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First European results of a new refractive lenticular extraction procedure—SmartSight by SCHWIND eye-tech-solutions

Eye volume 37, pages 3768–3775 (2023)Cite this article

Subjects

Abstract

Background

To evaluate vision 3 months after SmartSight lenticule extraction treatments.

Design

Case series.

Methods

This case series of patients were treated at Specialty Eye Hospital Svjetlost in Zagreb, Croatia. Sixty eyes of 31 patients consecutively treated with SmartSight lenticule extraction were assessed. The mean age of the patients was 33 ± 6 years (range 23–45 years) at the time of treatment with a mean spherical equivalent refraction of −5.10 ± 1.35 D and mean astigmatism of 0.46 ± 0.36 D. Monocular corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) were assessed pre- and post-operatively. Ocular and corneal wavefront aberrations have been postoperatively compared to the preoperative baseline values. Changes in ocular wavefront refraction, as well as changes in keratometric readings are reported.

Results

At 3 months post-operatively, mean UDVA was 20/20 ± 2. Spherical equivalent showed a low myopic residual refraction of −0.37 ± 0.58 D with refractive astigmatism of 0.46 ± 0.26 D postoperatively. There was a slight improvement of 0.1 Snellen lines at 3-months follow-up. Compared to the preoperative status, ocular aberrations (at 6 mm diameter) did not change at 3 months follow-up; whereas corneal aberrations increased (+0.22 ± 0.21 µm for coma; +0.17 ± 0.19 µm for spherical aberration; and +0.32 ± 0.26 µm for HOA-RMS). The same correction was determined using changes in ocular wavefront refraction, as well as changes in keratometric readings.

Conclusion

Lenticule extraction after SmartSight is safe and efficacious in the first 3 months postoperatively. The post-operative outcomes indicate improvements in vision.

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Fig. 1: Standard graphs for reporting outcomes in laser vision correction.
Fig. 2: Wavefront refraction.
Fig. 3: Wavefront refraction vs topographic changes.
Fig. 4: Change in high order aberrations.

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Data availability

Data are available upon request.

References

  1. Bohac M, Koncarevic M, Dukic A, Biscevic A, Cerovic V, Merlak M, et al. Unwanted astigmatism and high-order aberrations one year after excimer and femtosecond corneal surgery. Optom Vis Sci. 2018;95:1064–76. https://doi.org/10.1097/OPX.0000000000001298

    Article  PubMed  Google Scholar 

  2. Reinstein DZ, Archer TJ, Gobbe M. Small incision lenticule extraction (SMILE) history, fundamentals of a new refractive surgery technique and clinical outcomes. Eye Vis. 2014;1:3. https://doi.org/10.1186/s40662-014-0003-1

    Article  Google Scholar 

  3. Izquierdo L Jr, Sossa D, Ben-Shaul O, Henriquez MA. Corneal lenticule extraction assisted by a low-energy femtosecond laser. J Cataract Refract Surg. 2020;46:1217–21. https://doi.org/10.1097/j.jcrs.0000000000000236

    Article  PubMed  Google Scholar 

  4. Pradhan KR, Arba-Mosquera S. Three-month outcomes of myopic astigmatism correction with small incision guided human cornea treatment. J Refract Surg. 2021;37:304–11. https://doi.org/10.3928/1081597X-20210210-02. Epub 2021 May 1

    Article  PubMed  Google Scholar 

  5. Tsai PS, Blinder P, Migliori BJ, Neev J, Jin Y, Squier JA, et al. Plasma-mediated ablation: an optical tool for submicrometer surgery on neuronal and vascular systems. Curr Opin Biotechnol. 2009;20:90–99. https://doi.org/10.1016/j.copbio.2009.02.003. Epub 2009 Mar 5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Noack J, Vogel A. Laser-induced plasma formation in water at nanosecond to femtosecond time scales: calculation of thresholds, absorption coefficients, and energy density. IEEE J Quantum Electron. 1999;35:1156–67.

    Article  CAS  Google Scholar 

  7. Vogel A, Busch S, Jungnickel K, Birngruber R. Mechanisms of intraocular photodisruption with picosecond and nanosecond laser pulses. Lasers Surg Med. 1994;15:32–43. https://doi.org/10.1002/lsm.1900150106

    Article  CAS  PubMed  Google Scholar 

  8. Arba-Mosquera S, Verma S. Analytical optimization of the ablation efficiency at normal and non-normal incidence for generic super Gaussian beam profiles. Biomed Opt Express. 2013;4:1422–33. https://doi.org/10.1364/BOE.4.001422

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chernyak DA. From wavefront device to laser: an alignment method for complete registration of the ablation to the cornea. J Refract Surg. 2005;21:463–8. https://doi.org/10.3928/1081-597X-20050901-07

    Article  PubMed  Google Scholar 

  10. Gobbi PG, Carones F, Brancato R, Carena M, Fortini A, Scagliotti F, et al. Automatic eye tracker for excimer laser photorefractive keratectomy. J Refract Surg. 1995;11:S337–342. https://doi.org/10.3928/1081-597X-19950502-31

