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Am J Ophthalmol. 2017 Jul;179:159-170. doi: 10.1016/j.ajo.2017.05.005. Epub 2017 May 10.

Lower Laser Energy Levels Lead to Better Visual Recovery After Small-Incision Lenticule Extraction: Prospective Randomized Clinical Trial.

Author information

1
Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea; Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
2
Hankuk Academy of Foreign Studies, Yongin, South Korea.
3
Eyereum Eye Clinic, Seoul, South Korea.
4
London Vision Clinic, London, United Kingdom; Department of Ophthalmology, Columbia University Medical Center, New York, New York; Centre Hospitalier National d'Ophtalmologie, Paris, France; Biomedical Science Research Institute, University of Ulster, Coleraine, United Kingdom.
5
London Vision Clinic, London, United Kingdom; Biomedical Science Research Institute, University of Ulster, Coleraine, United Kingdom.
6
Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea; Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: tikim@yuhs.ac.

Abstract

PURPOSE:

To determine the effect of lowering laser energy on clinical outcomes in small-incision lenticule extraction (SMILE).

DESIGN:

Prospective randomized clinical trial.

METHODS:

A total of 151 patients (151 eyes) with moderate myopia scheduled for SMILE were included: 58 eyes received SMILE with low energy (100, 105, and 110 nJ; L-SMILE group) and 93 with conventional energy (115-150 nJ; C-SMILE group). Patients received complete ophthalmic examinations preoperatively and over 3 months postoperatively.

RESULTS:

Uncorrected distance visual acuity (logMAR UDVA) 1 day and 1 week postoperatively was significantly better in L-SMILE than in C-SMILE (P < .001 and P = .005, respectively). There was no significant difference between the groups at 1 and 3 months. L-SMILE induced significantly fewer corneal aberrations compared with C-SMILE at 1 week and 1 month postoperatively (both P < .01), but there were no significant differences at 3 months. Though there was no difference in logMAR UDVA over the postoperative period between the 100, 105, and 110 nJ subgroups, there was a significant difference in logMAR UDVA on postoperative day 1 between L-SMILE and each subgroup in which an energy level of 115 nJ or higher was used. Furthermore, logMAR UDVA on postoperative day 1 showed a significant correlation with laser energy (r = 0.451, P < .001) and multiple linear regression analysis revealed that energy level was the only independent factor associated with logMAR UDVA on postoperative day 1 (P < .001).

CONCLUSIONS:

SMILE using femtosecond energy of less than 115 nJ facilitates better visual acuity with less induction of corneal aberrations in the early postoperative period.

PMID:
28499707
DOI:
10.1016/j.ajo.2017.05.005
[Indexed for MEDLINE]

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