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Purpose: To compare the efficacy of digital-assisted reference marking for toric implantable collamer lenses (Callisto Eye System) with manual marking technique using a slit lamp markeur., Methods: This study included patients that underwent implantation of a toric implantable collamer lens (EVO Visian toric ICL, Staar Surgical). Patients were included if they had a myopia above -3 diopters (D) and regular corneal astigmatism of 0.75 diopters or higher. Between both groups a 1:2 matching regarding similar preoperative level of myopia and astigmatism was performed. Visual and refractive outcomes were evaluated. Vector analysis was performed to evaluate total astigmatic changes., Results: This study comprised 57 eyes of 57 patients with 19 eyes in the digital group and 38 eyes in the manual marking group. Postoperatively there were no statistically significant differences between both groups in UDVA ( p  = 0.467), spherical equivalent (SE) ( p  = 0.864), sphere ( p  = 0.761) and cylinder ( p  = 0.878). Vector analysis showed a slightly more accurate postoperative refractive astigmatism in the manual group (0.26 D at 107° ± 0.50 D) compared to the digital marking group (0.31 D at 107° ± 0.45 D), nevertheless with no statistically significant differences between both groups., Conclusions: A digital tracking approach for toric ICL alignment was an efficient and safe method for toric marking with similar results regarding visual and refractive outcomes compared to a conventional corneal marking method. Nevertheless, image-guided surgery helped to streamline the workflow in refractive ICL surgery.

Purpose: To evaluate postoperative subjective quality of vision in patients who underwent Implantable Collamer Lens (ICL) (STAAR Surgical) implantation for correction of myopia and to identify potential predictive parameters., Methods: In this single-center cross-sectional study, a total of 162 eyes of 81 patients (58 women, 23 men) who underwent ICL implantation were analyzed. The Quality of Vision (QOV) questionnaire was used to assess patient-reported outcomes. Baseline characteristics (eg, age), treatment parameters (eg, surgical corrected refraction), and refractive (eg, residual refraction) and visual (eg, uncorrected distance visual acuity) outcomes were analyzed regarding their effect on QOV., Results: Mean age was 33.3 ± 7.0 years (range: 21 to 51 years) and mean preoperative spherical equivalent was -8.42 ± 2.49 diopters (D) (range: -3.25 to -14.38 D). After a mean postoperative follow-up period of 19 ± 14 months (range: 6 to 54 months), the safety index score was 1.23 ± 0.21 and the efficacy index score was 1.17 ± 0.22. The mean QOV scores were 35.5 ± 11.3, 32.2 ± 11.1, and 23.3 ± 16.1 for frequency, severity, and bothersomeness, respectively. The most frequently experienced symptoms were halos (90.1%) and glare (66.7%). Halos appeared in 66.7% of the patients "occasionally" and 5 of them (6.2%) experienced them "very often." Only 1 patient (1.2%) classified halos as "very bothersome." Patients older than 36 years reported visual symptoms more frequently ( P < .05) and showed higher bothersomeness scores ( P = .01)., Conclusions: Halos are the most commonly perceived long-term visual disturbance after myopic ICL implantation with a central hole. Visual symptoms can persist more than 6 months postoperatively, causing only minor disturbances in most cases. Older patients seem more prone to experiencing these symptoms. [ J Refract Surg . 2022;38(5):280-287.] .

Purpose: To evaluate the value of total keratometry (TK) to estimate corneal power in eyes that underwent SMILE for treatment of myopia or myopic astigmatism in subgroups of low and high astigmatism., Methods: The difference between preoperative and postoperative measurements of corneal power (ΔTCRP, ΔTK) was compared with the surgically induced refractive change at the corneal plane (ΔSE co ) by Pearson correlation. Vector analysis of TCRP- and TK-derived astigmatism was performed to evaluate the corneal astigmatism. Single-angle plots were generated with the AstigMATIC tool for standard astigmatism vector analysis., Results: Paired t -test revealed statistically significant differences in preoperative ( p = .02) and postoperative ( p = .0455) measurements between TK and TCRP in the group of high-level astigmatism and the postoperative low astigmatism group ( p < .01). No significant differences were found in preoperative data in the group of low-level astigmatism ( p = .60). The correlation of ΔSEco and TK (low astigmatism, R 2  = 0.978; high astigmatism R 2  = 0.980) was stronger than the correlation of TCRP 4.0 mm and ΔSEco (low astigmatism, R 2  = 0.743; high astigmatism R 2  = 0.959) in both astigmatic groups. The vector analysis demonstrated nearly identical results concerning the correction index (CI) for TK and TCRP. Comparing the difference vector (DV) between both parameters, TK-derived results were closer to the optimum., Conclusions: The findings endorse TK as a reliable measure of corneal power after SMILE in patients with low and high astigmatism.

