Outcomes of Small Incision Lenticule Extraction (SMILE) in Low Myopia

Abstract

Original Article Dan Z. Reinstein, MD, MA(Cantab), FRCOphth; Glenn I. Carp, MBBCh, FCOphth (SA); Timothy J. Archer, MA(Oxon), DipCompSci(Cantab); Marine Gobbe, MSTOptom, PhD To report the visual and refractive outcomes of small incision lenticule extraction for low myopia using the VisuMax femtosecond laser (Carl Zeiss Meditec, Jena, Germany). A retrospective analysis of 120 consecutive small incision lenticule extraction procedures was performed for low myopia. Inclusion criteria were preoperative spherical equivalent refraction up to −3.50 diopters (D), cylinder up to 1.50 D, and corrected distance visual acuity of 20/20 or better. Outcomes analysis was performed for all eyes with 1-year follow-up according to the Standard Graphs for Reporting Refractive Surgery, and also including mesopic contrast sensitivity. One-year data were available for 110 eyes (92%). Preoperatively, mean spherical equivalent refraction was −2.61 ± 0.54 D (range: −1.03 to −3.50 D) and mean cylinder was 0.55 ± 0.38 D (range: 0.00 to 1.50 D). Postoperatively, mean spherical equivalent refraction was −0.05 ± 0.36 D (range: −0.94 to +1.25 D) and mean cylinder was ±0.50 D in 84% and ±1.00 D in 99% of eyes. Uncorrected distance visual acuity was 20/20 or better in 96% of eyes and 20/25 or better in 100% of eyes. One line of corrected distance visual acuity was lost in 9%, but no eyes lost two or more lines. There was an initial overcorrection in mean spherical equivalent refraction on day 1 (+0.37 D) as expected, which regressed to +0.10 D at 1 month and −0.05 D at 3 months, after which stability was reached (mean spherical equivalent refraction was −0.05 D at 1 year). Contrast sensitivity at 1 year was slightly increased at 3, 6, 12, and 18 cycles per degree (P < .05). Small incision lenticule extraction for low myopia was found to be safe and effective with outcomes similar to those previously reported for LASIK. [J Refract Surg. 2014;30(12):812–818.] From London Vision Clinic, London, United Kingdom (DZR, GIC, TJA, MG); the Department of Ophthalmology, Columbia University Medical Center, New York, New York (DZR); and Centre Hospitalier National d’Ophtalmologie, Paris, France (DZR). Dr. Reinstein is a consultant for Carl Zeiss Meditec (Jena, Germany) and has a proprietary interest in the Artemis technology (ArcScan, Inc., Morrison, CO) through patents administered by the Cornell Center for Technology Enterprise and Commercialization (Ithaca, NY). The remaining authors have no financial or proprietary interest in the materials presented herein. AUTHOR CONTRIBUTIONS Study concept and design (GIC, TJA, MG, DZR); data collection (GIC, TJA, MG, DZR); analysis and interpretation of data (GIC, TJA, MG, DZR); drafting of the manuscript (TJA, DZR); critical revision of the manuscript (GIC, MG); statistical expertise (TJA, DZR) Correspondence: Dan Z. Reinstein, MD, MA(Cantab), FRCOphth, London Vision Clinic, 138 Harley Street, London W1G 7LA, United Kingdom. E-mail: dzr@londonvisionclinic.com 10.3928/1081597X-20141113-07