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Eur J Ophthalmol. 2019 Jul 8:1120672119861481. doi: 10.1177/1120672119861481. [Epub ahead of print]

Small incision lenticule extraction for the correction of high myopia.

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1 Center for Refractive Surgery, Eye Department, St. Francis Hospital, Muenster, Germany.
2 University Eye Hospital, Ruhr University Bochum, Bochum, Germany.



Excimer laser-based refractive procedures can have less predictable results when used for correcting high myopia than when used for moderate myopia. Small incision lenticule extraction might overcome this weakness. However, small incision lenticule extraction is only Food and Drug Administration approved for use in myopic eyes up to -8 D with astigmatism of -3 D or less. We report outcomes of small incision lenticule extraction in highly and moderately myopic eyes and compare these to modern laser-assisted in situ keratomileusis.


Retrospective, observational consecutive case series. Inclusion criteria: attempted myopic spherical correction ⩾-8 or-3 to -7.75 D with astigmatism ⩽-3 D, and corrected distance visual acuity of 1.0 (decimal scale) or better.


A total of 62 highly myopic and 407 moderately myopic eyes were included. At 3 months postoperatively, the highly myopic eyes had a mean spherical equivalent refraction of -0.28 ± 0.41 D (range: -1.13 to +0.75 D). Mean uncorrected distance visual acuity was 1.0. Mean efficacy index was 0.84. Mean safety index was 1.03. Uncorrected distance visual acuity same or better than corrected distance visual acuity: 61%. Astigmatism was ⩽0.5 D in 90% and ⩽1 D in 100%. The results in the moderately myopic eyes were comparable.


We found equally good visual and refractive outcomes after small incision lenticule extraction for the correction of high and of moderate myopia combined with an astigmatic correction of up to 3 D, respectively.


Small incision lenticule extraction; high myopia; laser-assisted in situ keratomileusis; refractive predictability


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