Grenzen von SMILE (Small Incision Lenticule Extraction)

Zusammenfassung

Hintergrund SMILE ist ein relativ neues Verfahren der refraktiven Chirurgie, das bisher zur Korrektur von mittleren und höheren Myopien zugelassen wurde. Die Grenzen des Verfahrens sind nur unvollständig bekannt.

Methoden Literaturrecherche mithilfe von PubMed bis zum 1. 10. 2016.

Ergebnisse/Diskussion Neuere Messungen der Biomechanik der Hornhaut deuten darauf hin, dass die Schwächung der Hornhaut nach SMILE sich nicht oder nur schwach signifikant von der nach LASIK unterscheidet. Die Visusrehabilitation nach der Operation verläuft nach SMILE signifikant langsamer (z. T. Wochen) als nach LASIK (Tage). Die refraktive Trefferquote von SMILE ist nur noch wenig schlechter als die von LASIK (88 % gegenüber 94 % innerhalb ± 0,5 dpt). Nicht geklärt ist das Problem der Reoperation.

Schlussfolgerung Um SMILE vergleichbar zu LASIK zu machen, sind sowohl technische Entwicklungen als auch klinische Verbesserungen der Operationstechnik notwendig. Ein konkurrenzfähiges Produkt auf dem Markt würde den Fortschritt beschleunigen.

Abstract

Background SMILE is a relatively new technique to correct moderate and high myopia. The limits of SMILE are yet unknown.

Methods Literature research using PubMed until October 1, 2016.

Results/Discussion Recently presented axial 2D-strain-stress measurements indicate that the biomechanical impairment of the cornea after SMILE and LASIK is comparable. The difference in elastic moduli is statistically not different. The visual rehabilitation after SMILE takes significantly longer (weeks) compared to LASIK (days). The refractive success rate of SMILE is still not as good as that of LASIK (88 % vs. 95 % within ± 0.5 D) but SMILE has caught up during the past years. The problem of reoperations is not yet solved.

Conclusion More technical and clinical improvements are required to make SMILE comparable to LASIK regarding success rate and patient convenience. The biomechnical argument pro SMILE has turned out to be weak. To achieve the improvements a commercially competing femtosecond laser would be of advantage.

Schlüsselwörter

Small Incision Lenticule Extraction - SMILE - LASIK - Kornea - Biomechanik - Erfolgsrate

Key words

small incision lenticule extraction - SMILE - LASIK - Cornea - biomechanics - success rate

• Literatur

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