Vector analysis of low to moderate astigmatism with small incision lenticule extraction (SMILE): results of a 1-year follow-up

Jiamei Zhang, Yan Wang, Wenjing Wu, Lulu Xu, Xiaojing Li, Rui Dou, Jiamei Zhang, Yan Wang, Wenjing Wu, Lulu Xu, Xiaojing Li, Rui Dou

Abstract

Background: To evaluate the refractive outcomes for the correction of low to moderate astigmatism up to 1 year following small incision lenticule extraction (SMILE) surgery.

Methods: This retrospective study enrolled 98 eyes from 98 patients who underwent SMILE surgery for the correction of myopia and astigmatism. Only right eyes were included in this study to avoid the bias of orientation errors. The vector method was used to analyze the outcomes of astigmatism at 1 month, 6 months and 12 months after the procedure, including the double-angle plots, correction index (CI), index of success (IOS), angle of error (AofE) and magnitude of error (MofE). The effectiveness, safety, stability and predictability were also investigated during the 12-month follow-up.

Results: The preoperative cylinder ranged from -2.75 D to -0.25 D (average of -0.90±0.68 D), and the mean postoperative cylinder values were -0.24±0.29 D, -0.24±0.29 D, and -0.20±0.27 D at 1 month, 6 months, and 12 months, respectively. The mean astigmatism in vector form was -0.14 D×27.19° at 1 month, -0.13 D×27.29° at 6 months, and -0.10 D×28.63° at 12 months after surgery. The CI was 1.00±0.32 and IOS was 0.29±0.44 at the 12-month follow-up. Significant negative correlations were found between the CI and absolute target induced astigmatism (TIA) value, and positive correlations were found between the IOS and absolute AofE value (P<0.05). The MofE was limited within ±1.00 D at the 12-month follow-up. Fifty-six eyes (57.1%) gained one line in corrected distance visual acuity (CDVA) and five eyes (5.1%) gained two lines. There were no significant differences observed in the refractive outcomes among time points.

Conclusions: SMILE surgery was effective and safe in correcting low to moderate astigmatism, and stable refractive outcomes were observed at the long-term follow-up. The undercorrection of astigmatism could possibly be influenced by attempted astigmatism correction preoperatively, the axis rotation during the surgery or wound healing postoperatively. This study suggested that nomograms should be adjusted in correcting astigmatism with SMILE surgery.

Figures

Figure 1
Figure 1
The double-angle plots of the astigmatism. The preoperative TIA (A) and postoperative DV at 1 month (B), 6 months (C) and 12 months (D). The vector of astigmatism is represented by the red spots and the blue spot indicates the centroid value of each plotted vector.
Figure 2
Figure 2
The effectiveness of SMILE surgery. Postoperative cylinder compared with the preoperative cylinder (A) and pie chart of the cylinder at the 12-month follow-up (B).
Figure 3
Figure 3
The effectiveness and safety of SMILE surgery. The UDVA at the 12-month follow-up compared with the preoperative CDVA in cumulative of eyes (A) and change in lines of CDVA at 12 months after surgery (B).
Figure 4
Figure 4
The stability of SMILE surgery. The average of spherical refraction (A) and cylindrical refraction (B) changed with time. The mean value is demonstrated and the error bar illustrates the 95% confidence interval (CI).
Figure 5
Figure 5
The predictability of spherical refraction with SMILE surgery. The attempted versus achieved spherical correction in the absolute value with SMILE surgery at 1 month (A), 6 months (B) and 12 months (C). Above the green dashed line in the middle is overcorrection and below is undercorrection. The red solid line indicates the outcome of linear regression analysis.
Figure 6
Figure 6
The predictability of cylindrical refraction with SMILE surgery. The absolute TIA versus SIA with SMILE surgery at 1 month (A), 6 months (B) and 12 months (C). Above the green dashed line in middle is overcorrection and below is undercorrection. The red solid line indicates the outcome of linear regression analysis.

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Pre-publication history
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