Enhancement of refractive outcomes of small-incision lenticule extraction via tear-film control

Il Hwan Koh, Kyoung Yul Seo, Seong Bae Park, Hun Yang, Insik Kim, Sang Min Nam

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Purpose To suggest that tear film is a refractive outcome predictor in small-incision lenticule extraction (SMILE) for myopia and describe methods of controlling the tear film and its effects on refractive outcomes. Methods In this retrospective case–control study, the tear film was kept clear and appropriate in amount during tear-film-controlled SMILE (TFC-SMILE). In contrast, no special care to the tear film was given in direct-docking SMILE (DD-SMILE). Both procedures were performed by the same experienced surgeon, using the same surgical parameters, over defined periods. In select cases, scanning electron microscopy (SEM) of the lenticule and surgical videos of opaque bubble layers (OBLs) were obtained and compared. Results Forty-one eyes had DD-SMILE and 55 eyes had TFC-SMILE. Multivariate analysis showed that TFC-SMILE and the patient’s age were significant predictors of refractive outcomes. The refractive predictability of TFC-SMILE was better than that of DD-SMILE, and under-correction of high myopia was evident in the latter patients. The predictive errors of DD-SMILE became more myopic and variable during 1 year than those of TFC-SMILE. The lenticular surface on SEM was more serrated in DD-SMILE. Severe OBLs were evident in four cases of DD-SMILE and the OBL pattern was sporadic at the anterior surface of the lenticule. Conclusions The presence of a clear and appropriate tear film in SMILE enhanced predictability, minimized variability, and ensured stability of refractive outcomes. An uncontrolled tear film might render cutting imprecise and trigger severe OBL formation. TFC-SMILE had more predictable results than DD-SMILE.

Original languageEnglish
Pages (from-to)2259-2268
Number of pages10
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume256
Issue number11
DOIs
Publication statusPublished - 2018 Nov

Bibliographical note

Funding Information:
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1607010116).

Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2018.

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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