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Title: Enhancement after small-incision lenticule extraction
Authors: Liu, Yu-Chi
Mohamad Rosman
Mehta, Jodhbir Singh
Keywords: MRSE
Engineering::Mechanical engineering
Issue Date: 2017
Source: Liu, Y.-C., Mohamad Rosman., & Mehta, J. S. (2017). Enhancement after Small-Incision Lenticule Extraction. Ophthalmology, 124(6), 813-821. doi:10.1016/j.ophtha.2017.01.053
Series/Report no.: Ophthalmology
Abstract: Purpose:To report the incidence, risk factors, and outcomes of enhancement after small-incision lenticule extraction (SMILE). Design:Retrospective cohort study.Participants:Five hundred twenty-four eyes of 307 patients who underwent SMILE at Singapore National Eye Center between February 2012 and March 2016. Methods:The data collected included patient age at primary SMILE, gender, race, preoperative and postoperative manifest refraction spherical equivalent (MRSE), preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity, the occurrence of suction loss during the procedure, and the need for enhancement. All enhancements were carried out by performing an alcohol-assisted photorefractive keratectomy (PRK) procedure with application of mitomycin C (MMC).Main Outcome Measures:Incidence, prevalence, preoperative and intraoperative risk factors for enhancement, and outcomes after enhancement. Results:The prevalence of enhancement was 2.7%, and 71.4% eyes had enhancement within 1 year of primary SMILE. The incidence of enhancement was 2.1% and 2.9% at 1 and 2 years, respectively. Age older than 35 years, preoperative MRSE more than −6.00 diopters (D), preoperative myopia more than 6.00 D, preoperative astigmatism more than 3.00 D, and intraoperative suction loss were significant risk factors for enhancement after SMILE after adjusting for all other covariates (odds ratios, 5.58, 4.80, 1.41, 3.06, and 2.14, respectively; P = 0.004, 0.021, 0.022, 0.002, and 0.020, respectively). In the patients who underwent bilateral SMILE, the first-operated eye had a marginal trend toward significance for enhancement (P = 0.054). There was no gender or racial difference. In the 14 eyes requiring enhancement, the uncorrected distance visual acuity before enhancement ranged from 20/80 to 20/25, and the mean attempted enhancement spherical equivalent was −0.50±0.86 D. The uncorrected distance visual acuity improved in most patients (92.9%) after enhancement. Conclusions:The 2-year incidence of enhancement after SMILE was 2.9%. Risk factors associated with enhancement included older age at SMILE procedure, greater preoperative MRSE, greater preoperative myopia, greater preoperative astigmatism, and the occurrence of intraoperative suction loss. Clinical outcomes of using PRK with application of MMC for enhancement were good.
ISSN: 0161-6420
DOI: 10.1016/j.ophtha.2017.01.053
Schools: School of Materials Science & Engineering 
School of Mechanical and Aerospace Engineering 
Rights: © 2017 American Academy of Ophthalmology. All rights reserved.
Fulltext Permission: none
Fulltext Availability: No Fulltext
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