    Article  CAS  PubMed  Google Scholar 

  11. Dausch D, Klein R, Schröder E, Dausch B. Excimer laser photorefractive keratectomy with tapered transition zone for high myopia. A preliminary report of six cases. J Cataract Refract Surg. 1993;19:590–4. https://doi.org/10.1016/s0886-3350(13)80005-3

    Article  CAS  PubMed  Google Scholar 

  12. Bohac M, Biscevic A, Koncarevic M, Anticic M, Gabric N, Patel S. Comparison of wavelight allegretto eye-Q and Schwind Amaris 750 S excimer laser in treatment of high astigmatism. Graefes Arch Clin Exp Ophthalmol. 2014;252:1679–86. https://doi.org/10.1007/s00417-014-2776-2. Epub 2014 Aug 23

    Article  PubMed  PubMed Central  Google Scholar 

  13. Siedlecki J, Luft N, Keidel L, Mayer WJ, Kreutzer T, Priglinger SG, et al. Variation of lenticule thickness for SMILE in low myopia. J Refract Surg. 2018;34:453–9. https://doi.org/10.3928/1081597X-20180516-01

    Article  PubMed  Google Scholar 

  14. Giri P, Azar DT. Risk profiles of ectasia after keratorefractive surgery. Curr Opin Ophthalmol. 2017;28:337–42. https://doi.org/10.1097/ICU.0000000000000383

    Article  PubMed  PubMed Central  Google Scholar 

  15. Genc SL, Ma H, Venugopalan V. Low-density plasma formation in aqueous biological media using sub-nanosecond laser pulses. Appl Phys Lett. 2014;105:063701 https://doi.org/10.1063/1.4892665

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wang J, Schuele G, Palanker D. Finesse of transparent tissue cutting by ultrafast lasers at various wavelengths. J Biomed Opt. 2015;20:125004 https://doi.org/10.1117/1.JBO.20.12.125004

    Article  PubMed  Google Scholar 

  17. Vogel A, Capon MR, Asiyo-Vogel MN, Birngruber R. Intraocular photodisruption with picosecond and nanosecond laser pulses: tissue effects in cornea, lens, and retina. Investig Ophthalmol Vis Sci. 1994;35:3032–44.

    CAS  Google Scholar 

  18. de Ortueta D, Schreyger FD. Centration on the cornea vertex normal during hyperopic refractive photoablation using videokeratoscopy. J Refract Surg. 2007;23:198–200. https://doi.org/10.3928/1081-597X-20070201-13

    Article  PubMed  Google Scholar 

  19. Köse B.Detection of and compensation for static cyclotorsion with an image-guided system in SMILE. J Refract Surg.2020;36:142–9. https://doi.org/10.3928/1081597X-20200210-01.

    Article  PubMed  Google Scholar 

  20. Vinciguerra P, Roberts CJ, Albé E, Romano MR, Mahmoud A, Trazza S, et al. Corneal curvature gradient map: a new corneal topography map to predict the corneal healing process. J Refract Surg. 2014;30:202–7. https://doi.org/10.3928/1081597X-20140218-02

    Article  PubMed  Google Scholar 

  21. Gatinel D, Weyhausen A, Bischoff M. The percent volume altered in correction of myopia and myopic astigmatism with PRK, LASIK, and SMILE. J Refract Surg. 2020;36:844–50. https://doi.org/10.3928/1081597X-20200827-01

    Article  PubMed  Google Scholar 

  22. Kind R, Kiraly L, Taneri S, Troeber L, Wiltfang R, Bechmann M, et al. Flushing versus not flushing the interface during small-incision lenticule extraction. J Cataract Refract Surg. 2019;45:562–8. https://doi.org/10.1016/j.jcrs.2018.12.001. Epub 2019 Mar 4

    Article  PubMed  Google Scholar 

  23. Shetty R, Shroff R, Kaweri L, Jayadev C, Kummelil MK, Sinha Roy A. Intra-operative cap repositioning in Small Incision Lenticule Extraction (SMILE) for enhanced visual recovery. Curr Eye Res. 2016;41:1532–8. https://doi.org/10.3109/02713683.2016.1168848

    Article  PubMed  Google Scholar 

  24. Schiano-Lomoriello D, Bono V, Abicca I, Savini G. Repeatability of anterior segment measurements by optical coherence tomography combined with Placido disk corneal topography in eyes with keratoconus. Sci Rep. 2020;10:1124. https://doi.org/10.1038/s41598-020-57926-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Plaza-Puche AB, Salerno LC, Versaci F, Romero D, Alio JL. Clinical evaluation of the repeatability of ocular aberrometry obtained with a new pyramid wavefront sensor. Eur J Ophthalmol. 2019;29:585–92. https://doi.org/10.1177/1120672118816060. Epub 2018 Dec 5

    Article  PubMed  Google Scholar 

  26. Taneri S, Arba-Mosquera S, Rost A, Kießler S, Dick HB. Repeatability and reproducibility of manifest refraction. J Cataract Refract Surg. 2020;46:1659–66. https://doi.org/10.1097/j.jcrs.0000000000000343

    Article  PubMed  Google Scholar 

  27. Hamilton DR, Chen AC, Khorrami R, Nutkiewicz M, Nejad M. Comparison of early visual outcomes after low-energy SMILE, high-energy SMILE, and LASIK for myopia and myopic astigmatism in the United States. J Cataract Refract Surg. 2021;47:18–26. https://doi.org/10.1097/j.jcrs.0000000000000368

    Article  PubMed  Google Scholar 

  28. Rahaman A, Rahaman S, Fu H. Glass burn threshold: an innovative method to characterize refractive femtosecond laser performance. Invest Ophthalmol Vis Sci 2022;63:4364–A0301.

