Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

Gi Sung Son; Su Chan Lee; Tae Hyung Lim

doi:10.3341/jkos.2016.57.4.562

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Son, Lee, and Lim: Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

Original Article

J Korean Ophthalmol Soc 2016;57(4):562-567.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.562

Clinical Outcome of Small Incision Lenticule Extraction including Visual Quality Analysis

Gi Sung Son, MD, Su Chan Lee, MD, Tae Hyung Lim, MD, PhD

HanGil Eye Hospital, Incheon, Korea

Address reprint requests to Tae Hyung Lim, MD, PhD HanGil Eye Hospital, #35 Bupyeong-daero, Bupyeong-gu, Incheon 21388, Korea Tel: 82-32-503-3322, Fax: 82-32-504-3322 E-mail: limthnet@naver.com

Received 12 November 2015 Revised 15 December 2015 Accepted 29 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To present the clinical outcomes of small incision lenticule extraction (SMILE) including visual quality analysis in Korean patients with myopia

Methods

The medical records of 228 eyes of 116 patients who underwent SMILE in HanGil Eye Hospital LASIK Center from May 2014 to Feb 2015 and were followed-up for at least 3 months was analyzed retrospectively. The patients were followed up at 1 day, 1 week, 1 month, and 3 months after the operation. Refractive value, visual acuity, intraocular pressure, and visual quality were measured at each visit

Results

Preoperatively, uncorrected distant visual acuity was 0.01 ± 0.02 in log MAR, spherical equivalent was −5.03 ± 1.72 diopters, intraocular pressure was 15.85 ± 2.85 mm Hg, and the objective scattering index (OSI) value was 0.68 ± 0.49. The postoperative uncorrected distant visual acuity was 0.13 ± 0.10, 0.05 ± 0.08, 0.04 ± 0.09, and 0.02 ± 0.04 and OSI was 2.16 ± 1.89, 1.25 ± 0.64, 1.14 ± 0.69, and 0.81 ± 0.36 at 1 day, 1 week, 1 month, and 3 months after the operation, respectively. The postoperative intraocular pressure was 12.55 ± 3.74 mm Hg, 13.03 ± 4.35 mm Hg, 11.65 ± 2.49 mm Hg at 1 week, 1 month, and 3 months after the operation. The efficacy of refractive surgery 3 months after the operation was 0.97 ± 0.11, the safety was 0.99 ± 0.10, and predictability was 99.56% and 100.00% at the range of ±0.5 diopters and ± 1.0 diopter, respectively.

Conclusions

The SMILE operation showed comparable clinical outcomes with conventional refractive surgery in terms of efficacy, safety, and predictability. Intraocular pressure and visual quality normalized gradually throughout the 3-month postoperative period.

Keywords: Femtosecond laser, Optical quality analysis system, Small incision lenticule extraction

References

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Figure 1.

Postoperative cumulative uncorrected distant visual acuity. Visual acuity was expressed in log MAR. UDVA = uncorrected distant visual acuity.

Table 1.

Preoperative demographic data of the patients

Parameter	Value
Age (year)	26.84 ± 6.44
Gender (male/female)	56/60
S.E. (D)	−5.03 ± 1.72
CDVA (log MAR)	0.01 ± 0.02
K1^* (D)	42.51 ± 2.86
K2^* (D)	43.91 ± 1.35
Corneal thickness (μm)	566.17 ± 45.17
Pupil diameter (mm)	7.13 ± 4.57
OSI	0.68 ± 0.49
MTF	36.91 ± 10.06
Sterhl ratio	0.19 ± 0.06
IOP (mm Hg)	15.85 ± 2.85

Values are presented as mean ± SD unless otherwise indicated. S.E. = spherical equivalents; CDVA = corrected distant visual acuity; log MAR = logarithm of the minimum angle of resolution; OSI = objective scattering index; MTF = modulation transfer function; IOP = intraocular pressure.

^* Corneal refractive value by manual keratometry.

Table 2.

Postoperative refractive value and visual acuity

Period	Spherical equivalent (D)	Distant visual acuity (log MAR)
Period	Spherical equivalent (D)	Uncorrected	Corrected
Preoperative	−5.03 ± 1.72	−	0.01 ± 0.02
1 day	0.12 ± 0.15	0.13 ± 0.10	0.11 ± 0.08
1 week	0.14 ± 0.17	0.05 ± 0.08	0.05 ± 0.07
1 month	0.07 ± 0.25	0.04 ± 0.09	0.03 ± 0.05
3 months	0.05 ± 0.21	0.02 ± 0.04	0.01 ± 0.04

Values are presented as mean ± SD unless otherwise indicated.

D = diopter; log MAR = logarithm of the minimum angle of resolution.

Table 3.

Postoperative visual quality and intraocular pressure

Period	Visual quality^*			IOP (mm Hg)
	OSI^†	MTF	Sterhl ratio
Preoperative	0.67 ± 0.49	36.91 ± 10.06	0.19 ± 0.06	15.82 ± 2.85
1 day	2.16 ± 1.89 (p < 0.001)^†	28.84 ± 12.6	0.15 ± 0.06	−
1 week	1.25 ± 0.65 (p < 0.001)^†	32.02 ±13.31	0.17 ± 0.11	12.55 ± 3.74
1 month	1.14 ± 0.69 (p < 0.001)^†	31.5 ± 11.53	0.16 ± 0.60	13.03 ± 4.35
3 months	0.81 ± 0.36 (p = 0.146)^†	31.61 ± 11.44	0.16 ± 0.05	11.65 ± 2.49

Values are presented as mean ± SD unless otherwise indicated.

OSI = objective scattering index; MFT = modulation function test; IOP = intraocular pressure.

^* Visual Quality: The visual quality was measured using Optical Quality Analysis System II (OQAS II®, Visiometrics, Castelldefels, Barcelona, Spain),

^† The figure in parenthesis is the p-value when compared with the preoperative values.

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