Allogeneic Myopic SMILE’s Lenticule Implantation in high hyperopic small eyes: A comparative right-left study
Farideh Doroodgar, MD1 *, Mahmoud Jabbarvand, MD2 , Jorge L. Alio, MD, PhD FEBO3
- 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
- Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Vissum Miranza Alicante, Spain
Abstract: To verify the visual outcomes and complications of the implantation of lenticules obtained from myopic Small Incision Lenticule Extraction (SmILE) as an additive refractive procedure for overcoming high hyperopia.
Methods: A twenty-five-year-old patient with microphthalmos and amblyopia repeatedly came to my office with a spectacle removal request four years ago. Both eyes with +11D during subjective refraction achieved Snellen chart’s Best Corrected Distance Visual Acuity 6/10 and 5/10 respectively. The right and left eye had Axial Length 17.38, 17.53, the Anterior Chamber Depth ( ACD) and Horizontal Corneal Diameter was 11.5, 11.2 mm and 2.76, 2.79 respectively. The patient had two problems entity consisting of high hyperopia for laser refractive surgery and shallow ACD for phakic Intraocular Lens implantation. Hence, written and vocal informed consent was recorded, and Small incision Lenticule Implantation procedure “SLI” was performed (Video is attached) * to overcome the hyperopia in this short eye. The patient was successfully scheduled for immediate (by four hours) implantation of a 7.5mm extracted lenticule from a healthy donor with high myopia -10 diopters, in-depth 160 and 120 R-L using the VisuMax (Carl Zeiss Meditec, Jena, Germany) SMILE software. A comparative evaluation of outcomes such as refractive, thickness maps, and topometric indexes was done between the same patient’s eyes.
Results: At the late postoperative visits, the mean uncorrected distance visual acuity (UCVA) score increased from Counting fingers’ baseline preoperative values at two meters to +0.4 logarithms of the minimum angle of resolution (logMar). The visual, refractive, and keratometric outcomes from the third month onwards were stable. There was no significant change on the Endothelial Cell Density (ECD), Epithelial thickness map, ACD, and the level of the IOP postoperatively (P ≥ 0.05). Over two months, once stable refraction has been achieved during consecutive refractions at least two times, surgical enhancement of residual error in the left eye was corrected by CIRCLE software of VisuMax femtosecond laser (Video)*.
Conclusion: Altogether using a simple and reversible technique called “SLI” instead of more invasive intraocular procedures, rather than refractive predictability, may offer a safe and conceivable adjuvant way for this problematic entity in modern lens-based surgery.