    Google Scholar 

  29. Liu J, Wang Y. Influence of preoperative keratometry on refractive outcomes for myopia correction with small incision lenticule extraction. J Refract Surg. 2020;36:374–9. https://doi.org/10.3928/1081597X-20200513-01

    Article  PubMed  Google Scholar 

  30. Taneri S, Arba-Mosquera S, Rost A, Hansson C, Dick HB. Results of thin-cap small-incision lenticule extraction. J Cataract Refract Surg. 2021;47:439–44. https://doi.org/10.1097/j.jcrs.0000000000000470

    Article  PubMed  Google Scholar 

  31. Leccisotti A, Fields SV, De Bartolo G. Refractive corneal lenticule extraction with the CLEAR femtosecond laser application. Cornea. 2022. https://doi.org/10.1097/ICO.0000000000003123.

  32. Kaluzny BJ, Verma S, Piotrowiak-Słupska I, Kaszuba-Modrzejewska M, Rzeszewska-Zamiara J, Stachura J, et al. Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone. J Cataract Refract Surg. 2021;47:450–8. https://doi.org/10.1097/j.jcrs.0000000000000476

    Article  PubMed  Google Scholar 

  33. Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988;14:46–52. https://doi.org/10.1016/s0886-3350(88)80063-4

    Article  CAS  PubMed  Google Scholar 

  34. Qian Y, Liu Y, Zhou X, Naidu RK. Comparison of corneal power and astigmatism between simulated keratometry, true net power, and total corneal refractive power before and after SMILE surgery. J Ophthalmol. 2017;2017:9659481. https://doi.org/10.1155/2017/9659481.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sideroudi H, Lazaridis A, Messerschmidt-Roth A, Labiris G, Kozobolis V, Sekundo W. Corneal irregular astigmatism and curvature changes after small incision lenticule extraction: three-year follow-up. Cornea. 2018;37:875–80. https://doi.org/10.1097/ICO.0000000000001532

    Article  PubMed  Google Scholar 

  36. Ganesh S, Patel U, Brar S. Posterior corneal curvature changes following refractive small incision lenticule extraction. Clin Ophthalmol. 2015;9:1359–64. https://doi.org/10.2147/OPTH.S84354. eCollection 2015

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lee H, Roberts CJ, Arba-Mosquera S, Kang DSY, Reinstein DZ, Kim TI. Relationship between decentration and induced corneal higher-order aberrations following small-incision lenticule extraction procedure. Investig Ophthalmol Vis Sci. 2018;59:2316–24. https://doi.org/10.1167/iovs.17-23451

    Article  Google Scholar 

  38. Pradhan KR, Arba Mosquera S. Twelve-month outcomes of a new refractive lenticular extraction procedure. J Optom. 2023;16:30–41. https://doi.org/10.1016/j.optom.2021.11.001.

    Article  PubMed  Google Scholar 

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Funding

The study was self-financed.

Author information

Authors and Affiliations

  1. Specialty Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia

    Ivan Gabric, Maja Bohac & Kresimir Gabric

  2. SCHWIND eye-tech-solutions, Kleinostheim, Germany

    Samuel Arba Mosquera

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  1. Ivan Gabric
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Contributions

The authors confirm their contribution to the paper as follows: IG—study conception and design, data collection, analysis and interpretation of results, draft manuscript preparation. MB—study conception and design, data collection, analysis and interpretation of results, draft manuscript preparation. KG—study conception and design, data collection, analysis and interpretation of results. SAM—study conception and design, data collection, analysis and interpretation of results, draft manuscript preparation. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Maja Bohac.

Ethics declarations

Competing interests

SAM is an employee at and inventor in several patents owned by SCHWIND eye-tech-solutions. None of the other authors has financial or proprietary interests in materials or methods presented herein.

Ethical approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki. The study was retrospective with anonymized data. Ethics approval was not required due to the retrospective nature of the review chart. The purpose of this clinical research does not represent a clinical investigation. The medical device was used within its intended purpose without any additional invasive or patient-burdensome procedures used. Informed consent was obtained from all subjects involved in the study.

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Gabric, I., Bohac, M., Gabric, K. et al. First European results of a new refractive lenticular extraction procedure—SmartSight by SCHWIND eye-tech-solutions. Eye 37, 3768–3775 (2023). https://doi.org/10.1038/s41433-023-02601-0

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