Download PDF
Klin Monbl Augenheilkd 2017; 234(01): 125-129
DOI: 10.1055/s-0042-123194
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Grenzen von SMILE (Small Incision Lenticule Extraction)

Limitations of SMILE (Small Incision Lenticule Extraction)
T. Seiler
Augenarzt, Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Schweiz
,
T. Koller
Augenarzt, Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Schweiz
,
V. V. Wittwer
Augenarzt, Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zürich, Schweiz
› Author Affiliations
Further Information

Publication History

eingereicht 11 October 2016

akzeptiert 08 November 2016

Publication Date:
30 January 2017 (online)

Also available at
    Permissions and Reprints

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

  • 1 Waring 3rd GO, Lynn MJ, McDonnell PJ. Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol 1994; 112: 1298-1308
    CrossrefPubMedGoogle Scholar
  • 2 Seiler T, Kahle G, Kriegerowski M. Excimer laser (193 nm) myopic keratomileusis in sighted and blind human eyes. Refract Corneal Surg 1990; 6: 165-173
    PubMedGoogle Scholar
  • 3 Pallikaris IG, Papatzanaki ME, Siganos DS. et al. A corneal flap technique for laser in situ keratomileusis. Human studies. Arch Ophthalmol 1991; 109: 1699-1702
    CrossrefPubMedGoogle Scholar
  • 4 Seiler T, Koufala K, Richter G. Iatrogenic keratectasia after laser in situ keratomileusis. J Refract Surg 1998; 14: 312-317
    CrossrefPubMedGoogle Scholar
  • 5 Lubatschowski H, Maatz G, Heisterkamp A. et al. Application of ultrashort laser pulses for intrastromal refractive surgery. Graefes Arch Clin Exp Ophthalmol 2000; 238: 33-39
    CrossrefPubMedGoogle Scholar
  • 6 Sekundo W, Kunert K, Russmann C. et al. First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia: six-month results. J Cataract Refract Surg 2008; 34: 1513-1520
    CrossrefPubMedGoogle Scholar
  • 7 Denoyer A, Landman E, Trinh L. et al. Dry eye disease after refractive surgery: comparative outcomes of small incision lenticule extraction versus LASIK. Ophthalmology 2015; 122: 669-676
    CrossrefPubMedGoogle Scholar
  • 8 Winkler M, Chai D, Kriling S. et al. Nonlinear optical macroscopic assessment of 3-D corneal collagen organization and axial biomechanics. Invest Ophthalmol Vis Sci 2011; 52: 8818-8827
    CrossrefPubMedGoogle Scholar
  • 9 Reinstein DZ, Archer TJ, Randleman JB. Mathematical model to compare the relative tensile strength of the cornea after PRK, LASIK, and small incision lenticule extraction. J Refract Surg 2013; 29: 454-460
    CrossrefPubMedGoogle Scholar
  • 10 Scarcelli G, Pineda R, Yun SH. Brillouin optical microscopy for corneal biomechanics. Invest Ophthalmol Vis Sci 2012; 53: 185-190
    CrossrefPubMedGoogle Scholar
  • 11 Spiru B, Kling S, Hafezi F. et al. Biomechanical differences between FLEx and SMILE refractive procedures from 2D-extensiometry in ex-vivo porcine eyes. Vortrag gehalten bei der DOG, Berlin, 30. 9. 2016.
    PubMedGoogle Scholar
  • 12 El-Naggar MT. Bilateral ectasia after femtosecond laser-assisted small-incision lenticule extraction. J Cataract Refract Surg 2015; 41: 884-888
    CrossrefPubMedGoogle Scholar
  • 13 Wang Y, Cui C, Li Z. et al. Corneal ectasia 6.5 months after small-incision lenticule extraction. J Cataract Refract Surg 2015; 41: 1100-1106
    CrossrefPubMedGoogle Scholar
  • 14 Mastropasqua L. Bilateral ectasia after femtosecond laser-assisted small-incision lenticule extraction. J Cataract Refract Surg 2015; 41: 1338-1339
    CrossrefPubMedGoogle Scholar
  • 15 Sachdev G, Sachdev MS, Sachdev R. et al. Unilateral corneal ectasia following small-incision lenticule extraction. J Cataract Refract Surg 2015; 41: 2014-2018
    CrossrefPubMedGoogle Scholar
  • 16 Mattila JS, Holopainen JM. Bilateral ectasia after femtosecond laser-assisted small incision lenticule extraction (SMILE). J Refract Surg 2016; 32: 497-500