Purpose: To gauge the value of total keratometry (TK) to estimate corneal power change in eyes that underwent small-incision lenticule extraction (SMILE) for treatment of myopia or myopic astigmatism., Setting: Department of Ophthalmology, Ludwig-Maximilians-University, and SMILE Eyes Clinic Munich Airport, Munich, Germany., Design: Prospective cross-sectional trial., Methods: A total of 40 eyes of 40 patients who had undergone myopic SMILE were enrolled in this prospective study. Total corneal refractive power (TCRP; Pentacam HR) and TK (IOLMaster 700, Carl Zeiss Meditec AG) values were compared with the clinical history method (CHM). The surgically induced changes in TCRP (ΔTCRP) and TK (ΔTK) were also compared with the changes in spherical equivalent on the corneal plane (ΔSEco)., Results: Of the 40 eyes analyzed, the correlation between TK and CHM (R2 = 0.91, P < .001) was stronger than that between TCRP and CHM (R2 = 0.87, P < .001). When compared with the CHM, TCRP underestimated corneal power by a mean relative error of 0.59 diopter (D) and TK by 0.17 D. Linear regression analysis of ΔTCRP/ΔTK and the difference between preoperative and postoperative manifest refraction spherical equivalent at the corneal plane (ΔSEco) showed stronger correlation in ΔTK (R2 = 0.88) than that in ΔTCRP (R2 = 0.82)., Conclusions: The findings endorse TK as an accurate measure for corneal power after myopic SMILE., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Little is known about the connection between preoperative keratometry and postoperative results of myopic small-incision lenticule extraction (SMILE). To determine the influence of extreme (flat and steep) corneal keratometry on the safety and efficacy of SMILE, the databases of the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, and SMILE Eyes Linz, Austria, were screened for patients with steep and flat keratometry who had undergone SMILE. In this cross-sectional matched comparative cohort study, eyes with markedly flat (< 42.0 diopters; D) or steep (≥ 47.0D) preoperative corneal keratometry were matched to a cohort of eyes with regular keratometry (42.0-46.9D) by preoperative manifest refractive spherical equivalent and cylinder, age, corrected distance visual acuity and surgical SMILE parameters. The standardized graphs and terms for refractive surgery results were applied to compare the three groups. Changes in higher order aberrations (HOAs) were evaluated on Scheimpflug imaging. In total, 63 eyes (21 each) of 54 patients with a mean refractive spherical equivalent of  - 5.21 ± 1.59 D were followed up for a mean of 9.2 ± 6.1 (minimum ≥ 3) months. Mean baseline keratometry was 41.3 ± 0.7D (flat), 45.5 ± 1.0D (regular) and 47.7 ± 0.6D (steep) (p < 0.0001). Compared to the regular group, the flat and the steep cornea group resulted in a non-inferior percentage of eyes within ± 0.50 D of target refraction (p = 0.20), uncorrected distance visual acuity (p = 0.95) and corrected distance visual acuity (p = 0.20). Flat corneas however experienced a stronger induction of spherical aberration (SA) compared to the steep group (p = 0.0005). In conclusion, non-inferior outcomes of SMILE can also be expected in eyes with steep (≥ 47D) or flat (< 42D) preoperative keratometry, while SMILE however induces more SA in eyes with a flat keratometry., (© 2021. The Author(s).)

