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Two cases of epithelial ingrowth after small incision lenticule extraction.

ABSTRACT: Purpose:To report two cases of epithelial ingrowth after small incision lenticule extraction (SMILE) successfully treated without lifting the corneal cap. Observations:A 34-year-old woman and a 37-year-old man who both had undergone bilateral SMILE procedures earlier at another institution, developed visually significant epithelial ingrowth into the interface pocket with an incisional tear. In both patients, the interface pocket was meticulously irrigated with a balanced salt solution to facilitate separation of the epithelial ingrowth from the interface. After that, the epithelial ingrowth was manually scraped using a blunt spatula, and removed from the pocket using 27-gauge vitreous forceps. 10-0 nylon sutures and soft bandage contact lenses were placed for 1 week. The best spectacle-corrected visual acuity improved to 20/16 or more 1-month postoperatively. No significant complications occurred. Conclusions and importance:SMILE with incisional tear may cause epithelial ingrowth, resulting in significant visual disturbance. This can be successfully treated with meticulous surgical debridement of the corneal epithelium, even without lifting the corneal cap.

SUBMITTER: Kamiya K

PROVIDER: S-EPMC7374183 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Two cases of epithelial ingrowth after small incision lenticule extraction.

Kamiya Kazutaka K Takahashi Masahide M Shoji Nobuyuki N Naruse Saigen S

American journal of ophthalmology case reports 20200709

<h4>Purpose</h4>To report two cases of epithelial ingrowth after small incision lenticule extraction (SMILE) successfully treated without lifting the corneal cap.<h4>Observations</h4>A 34-year-old woman and a 37-year-old man who both had undergone bilateral SMILE procedures earlier at another institution, developed visually significant epithelial ingrowth into the interface pocket with an incisional tear. In both patients, the interface pocket was meticulously irrigated with a balanced salt solu ...[more]

PMID: 32715156

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Project description:BackgroundSmall-incision lenticule extraction (SMILE) is a surgical procedure for the refractive correction of myopia and astigmatism, which has been reported as safe and effective. However, over- and under-correction still occur after SMILE. The necessity of nomograms is emphasized to achieve optimal refractive results. Ophthalmologists diagnose nomograms by analyzing the preoperative refractive data with their individual knowledge which they accumulate over years of experience. Our aim was to predict the nomograms of sphere, cylinder, and astigmatism axis for SMILE accurately by applying machine learning algorithm.MethodsWe retrospectively analyzed the data of 3,034 eyes composed of four categorical features and 28 numerical features selected from 46 features. The multiple linear regression, decision tree, AdaBoost, XGBoost, and multi-layer perceptron were employed in developing the nomogram models for sphere, cylinder, and astigmatism axis. The scores of the root-mean-square error (RMSE) and accuracy were evaluated and compared. Subsequently, the feature importance of the best models was calculated.ResultsAdaBoost achieved the highest performance with RMSE of 0.1378, 0.1166, and 5.17 for the sphere, cylinder, and astigmatism axis, respectively. The accuracies of which error below 0.25 D for the sphere and cylinder nomograms and 25° for the astigmatism axis nomograms were 0.969, 0.976, and 0.994, respectively. The feature with the highest importance was preoperative manifest refraction for all the cases of nomograms. For the sphere and cylinder nomograms, the following highly important feature was the surgeon.ConclusionsAmong the diverse machine learning algorithms, AdaBoost exhibited the highest performance in the prediction of the sphere, cylinder, and astigmatism axis nomograms for SMILE. The study proved the feasibility of applying artificial intelligence (AI) to nomograms for SMILE. Also, it may enhance the quality of the surgical result of SMILE by providing assistance in nomograms and preventing the misdiagnosis in nomograms.

Project description:PurposeTo quantitatively evaluate outcomes after small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism.MethodsIt's a retrospective cohort study. Twenty-four eyes of 15 patients with more than 0.75 diopters (D) of astigmatism in hyperopic eyes were enrolled in this study. The hyperopic eye with astigmatism was first treated with SMILE to correct astigmatism; then a lenticule was extracted from a donor myopic eye and subsequently implanted into the hyperopic eye with astigmatism. Patients were examined preoperatively and 1 day, 1 week, 1,3 months and 1 year after surgery. The main outcome measures were the uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected near visual acuity (UNVA), spherical equivalent (SE), corneal topography, anterior segment optical coherence topography (OCT) and ocular response analyzer (ORA) parameters: corneal hysteresis (CH) and corneal resistance factor (CRF). Repeated-measures analyses of variance (ANOVA) and post hoc tests were used to analyze data of different follow-up visits.ResultsThe mean preoperative cylinder was 1.95±1.04(D). The UDVA (from 0.37±0.23 to 0.09±0.09), UNVA (from 0.49±0.21 to 0.08±0.06), SE (from +7.42±3.12 to -0.75±0.79) and astigmatism (+1.95±1.04 to -0.65±0.63) postoperatively were obviously better than those before surgery. Five eyes (26.3%) gained one line of CDVA, and 3 eyes (15.8%) gained two lines of CDVA one year after surgery compared with preoperative levels. The average corneal curvature was changed from (43.19±4.37) D to (49.19±3.87) D one year after surgery. The anterior segment OCT images of corneas with lenticule inlays at each follow-up visit showed that the implanted lenticule was shaped like a crescent in the corneal stroma. The CH and CRF didn't change significantly after surgery (p = 0.189 and p = 0.107respectively).ConclusionsSMILE combined with intrastromal lenticule inlay can be used to correct high hyperopia with astigmatism with good safety, efficacy and reproducibility.

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Two cases of epithelial ingrowth after small incision lenticule extraction.

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Two cases of epithelial ingrowth after small incision lenticule extraction.

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