Small-incision lenticule extraction for myopia proves safe, predictable

Issue: January 10, 2013

Small-incision lenticule extraction was safe and predictable in the correction of moderate to high myopia, according to a prospective study.

Perspective from Steven C. Schallhorn, MD

Small-incision lenticule extraction involves cutting an intrastromal lenticule with a femtosecond laser and extracting the lenticule manually, without a flap.

The procedure was performed on 279 eyes of 144 patients; one eye of each patient was randomly selected for analysis. Three-month postoperative analysis included 246 eyes of 127 patients.

In eyes targeted for emmetropia, 40% had uncorrected distance visual acuity of 0.1 logMAR or less 1 day after surgery; 73% had uncorrected distance visual acuity of 0.1 logMAR or less at 3 months.

Mean corrected distance visual acuity improved from –0.01 logMAR preop to –0.03 logMAR at 3 months; the improvement was statistically significant (P < .001).

At 3 months, no eyes lost two lines or more of corrected distance visual acuity, six eyes lost one line, one eye gained two lines, and 24 eyes gained one line.

The study authors said that 95% of patients would recommend small-incision lenticule extraction to others.

Perspective

Steven C. Schallhorn, MD

This article describes the results of a clinical trial using femtosecond-driven small-incision lenticular extraction to treat moderate to high myopia. The refractive predictability and visual outcomes were excellent. But there are several unknowns with this technique. What are the potential complications and complication rates? Are there complications unique to this technique, such as a torn lenticule upon extraction? One central epithelial defect and one presumed infection were reported in this study, but the sample size was relatively small. How well can it correct astigmatism? The authors had an enrollment criteria of up to 2 D of astigmatism, but it is not known what the level of astigmatism was in the enrolled patients. No cylinder analysis was reported. Another question remains: Can this technique correct hyperopia? Overall, a promising procedure, but more studies and analysis are needed.

Steven C. Schallhorn, MD

Professor of Ophthalmology, University of California, San Francisco

Disclosures: Schallhorn is a consultant for Abbott Medical Optics.

Published by:

Sources/Disclosures

Collapse

Source:

J Cataract Refract Surg. 2012;38(11):2003-2010.