Purpose: To analyse in depth the associations between objectively measured corneal higher-order aberrations (HOAs) and subjectively perceived visual quality after small incision lenticule extraction (SMILE) as quantified with the standardized and clinically validated quality of vision (QOV) questionnaire., Methods: This cross-sectional study included patients after bilateral simultaneous SMILE for the treatment of myopia and/or myopic astigmatism with plano target refraction. Scheimpflug imaging (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to objectively quantify corneal HOAs. The standardized and validated QOV questionnaire was employed to gauge patients' subjectively perceived visual quality regarding frequency, severity and bothering effect of visual disturbances., Results: A total of 394 eyes of 197 patients with a mean age of 32.4 ± 7.7 years and a mean postoperative follow-up of 24.3 ± 14.1 months were included. SMILE induced a statistically significant (p < 0.001) increase in spherical aberration (0.074 ± 0.131 µm), coma (0.142 ± 0.179 µm), trefoil (0.018 ± 0.067 µm) as well as in total HOAs (0.191 ± 0.176 µm). Surgically induced and postoperative levels of HOA showed no correlation with the three QOV scores representative of overall visual symptom frequency, severity and bothering effect (all R 2 values ≤ 0.016). In addition, the associations between specific visual symptoms (e.g. starburst) and singular HOA terms (e.g. haloes) were very weak (all Rho values ≤ 0.164)., Conclusions: Small incision lenticule extraction induced significant amounts of corneal HOAs that, however, showed no clear relationships to patient-reported QOV or specific long-term visual symptoms., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To compare characteristics of the vitreomacular interface (VMI) in myopic foveoschisis (mFS) and idiopathic epiretinal membrane foveoschisis (iERM-FS), and to correlate with optical coherence tomography and clinical data., Design: Clinicopathologic study., Methods: Epiretinal membrane and internal limiting membrane (ILM) specimens were removed from eyes with mFS (5 eyes) and iERM-FS (5 eyes). Harvested tissue was processed for immunocytochemistry and prepared by ultrathin series sectioning for transmission electron microscopy. Cell and collagen compositions were compared and correlated with clinical data., Results: All eyes presented fibrocellular membranes irrespective if associated with mFS or iERM-FS. Cell and collagen types and distribution on the vitreal side of the ILM were similar in both groups, consistent with presence of tractional membranes on optical coherence tomography images. Immunostaining of all specimens were positive for glial cells, microglia, and hyalocytes. Electron microscopy revealed evidence of epiretinal cell multilayers with masses of vitreous collagen and signs of vitreous remodeling in both groups. Three eyes with mFS but none of the eyes with iERM-FS showed massive thinning of the ILM with prominent retinal undulations and presence of retinal nerve fiber layer fragments., Conclusion: Whereas fibrocellular components of premacular tissue in mFS are similar to iERM-FS, pathologic abnormalities of the ILM were exclusively present in high myopia. Although peeling of the ILM appears important to completely remove tractional components of the VMI, histopathologic findings emphasize the risk for retinal damage in these highly myopic eyes, indicating that individual preoperative assessment and modification of surgical techniques require further investigation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To characterize patient-reported long-term quality of vision (QoV) after small-incision lenticule extraction (SMILE), and to identify potential clinical parameters that might predispose to experiencing deteriorated visual quality., Setting: University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany., Design: Prospective cross-sectional study., Methods: For the assessment and scoring of visual symptoms, the Quality of Vision questionnaire was employed, which constitutes a clinically validated, linear-scaled 30-item instrument providing a QoV score on three scales (symptom frequency, severity, and bothersome). Subgroup analyses were performed for patient subgroups stratified by baseline characteristics (eg, age) and treatment parameters (eg, surgical refractive correction) as well as refractive outcomes (eg, residual refraction) and visual outcomes (eg, uncorrected distance visual acuity [UDVA])., Results: The study comprised 394 eyes of 197 patients (117 women [59.4%], 80 men [40.6%]) were included with a mean postoperative follow-up of 24.4 months ± 14.1 (SD). The QoV scores for symptom frequency, severity, and bothersome were 34.63 ± 13.69, 29.60 ± 12.38, and 24.56 ± 16.00, respectively. Patients with a preoperative binocular corrected distance visual acuity (CDVA) of 20/12.5 or better, patients who lost 1 or more lines of UDVA as compared with preoperative CDVA, patients older than the age of 40, and patients with inadvertent anisometropia more than 0.375 diopters reported worse QoV scores., Conclusion: The relationship between objective clinical parameters and patient-reported subjective QoV after SMILE seems complex. Defined prognostic factors that convey a higher risk for experiencing visual disturbances were identifiable and should be discussed with patients seeking SMILE treatment during preoperative counseling., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To provide an overview of the currently available retreatment methods after myopic small-incision lenticule extraction (SMILE)., Design: Systematic literature review., Methods: The PubMed library was searched for articles containing the terms "small-incision lenticule extraction" and "enhancement" or "retreatment". The last search was performed on May 1, 2019., Results: In contrast to laser in-situ keratomileusis (LASIK), which can be retreated by a flap relift, repeat SMILE retreatment is currently not approved and only seldomly performed. As substitutes, surface ablation, cap-to-flap conversion using the CIRCLE program in the VisuMax platform, and thin-flap LASIK have been recently established. While all options offer safety and efficacy comparable to LASIK retreatments, each has its patient-specific advantages and disadvantages. While surface ablation preserves the flap-free approach of the primary procedure, the aspect of pain and a slow visual recovery might render it less attractive as compared with CIRCLE and thin-flap LASIK which offer quick recovery, however at the price of flap creation. Besides, each retreatment method generates specific tissue responses and has a different impact on corneal biomechanics, which is strongly dependent on the previous SMILE parameters, especially the cap thickness., Conclusions: Refractive enhancement after SMILE is currently mostly performed by surface ablation, CIRCLE cap-to-flap conversion or thin-flap LASIK, which all offer safety and efficacy comparable to LASIK retreatments. In this review, a detailed overview over each method, its technical aspects, and specific advantages and disadvantages is given.

