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      Corneal biomechanics after small-incision lenticule extraction versus Q-value–guided femtosecond laser-assisted in situ keratomileusis

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          Abstract

          Purpose

          The aim of this study was to compare the changes in corneal biomechanical properties following small-incision lenticule extraction (SMILE) versus Q-value–guided femtosecond laser-assisted in situ keratomileusis (Q-FS-LASIK).

          Methods

          In this prospective comparative study, patients with a sphere plus cylinder measurement of less than −10.00 D and cylinder measurement of less than −5.00 D were included in the study. A total of 160 patients (160 eyes) with myopia and myopic astigmatism were divided into the two groups, with 80 patients (80 eyes) allocated to SMILE and 80 patients (80 eyes) allocated to Q-FS-LASIK. Corneal hysteresis (CH) and the corneal resistance factor (CRF) were quantitatively assessed using the Ocular Response Analyzer (ORA) preoperatively and at 1 day, 2 weeks, and 1 and 3 months postoperatively.

          Results

          Both types of surgery were associated with statistically significant decreases in CH and the CRF at postoperative day 1 (both P < 0.01). In both groups, the decreases subsequently stabilized with no further deteriorations compared to postoperative day 1 (P > 0.05). Both groups showed similar biomechanical changes at each time point (all P > 0.05).

          Conclusions

          Both SMILE and Q-FS-LASIK resulted in a decrease in CH and the CRF at postoperative 1 day, with the decreases stabilizing after this point. There were no significant differences between the short term effects of SMILE and Q-FS-LASIK on corneal biomechanical properties.

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          Most cited references18

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          Corneal biomechanical effects: small-incision lenticule extraction versus femtosecond laser-assisted laser in situ keratomileusis.

          To compare the biomechanical properties of the cornea after small-incision lenticule extraction (lenticule extraction group) with those after femtosecond laser-assisted laser in situ keratomileusis (femtosecond LASIK group). Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, Tianjin, China. Prospective comparative case series. Corneal hysteresis (CH), the corneal resistance factor (CRF), and 37 other biomechanical waveform parameters were quantitatively assessed with the Ocular Response Analyzer preoperatively and 1 week and 1, 3, and 6 months postoperatively. Each group comprised 40 eyes. The decrease in CH and the CRF was statistically significant 1 week postoperatively compared with preoperatively in both groups (P<.0001). However, the CH and CRF values in the lenticule extraction group were significantly higher than those in the femtosecond LASIK group 3 months and 6 months postoperatively (P<.032). The residual stromal thickness index versus the CRF and CH and the planned lenticule thickness versus the change in central corneal thickness were statistically significant in the lenticule extraction group (r = 0.388 to 0.950, P<.018); no significant correlation was found in the femtosecond LASIK group. In the waveform analysis of the lenticule extraction group, 28 of the 37 biomechanical waveform parameters differed significantly between preoperative values and postoperative values (P<.035). Both small-incision lenticule extraction and femtosecond laser-assisted LASIK can cause biomechanical changes in the cornea. However, changes in the cornea's viscoelastic properties were less after lenticule extraction than after LASIK. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014. Published by Elsevier Inc.
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            Visual and refractive outcomes of femtosecond lenticule extraction and small-incision lenticule extraction for myopia.

            To compare the visual and refractive outcomes of femtosecond lenticule extraction (FLEx) and small-incision lenticule extraction (SMILE) in eyes with myopia. Prospective, randomized, masked clinical trial with intraindividual comparison. This study evaluated 52 eyes of 26 consecutive patients with spherical equivalents of -4.19 ± 1.65 diopters (D) (mean ± standard deviation) who underwent FLEx in 1 eye and SMILE in the other eye by randomized assignment. Before surgery, and 1 week and 1, 3, and 6 months after surgery, we assessed safety, efficacy, predictability, stability, and adverse events of the 2 surgical techniques. LogMAR uncorrected and corrected distance visual acuity was, respectively, -0.17 ± 0.10, -0.20 ± 0.07 in the FLEx group and -0.15 ± 0.10, -0.19 ± 0.07 in the SMILE group 6 months postoperatively. In the FLEx and SMILE groups 6 months postoperatively, 96% and 100% of eyes, respectively, were within 0.5 D of the targeted spherical equivalent correction. Changes of -0.02 ± 0.39 D and 0.00 ± 0.30 D occurred in manifest refraction from 1 week to 6 months in the FLEx and SMILE groups, respectively. No clinically significant complications occurred in the FLEx or the SMILE group. Both FLEx and SMILE performed well in the correction of myopia throughout the 6-month observation period. FLEx may be essentially equivalent to SMILE in terms of safety, efficacy, predictability, and stability, suggesting that the presence or absence of lifting the flap does not significantly affect these visual and refractive outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
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              Clinical Outcomes After SMILE and Femtosecond Laser-Assisted LASIK for Myopia and Myopic Astigmatism: A Prospective Randomized Comparative Study.

              To compare the clinical outcomes of small-incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK) for the correction of myopia and myopic astigmatism.
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                Author and article information

                Contributors
                Journal
                J Curr Ophthalmol
                J Curr Ophthalmol
                Journal of Current Ophthalmology
                Elsevier
                2452-2325
                03 September 2016
                December 2016
                03 September 2016
                : 28
                : 4
                : 181-187
                Affiliations
                [1]HangZhou Bright Vision Hospital, ZheJiang Province, China
                Author notes
                [] Corresponding author. 3rd Floor, HangZhou Bright Vision Hospital, No. 384 FengQi Road, XiaCheng District, HangZhou City, ZheJiang Province, 310006, China.3rd FloorHangZhou Bright Vision HospitalNo. 384 FengQi Road, XiaCheng DistrictHangZhou CityZheJiang Province310006China 164598113@ 123456qq.com
                Article
                S2452-2325(16)30070-1
                10.1016/j.joco.2016.08.004
                5093843
                27830201
                4b7d13df-ffe1-49ab-9e87-a1bb6b61238d
                © 2016, Iranian Society of Ophthalmology. Production and hosting by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 May 2016
                : 2 August 2016
                : 6 August 2016
                Categories
                Original Research

                small incision,q-value guided,femtosecond,biomechanical properties

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