Combination of Small Incision Lenticule Extraction with Prophylactic Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with Thin Cornea: Three Years Follow-up
Farideh Doroodgar, MD1 *, Mahmoud Jabbarvand, MD2 , Azad Sanginabadi, MSc 3
- Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
- Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
Abstract: To study the safety and clinical outcomes of ReLEx SMILE with accelerated cross-linking in eyes with thin corneas.
Methods: Before starting the study, we obtained ethical approval from the Iran University of Medical Sciences (https://ethics.research.ac.ir/IR.IUMS.REC.1399.609). This case series reports the outcomes of fifty-four thin corneas with corrected distance visual acuity of 20/25 or better, stable refraction of at least 1 year, age of 21 years or older, and residual corneal thickness of greater than 400 µm were studied before performing collagen crosslinking. Following the removal of lenticule, riboflavin 0.25% in saline was injected into the interface and allowed to diffuse for 90 seconds. Finally, eyes were exposed to UV-A radiation of 30 mW/cm2 for 60 seconds through the cap. Total energy delivered was 1.8 J/cm2.
Results: 54 eyes of 27 patients with a mean age of 25.22 ± 2.67 years were treated. Mean follow-up was 3years. Mean Spherical Equivalent (SE) was −5.58 ± 1.22D preoperatively and -0.111 ± 0.636 D postoperatively. The mean Central Corneal Thickness (CCT) and keratometry changed from 498.39 ± 11.79 µm to 417.85 ± 12.82 µm and 45.47 ± 0.68 D to 41.13 ± 1.13D, respectively. Mean uncorrected visual acuity (UCVA) was 20/25 or better in all eyes. No eye lost lines of Corrected Distant Visual Acuity (CDVA). After six months follow up, there were no complications like haze, keratitis, ectasia, or regression.
Conclusion: Long term clinical outcomes demonstrated that SMILE Xtra might be a safe method. SMILE Xtra can be a good option to minimize the possibility of corneal ectasia in the thin cornea.
