Gab-Alla Amr A
Faculty of Medicine, Ophthalmology Department, Suez Canal University, Ring Road, Ismailia, Egypt.
Eye Vis (Lond). 2021 Sep 1;8(1):28. doi: 10.1186/s40662-021-00254-2.
To evaluate predictability, stability, efficacy, and safety of transepithelial photorefractive keratectomy (TPRK) using smart pulse technology (SPT) (SmartSurface procedure) of Schwind Amaris with mitomycin C for correction of post small incision lenticule extraction (SMILE) myopic residual refractive errors.
This study is a prospective, non-comparative case series conducted at a private eye centre in Ismailia, Egypt, on eyes with post-SMILE myopic residual refractive errors because of undercorrection or suction loss (suction loss occurred after the posterior lenticular cut and the creation of side-cuts; redocking was attempted, and the treatment was completed in the same session with the same parameters) with myopia or myopic astigmatism. The patients were followed up post-SMILE for six months before the SmartSurface procedure, and then they were followed up for one year after that. TPRK were performed using Amaris excimer laser at 500 kHz. The main outcomes included refractive predictability, stability, efficacy, safety and any reported complications.
This study included 68 eyes of 40 patients out of 1920 total eyes (3.5%) with post-SMILE technique myopic residual refractive errors. The average duration between the SMILE surgery and TPRK was 6.7 ± 0.4 months (range 6 to 8 months). The mean refractive spherical equivalent (SE) was within ± 0.50 D of plano correction in 100% of the eyes at 12 months post-TPRK. Astigmatism of < 0.50 D was achieved in 100% of the eyes. The mean of the residual SE error showed statistically significant improvement from preoperative - 1.42 ± 0.52 D to 0.23 ± 0.10 D (P < 0.0001). Uncorrected distance visual acuity (UDVA) (measured by Snellen's chart and averaged in logMAR units) was improved significantly to 0.1 ± 0.07 (P < 0.0001). UDVA was 0.2 logMAR or better in 100% of the eyes, 0.1 logMAR or better in 91.2% of the eyes, and 0.0 logMAR in 20.6% of the eyes. Corrected distance visual acuity (CDVA) remained unchanged in 79.4% of eyes. 14.7% of eyes gained one line of CDVA (Snellen). 5.9% of eyes gained two lines of CDVA (Snellen).
Transepithelial photorefractive keratectomy using smart pulse technology with mitomycin C enhancement after SMILE is a safe, predictable, stable, and effective technique.
评估使用施温德阿玛瑞斯的智能脉冲技术（SPT）（SmartSurface手术）联合丝裂霉素C进行经上皮光性角膜切削术（TPRK）矫正小切口基质透镜切除术（SMILE）后近视残余屈光不正的可预测性、稳定性、有效性和安全性。
本研究是一项前瞻性、非对比性病例系列研究，在埃及伊斯梅利亚的一家私立眼科中心进行，研究对象为因欠矫或吸力丧失（吸力丧失发生在后透镜切割和侧切口形成后；尝试重新对接，并在同一会诊中使用相同参数完成治疗）导致SMILE术后近视残余屈光不正的近视或近视散光患者。患者在SMILE术后随访6个月后进行SmartSurface手术，之后再随访1年。使用阿玛瑞斯准分子激光以500kHz频率进行TPRK。主要观察指标包括屈光可预测性、稳定性、有效性、安全性以及任何报告的并发症。
本研究纳入了1920只眼中40例患者的68只眼（3.5%），这些眼存在SMILE术后近视残余屈光不正。SMILE手术与TPRK之间的平均间隔时间为6.7±0.4个月（范围6至8个月）。TPRK术后12个月时，100%的眼平均等效球镜度（SE）在±0.50D的平光矫正范围内。100%的眼散光度数<0.50D。残余SE误差的平均值从术前的-1.42±0.52D显著改善至0.23±0.10D（P<0.0001）。未矫正远视力（UDVA）（通过斯内伦视力表测量并以logMAR单位平均）显著提高至0.1±0.07（P<0.0001）。100%的眼UDVA为0.2 logMAR或更好，91.2%的眼UDVA为0.1 logMAR或更好，20.6%的眼UDVA为0.0 logMAR。79.4%的眼矫正远视力（CDVA）保持不变。14.7%的眼CDVA提高了一行（斯内伦视力表）。5.9%的眼CDVA提高了两行（斯内伦视力表）。
SMILE术后使用智能脉冲技术联合丝裂霉素C增强的经上皮光性角膜切削术是一种安全、可预测、稳定且有效的技术。
