Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction

To report a novel technique to treat superficial limbal dermoid by using the corneal intrastromal lenticules obtained from SMILE and to evaluate the initial clinical outcomes of lenticule patch graft for treatment of limbal dermoid. In this single-center case series, lenticules were obtained from patients undergoing SMILE for the correction of myopia and the lenticule patch graft was performed in three patients with limbal dermoid. Patients were postoperatively followed at first, second weeks and first, third months after surgery. The main measured outcome parameters were included the best-corrected visual acuity, transparency of graft, tectonic integrity and restoration of optical transparency. All surgeries were successful, and all patients recovered well. Obviously, improving tendency in visual acuity and astigmatism was seen at the final follow-up in all eyes. No statistically significant difference has found in the thickness of the cornea between the surgical field and the corresponding normal field. Globe integrity was achieved in all cases, and no immune rejection or perforation was detected until the last follow-up visit in all eyes treated. Lenticule keratoplasty may be a safe, feasible and inexpensive surgical option for the treatment of corneal dermoid. It retains globe integrity and decreases the risk of complications such as postoperative limbal ectasia and visible corneal scarring and should be widely promoted in the areas with shortage of donor corneas.     

Prophylactic corneal crosslinking in myopic small-incision lenticule extraction - Long-term visual and refractive outcomes

Purpose:To analyze the efficacy, safety, predictability, and stability in myopic and astigmatic small-incision lenticule extraction (SMILE) with simultaneous prophylactic corneal crosslinking (CXL) in thin corneas.Methods:A total of 48 eyes from 24 patients who underwent myopic and astigmatism SMILE with simultaneous prophylactic CXL were included in this retrospective study. All patients had a 24-month follow-up. A femtosecond laser was performed with VisuMax (Carl Zeiss Meditec). CXL treatment was applied when the predicted stromal thickness was less than 330 μm.Results:The patients’ mean age was 31.58 ± 6.23 years. The previous mean spherical equivalent was − 6.85 ± 1.80 (−9.75 to − 2.00) D. The postoperative mean spherical equivalent was − 0.50 ± 0.26 (−1.00 to + 0.25) D; 60% of the eyes had 20/20 or better; 19% lost one line; 58% were within ± 0.50 D; and 8.3% of the eyes changed 0.50 D or more between 3 and 24 months.Conclusion:Prophylactic CXL with simultaneous SMILE for myopia and astigmatism femtosecond laser surgery technique appears to be partially effective, safe, predictable, and stable after 24 months of follow-up.     

不同切削比全飞秒激光小切口角膜基质透镜取出术后早期角膜高阶像差的比较

目的　观察不同切削比的全飞秒激光小切口角膜基质透镜取出术（small-incision lenticule extraction，SMILE）术后早期角膜高阶像差（higher-order aberrations，HOAs）的变化，探讨切削比对角膜HOAs的影响。方法　选自2017年8月至2018年3月共58例 （114眼） 患者，所有患者均由同一位医师完成SMILE手术，按切削比（角膜切削深度/术前角膜厚度）将病例分为A组（切削比≤0.16）、B组（切削比>0.16～0.21）和C组（切削比＞0.21），记录患者在术前及术后 1 d、1周、1个月时测量的裸眼视力（uncorrected visual acuity，UCVA）、最佳矫正视力（best corrected visual acuity，BCVA）、角膜HOAs等。结果　术前及术后1 d、1 周及1个月的UCVA、BCVA三组间差异均无统计学意义（均为P＞0.05）；A组术后1 d球差、总HOAs分别为（0.27±0.10)μm、（1.71±2.04)μm，B组分别为（0.32±0.18)μm、（2.43±2.06)μm，C组分别为（0.37±0.18)μm、（3.90±2.28)μm，A组的球差、总HOAs均明显低于C组（均为P＜0.05），B组的总HOAs明显低于C组（P＜0.05）。A组术后1周球差、总HOAs分别为:（0.27±0.13)μm、（1.74±1.95)μm，B组分别为（0.34±0.19)μm、（2.52±2.08)μm，C组分别为（0.43±0.18)μm、（3.93±2.29)μm，A组和B组的球差、总HOAs均明显低于C组（均为P＜0.05）；A组、B组、C组术后1个月球差分别为（0.26±0.10)μm、（0.32±0.14)μm、（0.45±0.15)μm，A组和B组的球差均明显低于C组（均为P＜0.05）。术后球差、总HOAs与切削比均相关（均为P＜0.05）。结论　切削比越大的SMILE手术，术后早期角膜HOAs增加越明显，特别是角膜球差和总HOAs。因此，术前需考虑切削比对术后角膜HOAs的影响。     

SMILE来源的角膜基质透镜研究进展

自飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction, SMILE)普遍开展以来,术中取出的角膜基质透镜作为副产品已得到广泛的研究和应用,其作为一种良好的生物材料可以在一定程度上弥补角膜材料的匮乏。本文针对SMILE来源的角膜基质透镜的结构特征,各种保存方法如冷冻保存法、无水氯化钙法、甘油保存法等对其厚度、透明度、机械性能等方面的影响,及其在矫正远视和散光,治疗圆锥角膜、角膜穿孔、Mooren溃疡和翼状胬肉共存、角膜皮样瘤、准分子激光角膜原位磨镶术后角膜扩张、青光眼等眼科疾病中的相关应用进行综述,以期为深入研究及临床应用提供参考。     

Comparison of corneal aberrations and refractive outcomes after small-incision lenticule extraction and femtosecond-assisted laser-assisted in situ keratomileusis

International Ophthalmology - To retrospectively compare the short-term refractive outcomes and corneal aberrations after small-incision lenticule extraction (SMILE) and femtosecond-assisted...     

Comparison of corneal sensitivity between FS-LASIK and femtosecond lenticule extraction (ReLEx flex) or small-incision lenticule extraction (ReLEx smile) for myopic eyes

Background

To compare the effect on corneal sensitivity between femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and femtosecond lenticule extraction (ReLEx flex) or FS-LASIK and small-incision lenticule extraction (ReLEx smile) surgery.

Methods

Twenty-seven subjects (54 eyes) underwent FS-LASIK, 22 subjects (40 eyes) underwent ReLEx flex, and 32 subjects (61 eyes) underwent ReLEx smile surgery. Cochet-Bonnet esthesiometry (Luneau Ophthalmologie Chartres, Cedex, France) was used to evaluate corneal sensitivity preoperatively as well as at 1 week and 1 and 3 months after surgery.

Results

At 1 week, central, superior, nasal, and temporal corneal sensitivity in the ReLEx flex group was significantly higher than in the FS-LASIK group (P?=?0.007, 0.004, 0.020, 0.004 respectively) and in the central and inferior areas at 3 months (P?=?0.002, 0.009 respectively). A higher corneal sensitivity after ReLEx smile surgery was observed in every quadrant at 1 week and 1 and 3 months compared with FS-LASIK surgery (P?<?0.01). Furthermore, in the ReLEx smile group, there were no statistical differences in the superior and temporal quadrants at 1 month postoperatively compared with preoperatively (5.19?±?0.61 cm, P?=?0.198 and 5.64?±?0.48 cm, P?=?0.330 respectively) and no significant differences in any quadrant at 3 months.

Conclusions

Postoperative corneal sensitivity was not remarkably changed after ReLEx smile surgery compared with FS-LASIK. This might be because ReLEx is a flapless procedure.     

Effect of preoperative keratometry on visual outcomes after small-incision lenticule extraction for myopia

International Ophthalmology - To investigate the relationship between preoperative keratometry (K) and postoperative refraction and compare the visual outcomes after small-incision lenticule...     

小切口角膜基质透镜取出术与飞秒激光辅助准分子原位角膜磨镶术对角膜生物力学特性影响的对比分析

目的　比较小切口角膜基质透镜取出术（small-incision lenticule extraction,SMILE）与飞秒激光辅助准分子原位角膜磨镶术（femtosecond laser-assisted laser in situ keratomileusis,FS-LASIK）治疗近视对患者角膜生物力学特性的影响。方法　选取在我院行SMILE和FS-LASIK手术的近视患者共67例134眼。根据手术方式及等效球镜度数（spherical equivalent,SE）的不同将患者分为4组:中度近视SMILE组15例30眼和中度近视FS-LASIK组16例32眼（-3.00 D≤SE＜-6.00 D）;高度近视SMILE组18例36眼和高度近视FS-LASIK组18例36眼（6.00 D≤SE＜-9.00 D）。分别于术前及术后3 d 、10 d、1个月、3个月使用眼反应分析仪ORA测量4组患者角膜滞后量（corneal hysteresis,CH）和角膜阻力因子（corneal resistance factor,CRF）。计算4组患者术后各时间点的CH和CRF改变量,并分别比较中度近视SMILE组和中度近视FS-LASIK组、高度近视SMILE组和高度近视FS-LASIK组CH和CRF改变量的差异。结果　中度近视SMILE组患者△CH在术后3 d（P=0.030）和术后3个月（P=0.030）时均小于中度近视FS-LASIK组。中度近视SMILE组患者△CRF在术后3 d（P=0.000）、10 d（P=0.008）、1个月（P=0.011）、3个月（P=0.001）时均小于中度近视FS-LASIK组。高度近视SMILE组△CH和△CRF在术后3 d、10 d、1个月、3个月时均小于高度近视FS-LASIK组（均为P=0.000）。结论　SMILE与FS-LASIK手术都会引起角膜生物力学稳定性的降低,但SMILE对角膜生物力学变化的影响更小。