Purpose: To compare the outcomes of enhancement after small incision lenticule extraction (SMILE) using surface ablation versus the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond laser-assisted laser in situ keratomileusis flap., Methods: The databases of the SMILE Eyes centers in Munich, Marburg, and Cologne, Germany, and Linz, Austria, were screened for eyes that had undergone enhancement using surface ablation with mitomycin C or CIRCLE. Eyes from both enhancement methods suitable for a retrospective matched analysis were identified based on pre-SMILE and pre-enhancement mean refractive spherical equivalent (MRSE), astigmatism, age, and corrected and uncorrected distance visual acuity (CDVA/UDVA). Refractive and functional outcomes were compared after a follow-up of 3 months., Results: After the application of the matching criteria on 2,803 SMILE procedures, 24 eyes (12 in each group) with a follow-up of 3 months or longer were available for analysis. Enhancement was performed after a mean 9.7 ± 7.2 (surface ablation) and 11.0 ± 4.4 (CIRCLE) months for a residual MRSE of -0.91 ± 0.55 (surface ablation) and -0.90 ± 0.61 (CIRCLE) diopters. At 3 months, residual MRSE showed comparable accuracy with -0.07 ± 0.19 (surface ablation) and 0.04 ± 0.22 (CIRCLE) diopters (P = .18). UDVA improvement was similar to a final value of 0.02 ± 0.10 (surface ablation) versus 0.03 ± 0.07 (CIRCLE) logMAR (P = .78). Only one eye in the surface ablation group and no eye in the CIRCLE group lost one line of CDVA. At 3 months, the safety (surface ablation: 1.00, CIRCLE: 1.06; P = .36) and efficacy (surface ablation: 0.95, CIRCLE: 1.03; P = .36) indices were equivalent. In terms of speed of visual recovery, at week 1 UDVA and CDVA were significantly better after CIRCLE than surface ablation (P = .008 and .002, respectively)., Conclusions: In this first study directly comparing surface ablation versus CIRCLE enhancement after SMILE, both methods yielded comparable results at 3 months. However, CIRCLE re-treated eyes showed a markedly increased speed of recovery concerning UDVA and CDVA compared to surface ablation. [J Refract Surg. 2019;35(5):294-300.]., (Copyright 2019, SLACK Incorporated.)

