Brar Sheetal, Sriganesh Skanda, Sute Smith Snehal, Ganesh Sri
Nethradhama Super Speciality Eye Hospital, Bangalore, India.
J Ophthalmol. 2022 Feb 28;2022:4319785. doi: 10.1155/2022/4319785. eCollection 2022.
To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures.
This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months.
At the end of follow-up, the mean sphere, cylinder, and SE reduced to -0.03, -0.09, and -0.08 D in the SMILE group and -0.06, -0.15, and -0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error.
Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline.
比较小切口基质透镜切除术（SMILE）与小切口基质透镜切除术联合加速交联术（SMILE XTRA）后的长期安全性、有效性、可预测性和屈光稳定性，并具体研究两种手术方式后的回退模式。
本回顾性研究纳入了分别根据某些预先定义的地形特征和危险因素，接受SMILE手术的54只眼和接受SMILE XTRA手术的54只眼，分别用于治疗近视/近视散光的正常和临界病例。两组患者在年龄和屈光不正方面进行了匹配。SMILE组术后平均随访时间为22.18±10.41个月，SMILE XTRA组为21.81±10.19个月。
随访结束时，SMILE组的平均球镜、柱镜和等效球镜度数分别降至-0.03D、-0.09D和-0.08D，SMILE XTRA组分别降至-0.06D、-0.15D和-0.13D。SMILE组和SMILE XTRA组分别有96%和93%的眼睛屈光度数在±0.50D以内，SMILE组和SMILE XTRA组均有94%的眼睛最佳矫正视力维持在20/20或更好。SMILE组的安全性和有效性指数分别为1.03和1.00。SMILE XTRA组的安全性和有效性指数分别为1.00和0.99。两组均无眼出现术后角膜扩张或因明显残余屈光不正而进行增效手术。
SMILE组和SMILE XTRA组在视觉效果、安全性和有效性方面表现相当。与普遍看法相反，预防性角膜交联术与SMILE联合应用长期并未导致远视性移位。两组均无眼出现术后角膜扩张；然而，由于该组所有接受治疗的眼睛均为临界病例，建议进一步随访以确定SMILE XTRA术后对屈光和角膜稳定性的长期影响。
