Dataset Information

Changes in accommodative function following small-incision lenticule extraction for high myopia.

ABSTRACT:

Purpose

To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE).

Methods

35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders push-up-method was used to measure the amplitude of accommodation. The accommodative response was assessed using an open-field autorefractor"Grand Seiko WAM-5500" (Grand Seiko Co. Ltd., Hiroshima, Japan) in combination with a Badal optometer and stimuli of accommodation at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D, respectively. Accommodative facility was measured at 40 cm with ±2,00D flipper lenses. All measurements of accommodation were performed monocularly with the refractive error corrected with soft contact lenses.

Results

The amplitude of accommodation did not change statistically significantly (mean difference -0.24 D (SD 0.98), 95% CI of mean difference -0.58 D to 0.11 D, paired-sample t(34) = -1.39; P = 0.17). The accommodative responses at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D did not statistically significantly change either (F(6,29) = 1.15; P = .36). Finally, the accommodative facility was also unchanged with a mean difference of 1.11 cycles per minute (SD 5.11, 95% CI of mean difference -0.64 to 2.87, paired-sample t(34) = 1.29; P = 0.21). No clinically significant associations between changes in accommodation and higher-order aberrations were found.

Conclusions

SMILE does not alter the amplitude of accommodation, the accommodative response, nor the accommodative facility for highly myopic patients, and the surgically induced corneal higher-order aberrations do not affect the accommodative function.

SUBMITTER: Gyldenkerne A

PROVIDER: S-EPMC7773189 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Changes in accommodative function following small-incision lenticule extraction for high myopia.

Gyldenkerne Anders A Aagaard Nicolaj N Jakobsen Malene M Toftelund Carina C Hjortdal Jesper J

PloS one 20201230 12

<h4>Purpose</h4>To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE).<h4>Methods</h4>35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders pus ...[more]

PMID: 33378342

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Project description:AimTo compare postoperative clinical outcomes of high myopia after small-incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).MethodsFrom March 2018 to July 2020, PubMed, MEDLINE, Embase, the Cochrane Library, and several Chinese databases were comprehensively searched. The studies meeting the criteria were selected and included; the data were extracted by 2 independent authors. The clinical outcome parameters were analyzed with RevMan 5.3.ResultsThis meta-analysis included twelve studies involving 766 patients (1400 eyes: 748 receiving SMILE and 652 receiving FS-LASIK). Pooled results revealed no significant differences in the following outcomes: the logarithm of the mean angle of resolution (logMAR) of postoperative uncorrected distance visual acuity (weighted mean difference (WMD) = -0.01, 95% confidence interval (CI): -0.02 to 0.00, I2 = 0%, P = 0.07 at 1 mo; WMD = -0.00, 95% CI: -0.01 to 0.01, I2 = 0%, P = 0.83 at 3 mo; WMD = -0.00, 95% CI: -0.01 to 0.00, I2 = 32%, P = 0.33 in the long term), and the postoperative mean refractive spherical equivalent (WMD = -0.03, 95% CI: -0.09 to 0.03, I2 = 13%, P = 0.30). However, the SMILE group had significantly better postoperative corrected distance visual acuity (CDVA) than the FS-LASIK group (WMD = -0.04, 95% CI, -0.05 to -0.02, I2 = 0%, P<0.00001). In the long term, postoperative total higher-order aberration (WMD = -0.09, 95% CI: -0.10 to -0.07, I2 = 7%, P<0.00001) and postoperative spherical aberration (WMD = -0.15, 95% CI: -0.19 to -0.11, I2 = 29%, P<0.00001) were lower in the SMILE group than in the FS-LASIK group; a significant difference was also found in postoperative coma (WMD = -0.05, 95% CI: -0.06 to -0.03, I2 = 30%, P<0.00001).ConclusionFor patients with high myopia, both SMILE and FS-LASIK are safe, efficacious and predictable. However, the SMILE group demonstrated advantages over the FS-LASIK group in terms of postoperative CDVA, while SMILE induced less aberration than FS-LASIK. It remains to be seen whether SMILE can provide better visual quality than FS-LASIK; further comparative studies focused on high myopia are necessary.

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.

Dataset Information

Changes in accommodative function following small-incision lenticule extraction for high myopia.

Purpose

Methods

Results

Conclusions

Publications

Changes in accommodative function following small-incision lenticule extraction for high myopia.

Similar Datasets

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