Purpose: To report the impact of increasing minimum lenticule thickness on the safety and efficacy of small incision lenticule extraction (SMILE) in low myopia up to -3.50 diopters (D)., Methods: SMILE was performed in 76 eyes of 76 patients. Thirty-eight eyes of 38 patients with low myopia were prospectively operated on with a programmed minimum lenticule thickness of 15 to 30 μm (thicker lenticule group). Thirty-five eyes suitable for analysis were then retrospectively matched by spherical equivalent to 35 eyes operated on with a minimum standard setting of 10 μm (standard thickness group), as provided in the database of the SMILE Eyes Clinic Linz, Linz, Austria. Comparison of outcomes was performed with the Standard Graphs for Reporting Refractive Surgery and by analysis of higher order aberrations as provided by Scheimpflug imaging., Results: Apart from lenticule thickness, there was no significant difference in preoperative baseline or treatment parameters between both groups. Mean minimum lenticule thickness differed significantly (standard thickness = 10 ± 0 μm; thicker lenticule = 20 ± 5 μm; P < .0001). This also translated into a significant difference in maximum lenticule thickness (standard thickness: 54 ± 11 μm; thicker lenticule: 62 ± 8 μm; P = .0002). Mean SEQ preoperatively was -2.25 ± 0.51 (standard thickness) and -2.24 ± 0.46 (thicker lenticule) D, respectively, and changed to -0.11 ± 0.50 (standard thickness) and +0.01 ± 0.36 (thicker lenticule) D postoperatively (P < .0001 for both comparisons). Uncorrected postoperative visual acuity was -0.08 ± 0.35 (standard thickness) versus -0.10 ± 0.09 (thicker lenticule) logMAR (P = .706). After SMILE, the thicker lenticule group showed better safety (1.20 vs 1.08; P = .025) and efficacy (1.14 vs 0.96; P = .011) indices, translating into more eyes within ±0.50 D from target (91% vs 77%) and with at least 0.0 logMAR visual acuity (97% vs 86%), and fewer eyes losing one (3% vs 17%) and two (0% vs 3%) lines., Conclusions: Increasing minimum lenticule border thickness seems to improve the safety and efficacy of SMILE in low myopia. [J Refract Surg. 2018;34(7):453-459.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To evaluate the outcomes of myopic small incision lenticule extraction (SMILE) monovision in presbyopic patients., Methods: This study included 49 presbyopic patients older than 45 years seeking surgical correction of myopia or myopic astigmatism who underwent bilateral SMILE with planned monovision in the SMILE Eyes Clinic Linz, Austria. Target refraction was plano for dominant (distance) eyes and ranged between -1.25 and -0.50 D for nondominant (near) eyes. Best-corrected distance visual acuity, uncorrected distance visual acuity (UDVA), uncorrected near visual acuity, as well as spectacle dependence were assessed after a mean postoperative period of 7.2 ± 4.8 months., Results: Mean age was 49 ± 3 years and female to male ratio was 30:19. Distance eyes achieved a spherical equivalent correction of ±0.50 D from target refraction in 80% of patients and 96% were within ±1.0 D. Binocular UDVA of 20/20 or better was achieved by 90% of patients and all patients achieved 20/25 or better. The proportion of patients with a binocular UDVA of 20/20 or better who could read J2 or better amounted to 84%. Complete spectacle independence was achieved by 84% of patients and independence from reading glasses was achieved in 92% of cases. No patient requested refractive enhancement or monovision reversal., Conclusions: This first evaluation of SMILE monovision endorses the approach as a safe and effective option for the correction of presbyopia in myopic patients seeking refractive surgery.

Purpose: To report the outcomes of enhancement after small incision lenticule extraction (SMILE) using the VisuMax CIRCLE option (Carl Zeiss Meditec AG, Jena, Germany), which converts the SMILE cap into a femtosecond LASIK flap for secondary excimer laser application., Methods: Of 2,065 SMILE procedures, 22 eyes (1.1%) re-treated with CIRCLE with a follow-up of 3 months were included in the analysis. SMILE was performed in the usual manner. For re-treatment, the CIRCLE procedure was performed with pattern D flap creation on the VisuMax system and subsequent excimer laser ablation with a Zeiss MEL 90 laser (Carl Zeiss Meditec) with plano target in all cases., Results: Spherical equivalent was -5.56 ± 2.22 diopters (D) before SMILE and -0.51 ± 1.08 D before CIRCLE. CIRCLE enhancement was performed after a mean of 10.0 ± 7.9 months, allowed for safe flap lifting in all eyes, and resulted in a final manifest refraction spherical equivalent of 0.18 ± 0.31 D at 3 months (P < .008). The number of eyes within 0.50 and 1.00 D from target refraction increased from 31.8% to 90.9% and from 77.3% to 100%, respectively. Mean uncorrected distance visual acuity (UDVA) had already improved from 0.37 ± 0.16 to 0.08 ± 0.16 logMAR at 1 week (P < .0001), resulting in 0.03 ± 0.07 logMAR at 3 months (P < .0001). All eyes gained at least one line of UDVA. Corrected distance visual acuity (CDVA) remained unchanged at all time points (before vs after CIRCLE, P = .40). Two eyes (9.1 %) lost one line of CDVA; no eye lost two or more lines. The safety and efficacy indices were 1.03 and 0.97 at 3 months., Conclusions: The CIRCLE procedure represents an effective re-treatment option after SMILE. Compared to surface ablation re-treatment after SMILE, CIRCLE seems to offer advantages in respect to speed of visual recovery, safety, and predictability, but at the price of flap creation. [J Refract Surg. 2018;34(5):304-309.]., (Copyright 2018, SLACK Incorporated.)

