Tian Han

In vivo confocal microscopic investigation of the cornea after autologous implantation of lenticules obtained through small incision lenticule extraction for treatment of hyperopia.

To investigate re‐innervation in the implanted lenticule, as well as changes to the cornea, after correcting hyperopia with an autologous implantation of a lenticule obtained through small incision lenticule extraction (SMILE).

Five Signs of Unintended Initial Dissection of the Posterior Plane During SMILE.

To the Editor: After several years of development, small incision lenticule extraction (SMILE) has achieved somewhat stable efficacy and is seeing increasing popularity among refractive surgeons.1,2 It is advised to dissect the anterior plane first before the posterior plane. However, unintended initial dissection of the posterior plane is a common problem for surgeons who are newly acquainted with SMILE. This increases the difficulty of lenticule dissection and can even lead to complications such as tearing and rupture of the corneal cap or lenticule.3,4 It is essential for surgeons who are learning SMILE to identify unintended initial dissection of the posterior plane in time during operations. Jacob et al.5 reported the use of the white ring sign of the lenticule to assess the dissected plane. Nevertheless, it is not enough to merely observe the white ring sign. Liquid could enter the corneal stroma and obscure the anatomical structure, thus affecting the surgeon’s judgment. We introduce five signs of unintended initial dissection of the posterior plane that may help shorten the learning curve.

Three-year outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism

Aims To compare long-term clinical outcomes following small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia and myopic astigmatism correction. Methods In this retrospective study, we enrolled a total of 101 patients (101 eyes) who underwent SMILE or FS-LASIK 3 years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction and corneal wavefront aberrations. Results No significant differences in patient characteristics were found between the two groups. At the 3-year follow-up, UDVA was better than or equal to 20/20 in 90% and 85% (p=0.540) of the eyes; the efficacy indexes were 1.05±0.19 and 1.01±0.21 in the SMILE and FS-LASIK groups, respectively (p=0.352). Safety indexes were 1.19±0.17 and 1.15±0.20 in the SMILE and FS-LASIK groups, respectively (p=0.307). Eighty per cent and 65% of eyes were within ±0.50 D of the attempted spherical equivalent correction after SMILE and FS-LASIK, respectively (p=0.164). Vector analysis revealed no significant differences in astigmatic correction between the two groups (p>0.05). Surgically induced spherical aberration was higher in the FS-LASIK group than in the SMILE group (p<0.001). Conclusion Long-term follow-up analysis suggested that both SMILE and FS-LASIK were safe and equally effective for myopic and astigmatic correction.

Minimum pupil in pupillary response to light and myopia affect disk halo size: a cross-sectional study

Objectives To evaluate the relationship between pupillary response to light, myopia and disk halo size. Design Cross-sectional study. Setting Single refractive surgery centre. Participants In this study, 197 right eyes of 197 patients between 20 and 35 years of age were evaluated for disk halo size and pupillary response to light with a vision monitor. Primary and secondary outcome measures Halo radius, age, spherical equivalent (SE), axial length (AL), initial diameter, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilation, duration of dilation, velocity of dilation, maximum pupil, minimum pupil, average pupil and dark pupil. Results Significant associations were found between disk halo size and SE (r=−0.219, P=0.002), AL (r=0.152, P=0.033) and minimum pupil (r=0.149, P=0.037). There were no associations between disk halo size and initial diameter, amplitude of contraction, latency of contraction, duration of contraction, velocity of contraction, latency of dilation, duration of dilation, velocity of dilation, maximum pupil, average pupil, dark pupil and age (P>0.05). A significant difference in disk halo size was detected between the low-moderate and high myopia (SE< −6 D) groups (P=0.002) and between the small and large (minimum pupil≥4 mm) minimum pupil size groups (P=0.014). Conclusions Patients with a high SE and large minimum pupil size (minimum pupil ≥4 mm) suffered more disability glare than those with a low SE and small minimum pupil size.

Contralateral eye comparison of the long-term visual quality and stability between implantable collamer lens and laser refractive surgery for myopia

To investigate the long‐term visual quality and stability of implantable collamer lens (ICL) and laser refractive surgery (LRS) for myopia.