Eyeworld

97 EW REFRACTIVE October 2017 Dr. Hofmeister: This paper fascinated me because I was not even aware that hyperopic treatments, which tend to be "donut" shaped with almost no tissue ablated centrally, could be possible using a SMILE technique. It is encour- aging that refractive predictability was similar to or better than LASIK, and I look forward to hearing the results of larger trials with longer follow-ups. Comparing outcomes of small incision lenticule extraction versus combined topography- guided and wavefront-optimized LASIK Shreyas Ramamurthy, MD Purpose: To compare safety and efficacy of SMILE versus a novel combined topography-guided and wavefront-optimized excimer laser ablation (Contoura Vision, Alcon, Fort Worth, Texas). Methods: Prospective non-random- ized comparative interventional study conducted between January and September 2016 at a tertiary eye institute. Patients >18 years of age with stable refraction and normal tomographies with refractive error ranging between –0.5 and –9 D sphere and <–5 D cylinder were included in the study. Patients then underwent bilateral SMILE using the VisuMax platform (Carl Zeiss Meditec) (Group A) or bilateral LASIK with a novel combined to- pography-guided and wavefront-op- timized ablation profile using the WaveLight EX500 platform (Alcon) (Group B). At preoperative and at 6-week and 6-month follow-up vis- its, patients underwent tomography, aberrometry, contrast sensitivity, and dry eye work-up. Minimum follow-up was 6 months. Results: 400 eyes with 200 in each group were included in the study. The mean spherical equivalent was tion and diameter (using tangential curvature difference maps) and change in corneal spherical aberra- tion were analyzed and compared to MEL 80 (Carl Zeiss Meditec, Jena, Germany) LASIK matched control groups for 6.5 mm and 7 mm optical zones (transition 2 mm). Visual and refractive outcomes at 3 months were analyzed for eyes with CDVA 20/40 or better (sighted eyes, n=31). Refractive predictability was com- pared to a MEL 80 LASIK matched control group. Results: Mean attempted SEQ was +5.58 ± 0.95 D (+3.20 to +6.50 D), and cylinder was 1.10 ± 0.73 D (0.00 to 2.75 D). Mean optical zone offset was less (p<.05) after SMILE (0.23 ± 0.15 mm) than LASIK (0.31 ± 0.19 mm). Mean achieved opti- cal zone diameter was 5.03 ± 0.30 mm for SMILE, larger than 6.5 mm LASIK (4.53 ± 0.25 mm, p<0.001) and 7 mm LASIK (4.96 ± 0.25 mm, p<0.05). Mean spherical aberration change was –0.53 μm in SMILE, equivalent to 7 mm LASIK (–0.47 μm, p=0.916), but less than 6.5 mm LASIK (–0.76 μm, 0.01). For 31 sighted eyes, UDVA was 20/40 or better in 84% and 20/63 or better in 100% of eyes. Mean postop SEQ relative to the intended target was –0.04 ± 0.79 D (–2.20 to +1.88 D), with 65% within ±0.50 D and 87% within ±1.00 D. No eyes lost two or more lines CDVA. Predictability was 53% within ±0.50 D for the LASIK control group. Conclusion: Optical zone centration was similar between vertex-centered hyperopic SMILE and LASIK. Less spherical aberration was induced by 6.3–6.7 mm SMILE than 6.5 mm LASIK and was equivalent to 7 mm LASIK. Achieved topographic optical zone diameter was larger for 6.3 mm SMILE than 6.5 and 7 mm LASIK. Refractive predictability of SMILE was similar or better than for LASIK. cases (95.0 ± 24.6 μm). The differ- ence was smallest at 6 weeks postop- eratively (9.8 ± 7.8 μm). Conclusion: Significant anatomical changes of the corneal stroma were detected during the first postopera- tive year after SMILE. The achieved lenticule thickness was systemati- cally lower than planned, and the mismatch was more pronounced with higher lenticule thickness. Refractive outcome appeared to be uninfluenced by stromal remodeling and lenticule thickness accuracy. Dr. Hofmeister: Small incision lenti- cule extraction is another example of technology that has only very recently become available to U.S. surgeons, with its FDA approval in September 2016, so we are eager to learn all we can about refractive outcomes, visual recovery and refractive stability. Small incision lenticule extraction for hyperopia: visual and refractive outcomes, optical zone centration, diameter, and aberration induction Dan Reinstein, MD, Kishore Pradhan, MD, Purushottam Dhungana, Glenn Carp, MBBCh FC Ophth(SA), Timothy Archer, MA(Oxon), Raynan Khan, BSc, Marine Gobbe, PhD Purpose: To evaluate visual and refractive outcomes, optical quality and centration of small incision lenticule extraction (SMILE) for hyperopia. Methods: Prospective study of vertex-centered hyperopic SMILE (n=60). Inclusion criteria were intended sphere <+7.00 D, astig- matism <6.00 D, and age >21 years. Lenticule parameters were 6.3–6.7 mm diameter, 2 mm transition zone, 30 μm minimum thickness, and 120 μm cap thickness. The study was divided into phases based on CDVA, from densely amblyopic progressing to sighted eyes. Optical zone centra- patient selection for this newly avail- able device. 1. Schallhorn SC, et al. Pupil size and quality of vision after LASIK. Ophthal- mology. 2003;110:1606–14. Stromal remodeling and lenticule thickness accuracy in small incision lenticule extraction: 1-year prospective study Martin Dirisamer, MD Purpose: To prospectively character- ize the stromal thickness changes during the first year after myopic small incision lenticule extraction (SMILE) by means of spectral domain optical coherence tomog- raphy (SD-OCT). Secondary aim was to assess the lenticule thickness accuracy in SMILE and to elucidate potential associations with refractive outcome. Methods: This prospective, obser- vational study included 42 eyes of 21 subjects undergoing SMILE for the treatment of myopia or myo- pic astigmatism. A high-resolution SD-OCT system in conjunction with a customized image segmentation algorithm was applied to directly measure stromal thickness within the central 5.00 mm corneal zone. Measurements were obtained preop- eratively, on the first postoperative day, 1 week, 6 weeks, 3 months, 6 months, and 1 year after surgery. Results: Average surgical refractive correction was –4.94 ± 1.75 D. Stro- mal thickness showed a significant decrease during the first 6 weeks, which amounted to 10.4 ± 6.3 μm at the apex (p<0.001). Subsequent- ly, the central stromal thickened by 8.8 ± 5.9 μm up until the 1-year follow-up time point (p<0.001). The observed central stromal thickness reduction was smaller than the planned lenticule thickness in all Refractive Watch a video of Dr. Hofmeister's presentation on EWAR continued on page 98

• Blank Page
• Blank Page (1)