Experience with initial 1000 eyes of myopia and myopic astigmatism treated with femtosecond lenticule extraction (ReLEx SMILE)

Session Details

Session Title: SMILE for Myopia I

Session Date/Time: Sunday 14/09/2014 | 08:00-09:30

Paper Time: 08:12

Venue: Capital Hall B

First Author: : S.Ganesh INDIA

Co Author(s): :    S. Brar   R. Gupta           

Abstract Details

Purpose:

To evaluate the safety, accuracy, refractive predictability, post operative optical aberrations, dry eyes, refractive outcomes and complications of the all femtosecond , minimally invasive lenticular extraction – ReLEx SMILE

Setting:

Nethradhama Super Speciality Eye hospital, Bangalore

Methods:

1000 eyes of 504 patients underwent ReLEx SMILE for the correction of myopia and myopic astigmatism. Mean age was 27 ±6 years and M: F ratio was 1:1.23 M (447), F(553).The mean pre-op SEQ treated was -4.7±2.42 D . Visumax femtosecond laser was used to create a refractive lenticule corresponding to the refractive error. Optical zone was set at 6mm / 6.5mm depending upon pupil size and refractive error. Cap thickness was set at 100microns irrespective of the refractive power and minimal residual bed 280microns. Both planes of the lenticule were identified and dissected with blunt spatula and removed through a superior 2 mm incision. Average surgical time was 4min per eye. Intra-operatively, 5 eyes had suction loss, 3 eyes were re-docked and treated with SMILE, 2 eyes required conversion to flap with excimer correction, 2 eyes had extension of incision (cap tear), 2 eyes had lenticular tear, 1 eye had incomplete incision, 1 eye had retained lenticule which had to be removed later. Patients were assessed at 1st day and 15 day and 3 months post-op for visual acuity, refraction, pain, glare, dry eye assessment and aberrometry and contrast sensitivity.

Results:

Postoperatively on day 1, patients were comfortable and did not report any significant symptoms. Slit lamp examination showed clear eyes with no sub-conjunctival hemorrhage, haze or interface problems. On post-operative day 15 of the 1000eyes, 98.8% had UCVA of 6/6 or better, only 1.2% eyes had UCVA of 6/6p – 6/12. Mean follow up was 3 months ± 18 days. At 3 months post op, mean residual refractive error was within 0.25 D SEQ in 67.2% patients, 0.5 D SEQ in 99.2 % patients and within 0.75D in 100% patients. There was a mild reduction of TBUT from an average 9 sec pre-op to 7 sec post op .The contrast sensitivity dropped slightly from the pre op levels for all spatial frequencies more so for higher spatial frequency but was within the normal band. There was a slight increase in the optical aberrations from the average pre op value of 0.38 to average 0.41RMS post op. None of the eyes had loss of BCVA. None of the patients required glasses / contact lenses/ enhancement.

Conclusions:

In our experience, ReLEx SMILE has proved to be a safe and reliable technique in terms of clinical and refractive outcomes with high patient satisfaction. Various advantages being– procedure is painless, flapless, with quick post-operative recovery, better corneal biomechanical stability, less incidence of post operative dry eye, less induction of aberrations and lesser chances of regression. The refractive outcomes are predictable and stable even for higher degrees of refractive errors and patient acceptability is excellent.

Financial Interest:

One or more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, One or more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented