Refractive lenticule extraction (SMILE) vs LASIK: a contralateral eye study of refractive, visual function outcomes, procedure centration, transient dry eye and postoperative inflammation

Session Details

Session Title: SMILE: Small Intrastromal Lenticule Extraction I

Session Date/Time: Sunday 11/09/2016 | 08:00-10:00

Paper Time: 08:46

Venue: Hall H1

First Author: : A.Kanellopoulos GREECE

Co Author(s): :                        

Abstract Details

Purpose:

To comparatively evaluate refractive and vision outcomes, epithelial remodeling differences and postoperative inflammation between myopic correction performed with Small Incision Lenticule Extraction (SMILE) and Femtosecond assisted topography-guided LASIK.

Setting:

LaserVision.gr Clinical and Research Eye Institute, Athens, Greece

Methods:

This was a contralateral eye study of treatments for -3 to -10 Diopters of myopia, and up to -5 diopters of astigmatism. Group-A involved 25 randomly assigned eyes in which the SMILE procedure was applied, while Group-B, the 25 contralateral eyes treated with topography-guided LASIK. All cases were evaluated for perioperative visual acuity, refraction, dry eye symptoms, ECD, keratometry, Scheimpflug and Placido based topography, effective tissue removal centration as well as anterior segment OCT pachymetry and epithelial maps for a total of 12 months follow-up. MMP-9 inflammatory marker was evaluated as well.

Results:

Mean refractive error was -5.5 Diopters of myopia and -1.5 diopters of astigmatism. Group A vs. Group B respectively: The average UDVA improved from 20/200 to 20/20 vs. 20/15. The average centration was 450um vs. 150um, MMP-9 positive 2/25 vs. 18/25; dry-eye symptoms 6/25 and 12/25. Central epithelial thickness increase of +1.86μm (p=0.0035) centrally, and mid-peripherally +4.01 μm (p<0.001) vs. +1.98μm (p=0.0022) centrally and mid-peripherally +4.58 μm (p<0.001). When comparing subgroups of matched myopic correction: For high myopia (more than 6.00 D), the mid-periphery epithelial thickness increase was +4.54μm vs 8.07μm.

Conclusions:

Myopic SMILE and femto-second LASIK appear to result in comparable refractive outcomes, despite worse Smile centration achieved. LASIK appears to offer superior visual performance. Dry eye symptoms appear worse in LASIK, as does +MMP-9 detection and epithelial thickness remodeling especially in higher corrections.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented