Confocal Comparison of Corneal Reinnervation after Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In Situ Keratomileusis (FS-LASIK)

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Abstract

Purpose

To evaluate corneal reinnervation, and the corresponding corneal sensitivity and keratocyte density after small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK).

Methods

In this prospective, non-randomized observational study, 18 patients (32 eyes) received SMILE surgery, and 22 patients (42 eyes) received FS-LASIK surgery to correct myopia. The corneal subbasal nerve density and microscopic morphological changes in corneal architecture were evaluated by confocal microscopy prior to surgery and at 1 week, 1 month, 3 months, and 6 months after surgery. A correlation analysis was performed between subbasal corneal nerve density and the corresponding keratocyte density and corneal sensitivity.

Results

The decrease in subbasal nerve density was less severe in SMILE-treated eyes than in FS-LASIK-treated eyes at 1 week ( P = 0.0147), 1 month ( P = 0.0243), and 3 months ( P = 0.0498), but no difference was detected at the 6-month visit ( P = 0.5277). The subbasal nerve density correlated positively with central corneal sensitivity in both groups (r = 0.416, P<0.0001, and r = 0.2567, P = 0.0038 for SMILE group and FS-LASIK group, respectively). The SMILE-treated eyes have a lower risk of developing peripheral empty space with epithelial cells filling in ( P = 0.0005).

Conclusions

The decrease in subbasal nerve fiber density was less severe in the SMILE group than the FS-LASIK group in the first 3 months following the surgeries. The subbasal nerve density was correlated with central corneal sensitivity.

Related collections

Most cited references 14

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Experimental Eye Research, 76(5), 521-542

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Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery.

Rupal Shah, Samir Shah, Sayantan Sengupta (2011)

To report the clinical results of small incision lenticule extraction to correct refractive errors using a femtosecond laser to refine the femtosecond lenticule extraction technique. Private laser center, Vadodara, India. Prospective clinical study. The VisuMax femtosecond laser system was used to perform small incision lenticule extraction to treat refractive errors. The laser was used to cut a refractive lenticule intrastromally to correct myopia and myopic astigmatism. The lenticule was then extracted from the stroma through a 3.0 to 5.0 mm incision. Outcome measures were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), and manifest refraction during 6 months of follow-up. Corneal topography and ocular wavefront aberrations were also measured. The study enrolled 51 eyes of 41 patients. The mean spherical equivalent was -4.87 diopters (D) ± 2.16 (SD) preoperatively and +0.03 ± 0.30 D 6 months postoperatively. Refractive stability was achieved within 1 month (P<.01). Six months after surgery, 79% of all full-correction cases had a UDVA of 20/25 or better. The 6-month postoperative CDVA was the same as or better than the preoperative CDVA in 95% of eyes. Two eyes lost 1 line of CDVA. All-in-one femtosecond refractive correction using a small incision technique was safe, predictable, and effective in treating myopia and myopic astigmatism. No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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Dry eye associated with laser in situ keratomileusis: Mechanical microkeratome versus femtosecond laser.

Marcella Q. Salomão, Renato Ambrósio, Steven E. Wilson (2009)

To compare the incidence of laser in situ keratomileusis (LASIK)-associated dry eye and the need for postoperative cyclosporine A treatment after flap creation with a femtosecond laser and a mechanical microkeratome. Cole Eye Institute, Cleveland, Ohio, USA. Eyes were randomized to flap creation with an IntraLase femtosecond laser (30 or 60 kHz) or a Hansatome microkeratome. No patient had signs, symptoms, or treatment of dry eye preoperatively. Flap thickness was determined by intraoperative ultrasonic pachymetry. Slitlamp assessments of the cornea and need for postoperative dry-eye treatment were evaluated preoperatively and 1 month postoperatively. The flap was created with the femtosecond laser in 113 eyes and with the microkeratome in 70 eyes. The difference in mean central flap thickness between the femtosecond group (111 mum +/- 14 [SD]) and the microkeratome group (131 +/- 25 mum) was statistically significant (P<.001). The incidence of LASIK-associated dry eye was statistically significantly higher in the microkeratome group (46%) than in the femtosecond group (8%) (P<.0001), as was the need for postoperative cyclosporine A treatment (24% and 7%, respectively) (P<.01). In the microkeratome group, there was no correlation between thick flaps and a higher incidence of LASIK-induced dry eye. Eyes with femtosecond flaps had a lower incidence of LASIK-associated dry eye and required less treatment for the disorder. In addition to neurotrophic effects from corneal nerve cutting, other factors may be important because no correlation was found between flap thickness (or ablation depth) and the incidence of LASIK-induced dry eye.

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Author and article information

Contributors

Suzanne Fleiszig: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 9 December 2013

Volume: 8

Issue: 12

Electronic Location Identifier: e81435

Affiliations

[1 ]Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China

[2 ]Department of Ophthalmology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, United States of America

[3 ]Duke University, Durham, North Carolina, United States of America

[4 ]Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China

UC Berkeley, United States of America

Author notes

* E-mail: doctzhouxingtao@ 123456163.com

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: XTZ MYL LLN WPM. Performed the experiments: MYL XTZ LLN BQ JX QHL AJW. Analyzed the data: MYL XTZ WPM LLN. Contributed reagents/materials/analysis tools: XTZ QHL JX. Wrote the paper: MYL LLN ZMZ KN.

Article

Publisher ID: PONE-D-13-30058

DOI: 10.1371/journal.pone.0081435

PMC ID: 3857190

PubMed ID: 24349069

SO-VID: ee99fb51-5a56-478e-a077-a91ee0190315

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 9 July 2013

Date accepted : 11 October 2013

Page count

Pages: 9

Funding

1) Natural Science Foundation of China (Grant No. 11074052); http://www.nsfc.gov.cn/Portal0/default152.htm. 2) The Key Project of Science and Technology of Shanghai (Grant No. 11JC1402000); http://www.stcsm.gov.cn/. 3) Scholarship Award for Excellent Doctoral Student granted by Ministry of Education; http://www.moe.gov.cn/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.