Purpose: To report the feasibility and outcomes of surface ablation after small incision lenticule extraction (SMILE)., Methods: In this retrospective evaluation of 1,963 SMILE procedures, 43 eyes (2.2%) were re-treated at three separate clinics. Of these, 40 eyes of 28 patients with a follow-up of at least 3 months were included in the analysis. During surface ablation, mitomycin C was applied for haze prevention., Results: Spherical equivalent was -6.35 ± 1.31 diopters (D) before SMILE and -0.86 ± 0.43 D before surface ablation. Surface ablation was performed after a mean of 9.82 ± 5.27 months and resulted in a spherical equivalent of 0.03 ± 0.57 D at 3 months (P < .0001). The number of patients within ±0.50 and ±1.00 D of target refraction increased from 22.5% to 80% and from 72.5% to 92.5%, respectively. Mean uncorrected distance visual acuity (UDVA) improved from 0.23 ± 0.20 to 0.08 ± 0.15 logMAR (P < .0001); 65% of patients gained at least one line. Corrected distance visual acuity (CDVA) remained unchanged with 0.01 ± 0.07 logMAR before versus -0.01 ± 0.05 logMAR after re-treatment (P = .99). Six eyes (15.0%) lost one line of CDVA, but final CDVA was 0.00 logMAR in four and 0.10 logMAR in two of these cases. The safety and efficacy indices were 1.06 and 0.90 at 3 months, respectively. Three of the four surface ablation profiles (Triple-A, tissue-saving algorithm, and topography-guided) resulted in equally good results, whereas enhancement with the aspherically optimized profile (ASA), used in two eyes, resulted in overcorrection (+1.38 and +1.75 D)., Conclusions: Combined with the intraoperative application of mitomycin C, surface ablation seems to be a safe and effective method of secondary enhancement after SMILE. Due to the usually low residual myopia, the ASA profile is not recommended in these cases. [J Refract Surg. 2017;33(8):513-518.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To prospectively characterize the stromal thickness changes during the first year after myopic small-incision lenticule extraction using spectral-domain optical coherence tomography (SD-OCT)., Setting: Department of Ophthalmology, Kepler University Hospital, Linz, Austria., Design: Prospective case series., Methods: This study evaluated eyes that had small-incision lenticule extraction to treat myopia or myopic astigmatism. A high-resolution SD-OCT system (RS 3000 Advance) in conjunction with a custom image-segmentation algorithm was applied to directly measure stromal thickness within the central 5.0 mm corneal zone. Measurements were obtained preoperatively and postoperatively at 1 day, 1 week, 6 weeks, 3 months, 6 months, and 1 year., Results: The study enrolled 42 eyes of 21 patients. The mean surgical refractive correction was -4.94 diopters ± 1.75 (SD). Postoperatively, the stromal thickness showed a significant decrease during the first 6 weeks, which amounted to a mean of 10.4 ± 6.3 μm at the apex (P < .001). Subsequently, the central stroma thickened by a mean of 8.8 ± 5.9 μm up until the 1-year follow-up (P < .001). One year postoperatively, the mean observed central stromal thickness reduction was 18.7 ± 5.7 μm smaller than the planned lenticule thickness. This difference was smallest 6 weeks postoperatively (mean 9.8 ± 7.8 μm)., Conclusions: Significant anatomic changes in the corneal stroma were detected during the first year after small-incision lenticule extraction. The achieved lenticule thickness was systematically lower than planned, and the mismatch was more pronounced with higher lenticule thickness. Refractive outcomes did not appear to be influenced by lenticule thickness accuracy., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To test the reliability of a novel algorithm for measuring corneal epithelial thickness (ET) and stromal thickness of normal eyes and post-small incision lenticule extraction (SMILE) corneas with spectral-domain optical coherence tomography., Methods: In this prospective observational study, a customized semiautomated software algorithm was developed and applied to measure corneal ET and stromal thickness along the horizontal corneal meridian. Measurements were performed by 2 examiners in a randomized fashion on a sample of 40 eyes with previous SMILE for treatment of myopia and a control group composed of 40 normal eyes. The intrauser repeatability and interuser reproducibility were analyzed by calculating typical indices including the coefficient of variation and intraclass correlation coefficient. Corneal sublayer thickness profiles were compared between normal and post-SMILE eyes., Results: In both groups, coefficients of variation were 3.2% or lower and intraclass correlation coefficients were 0.929 or higher indicating excellent reliability of the measurement method. Central ET was on an average 6 μm greater in post-SMILE corneas (58.8 ± 5.4 μm) compared with normal eyes (52.8 ± 4.0 μm), with P < 0.01. Also, there was greater interindividual variability in ET in post-SMILE corneas and their horizontal epithelial profile seemed to show a lenticular appearance., Conclusions: Highly favorable indices of measurement reliability were achieved for this novel method of measuring corneal sublayer pachymetry not only in normal eyes but also in eyes with previous SMILE. The corneal ET profile was significantly altered in post-SMILE eyes compared with normal corneas.