    CrossrefPubMedGoogle Scholar
  • 17 Moshirfar M, McCaughey MV, Reinstein DZ. et al. Small-incision lenticule extraction. J Cataract Refract Surg 2015; 41: 652-665
    CrossrefPubMedGoogle Scholar
  • 18 Hansen RS, Lyhne N, Grauslund J. et al. Small-incision lenticule extraction (SMILE): outcomes of 722 eyes treated for myopia and myopic astigmatism. Graefes Arch Clin Exp Ophthalmol 2016; 254: 399-405
    CrossrefPubMedGoogle Scholar
  • 19 Muñoz G, Albarrán-Diego C, Sakla HF. et al. Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser. Incidence and prevention. J Cataract Refract Surg 2006; 32: 2075-2079
    CrossrefPubMedGoogle Scholar
  • 20 Agca A, Ozgurhan EB, Yildirim Y. et al. Corneal backscatter analysis by in vivo confocal microscopy: fellow eye comparison of small incision lenticule extraction and femtosecond laser-assisted LASIK. J Ophthalmol 2014; 2014: 265012
    PubMedGoogle Scholar
  • 21 Hammer CM, Petsch C, Klenke J. et al. Corneal tissue interactions of a new 345 nm ultraviolet femtosecond laser. J Cataract Refract Surg 2015; 41: 1279-1288
    CrossrefPubMedGoogle Scholar
  • 22 Prakash G, Srivastava D, Suhail M. Femtosecond laser-assisted wavefront-guided LASIK using a newer generation aberrometer: 1-year results. J Refract Surg 2015; 31: 600-606
    CrossrefPubMedGoogle Scholar
  • 23 Ziaei M, Mearza AA, Allamby D. Wavefront-optimized laser in situ keratomileusis with the Allegretto Wave Eye-Q excimer laser and the FEMTO LDV Crystal Line femtosecond laser: 6 month visual and refractive results. Cont Lens Anterior Eye 2015; 38: 245-249
    CrossrefPubMedGoogle Scholar
  • 24 Sáles CS, Manche EE. One-year outcomes from a prospective, randomized, eye-to-eye comparison of wavefront-guided and wavefront-optimized LASIK in myopes. Ophthalmology 2013; 120: 2396-2402
    CrossrefPubMedGoogle Scholar
  • 25 Tomita M, Watabe M, Yukawa S. et al. Safety, efficacy, and predictability of laser in situ keratomileusis to correct myopia or myopic astigmatism with a 750 Hz scanning-spot laser system. J Cataract Refract Surg 2014; 40: 251-258
    CrossrefPubMedGoogle Scholar
  • 26 MacKenzie GE. Reproducibility of sphero-cylindrical prescriptions. Ophthalmic Physiol Opt 2008; 28: 143-150
    CrossrefPubMedGoogle Scholar
  • 27 Chan C, Lawless M, Sutton G. et al. Small incision lenticule extraction (SMILE) in 2015. Clin Exp Optom 2016; 99: 204-212
    CrossrefPubMedGoogle Scholar
  • 28 Shen Z, Shi K, Yu Y. et al. Small incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia: a systematic review and meta-analysis. PLoS One 2016; 11: e0158176
    CrossrefPubMedGoogle Scholar
  • 29 Blum M, Täubig K, Gruhn C. et al. Five-year results of small incision lenticule extraction (ReLEx SMILE). Br J Ophthalmol 2016; 100: 1192-1195
    CrossrefPubMedGoogle Scholar
  • 30 Pedersen IB, Ivarsen A, Hjortdal J. Three-year results of small incision lenticule extraction for high myopia: refractive outcomes and aberrations. J Refract Surg 2015; 31: 719-724
    CrossrefPubMedGoogle Scholar
  • 31 Ramirez-Miranda A, Ramirez-Luquin T, Navas A. et al. Refractive lenticule extraction complications. Cornea 2015; 34 (Suppl. 10) S65-S67
    CrossrefPubMedGoogle Scholar
  • 32 Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology 2014; 121: 822-828
    CrossrefPubMedGoogle Scholar
  • 33 Donate D, Thaëron R. Preliminary evidence of successful enhancement after a primary SMILE procedure with the sub-cap-lenticule-extraction technique. J Refract Surg 2015; 31: 708-710
    CrossrefPubMedGoogle Scholar
  • 34 Ivarsen A, Hjortdal JØ. Topography-guided photorefractive keratectomy for irregular astigmatism after small incision lenticule extraction. J Refract Surg 2014; 30: 429-432
    CrossrefPubMedGoogle Scholar