological features, and treatment outcomes were studied. Patients were treated with SMILE or AspaMetDex regimes sandwiched with radiotherapy. Statistical analysis was performed using software “Epi Info” Version 7.2, (CDC, Atlanta, Georgia, USA). Results: Fourteen patients were diagnosed with ENKTL-NT during this period. Eight patients received SMILE, and six patients have received AspaMetDex as induction chemotherapy. Ten (71.42%) of 14 patients have achieved CR. At the median follow-up of 30 months (4–47 months), nine patients relapsed with median progression-free survival of 22 months. The median overall survival was not reached. There were two induction deaths, one in AspaMetDex and one in the SMILE group. All patients receiving SMILE experienced at least one episode of Grade 3/4 hematological toxicity. Patients receiving AspaMetDex did not have any Grade 3/4 hematological toxicity. Discussion: ENKTL-NT in India is not as common as reported in other Asian countries. Patients usually present at an earlier stage because of the peculiar site of affection. It has high response rates, but relapses are common. Most of the relapses occur within the first 2 years of follow-up. Conclusion: ENKTL-NT is rare aggressive NHL subtype with good response to L-asparaginase-based chemotherapy sandwiched with radiation therapy. SMILE is a more toxic regime than AspaMetDex but can be managed with proper supportive care.

Kinematic Analysis of Smiles in the Healthy Pediatric Population Using 3-Dimensional Motion Capture.

Facial normalcy, as measured with 2-dimensional or 3-dimensional photographs, has been documented in the healthy pediatric population. However, static images convey far from a complete representation of an individual's daily interactions with peers. Craniofacial surgery induces changes to soft or osseous tissues and thereby affects dynamic facial expression. To-date, there has not been rigorous, dynamic quantification of normal facial expression. In this study, we used 4-dimensional (4D) imaging to assess the facial expression of healthy children to provide a normative reference point for craniofacial surgeons. A total of 36 healthy pediatric volunteers underwent 4D video recordings while performing a maximal voluntary smile. A face template containing 884 landmarks was registered and tracked throughout the videos using Dimensional Imaging software. Participants were divided into 2 smile groups: open-lip smile and closed-lip smile. Kinematic analysis of smiles was calculated for every landmark from its position in the resting frame to its terminal displacement. Composite smiles and Euclidean distance maps were generated displaying areas of greatest displacement near the oral commissures. There was significant difference between closed-lip and open-lip groups in regions of eyes and cheeks. In addition, the open-lip smile group demonstrated significantly greater displacement in the oral commissure on the left side compared to the right (P < .05); whereas, in the closed-lip group, the eyes and cheeks moved significantly more on the right side. This study presents an innovative method that can be used to evaluate facial expressions to help craniofacial surgeons restore functional movement in patients with facial anomalies.

Efficacy and Survival in Newly Diagnosed Advanced Extranodal Natural Killer/T-Cell Lymphoma: A Randomized, Controlled, Multicenter and Open-Labled Study with Ddgp Regimen Versus SMILE Regimen

Background Extranodal NK/T cell lymphoma (ENKTL) is rare in western countries but rather common in Asia and South America, characterized with Epstein-Barr virus (EBV) infection. Patients with advanced stage (III/IV) ENKTL has a poor survival and low response to conventional CHOP-like chemotherapy, with a 5-year overall survival rate of only 30%. Retrospective study showed that SMILE regimen had a certain effect on ENKTL, but the toxicity limited its further clinical application. More effective treatment regimens are required to be explored for systematic, prospective, controlled, randomized clinical trials. Recently, studies revealed that asparaginase-based combination chemotherapy such as P-Gmox(Pegaspargase, Gemcitabine, Oxaliplatin)is effective in patients of ENKTL. However standard treatment for newly untreated advanced ENKTL is still controversial. We developed a refined chemotherapeutic DDGP (dexamethasone, cisplatin, gemcitabline, and peg-asparaginase) regimen and proceeded a prospective randomized, multicenter and open-label clinical trial to evaluate and compare the efficacy and safety of DDGP with SMILE regimen in patients with newly diagnosed stage III/IV ENKTL in January 2011. Based on the encouraging interim results in 2016(Li, L et al.Clin Cancer Res, 2016), we presented the final results of this clinical investigation (ClinicalTrials.gov, No. NCT01501149). Patients and methods: The study was initiated at 9 centers in China in January 2011. Patients aged 14-70 with newly diagnosed ENKTL in stages III/IV, and ECOG performance score of 0-2 were enrolled. According to a computer-generated randomization schedule, eligible patients were assigned either DDGP regimen (cisplatin 20 mg/m² on day 1-4; dexamethasone 15mg/m2 on d1-5; gemcitabine 800mg/m2 on d1,8; pegaspargase 2500 IU/m2 on d1; 21 days per cycle)or SMILE regimen (methotrexate 2g/m2 on d1; dexamethasone 40mg/m2 on d2-4; ifosfamide 1500mg/m2 on d2-4; L-asparaginase 6000 U/m2 on d3-9; etoposide 100 mg/m2 on d2-4; 21 days per cycle) for up to 6 cycles unless disease progression, unacceptable toxicity or patient rejection. Efficacy was evaluated every two cycles. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall response rate (ORR) and overall survival (OS). In addition we compared the safety and tolerability between DDGP and SMILE regimens. The Kaplan-Merier method was used to evaluate for survival of freedom from events, and the log-rank test was used to evaluate differences among two groups. Results: A total of 87 eligible newly diagnosed advanced ENKTL patients were randomly assigned for the study and 80 patients were included into intention-to-treat population (40 patients in DDGP group and 40 patients in SMILE group). Data were collected from January 2011 to February 2019. Baseline characteristics of the two group patients were well balanced. At median follow-up of 41.5 months, the median PFS and OS in the SMILE group were 6.83 months and 75.2 months, respectively, while the median PFS and OS in the DDGP group have not been reached (Fig 1). The 3-year PFS rate and 5-year OS rate in DDGP group were higher than in SMILE group (56.6% vs. 41.8% for 3-year PFS, P=0.004; 74.3% vs. 51.7% for 5-year OS, P=0.02). No difference of the complete remission (CR) rate was observed between two groups, while overall response rate (ORR) in DDGP group was higher than in SMILE group (90.0% vs. 60.0%, p=0.002) (Table 1). More frequently 3/4 grade hematologic toxicities such as leucopenia and netropenia were observed in SMILE group than in DDGP group (p=0.022, p=0.015). Non-hematologic toxicities included elevated transaminase, mucositis and allergy were higher in SMILE group than in DDGP group(p=0.027, p&amp;lt;0.001, p=0.024). Pancreatitis occurred in 2 patients in SMILE group, but not in DDGP group (Table 2). In addition, treatment-related deaths rate was up to 17.5% in SMILE regimen which was mainly caused by infection and hemorrhage due to bone marrow suppression. Such event was only 10% in DDGP regimen. Conclusion: DDGP regimen produced prolonged survival, better tolerability and safety than SMILE regimen in newly diagnosed advanced ENKTL. Disclosures No relevant conflicts of interest to declare.