Purpose: To assess the reactive changes of the corneal epithelial thickness (ET) profile induced by small incision lenticule extraction (SMILE) for treatment of myopia., Methods: This prospective observational study included 46 eyes of 23 patients that were scheduled for myopic SMILE. High-resolution spectral-domain optical coherence tomography (SD-OCT) and a custom image segmentation algorithm were applied to measure corneal ET at multiple time points within the central 5-mm zone. Postoperative ET alterations were correlated with treatment parameters and refractive outcomes., Results: Mean age was 33 ± 6 years and mean spherical equivalent of surgical refractive correction was -4.78 ± 1.75 diopters. The average ET (averaged over the central 5-mm zone) increased from 52.3 ± 3.6 μm preoperatively to 57.7 ± 5.1 μm 6 months postoperatively (P < 0.01). Average ET was 101.9% of the preoperative thickness at 24 hours postoperatively, 103.2% at 1 week, 106.7% at 6 weeks, 109.3% at 3 months, and 110.4% at 6 months postoperatively. The epithelial thickening response could be modeled by an exponential recovery function and stabilized after 3 months. The extent of epithelial hyperplasia was highly dependent on the magnitude of the induced refractive correction (P = 0.002)., Conclusions: In this initial study of corneal ET remodeling after myopic SMILE, significant epithelial thickening was detected as a function of the extent of surgical refractive correction. Moreover, the epithelial remodeling response to the corneal refractive change appeared to decrease with higher age. In our hands, the observed epithelial changes did not appear to affect the refractive outcome of SMILE. (ClinicalTrials.gov number, NCT02614625).

Purpose: To compare immunohistochemical findings in human donor corneas after successful laser in situ keratomileusis (LASIK) without clinical complications with a recently established human LASIK in vitro model., Methods: Donor corneas with prior LASIK treatment were investigated. Cryostat sections were stained immunohistochemically for collagen types I, III, and VI and laminin and fibronectin., Results: With light microscopy, the interface of the LASIK flap could hardly be detected. In all samples, fibronectin was consistently detected along the entire extent of the surgical wound. In contrast, collagen type III and laminin only stained the superficial portion of the LASIK incision site. Staining for collagen types I and VI showed no changes after LASIK., Conclusion: Histologic findings in donor corneas with prior LASIK treatment confirm histologic observations in a recently introduced human organ culture LASIK model. This strengthens the reliability of the latter LASIK model for further studies concerning wound healing after LASIK surgery.

With more individuals having laser in situ keratomileusis (LASIK), eye banks are challenged to detect prior refractive surgery in donor tissue. We report the case of a donor who had LASIK 9 months before his death. Slitlamp biomicroscopy, corneal topography, and optical coherence tomography (OCT) were performed to evaluate the corneas. Few changes were detected under slitlamp examination and corneal topography. We demonstrate that OCT is capable of detecting LASIK-induced structural changes in the immediate postmortem evaluation and during the early and late period of organ culture. We recommend OCT screening of potential donor corneas before organ culture and between days 9 and 12 of organ culture.