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Refractive lenticule extraction yields stable visual, refractive outcomes at 5 years
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Femtosecond laser-assisted refractive lenticule extraction offered long-term stability in correcting myopia and myopic astigmatism, according to a study.
The prospective clinical trial included 41 eyes of 22 patients who underwent the procedure. A 200 kHz VisuMax femtosecond laser (Carl Zeiss Meditec) was used to cut a flap and a lenticule of intrastromal corneal tissue. The lenticule was removed manually, and the flap was repositioned.
At 5 years after surgery, correction was within 1 D of the goal in 100% of eyes and within 0.5 D in 73% of eyes. No eyes lost two or more lines of Snellen visual acuity; one eye lost one line. Mean regression was 0.07 D.
All patients were treated for dry eye symptoms for 3 months after surgery, but none required further treatment after 3 months or complained of side effects at 5 years.
No other complications were reported.
“As refractive lenticule extraction gains acceptance with the introduction of the flap-free small-incision lenticule extraction technique, new studies might ameliorate remaining concerns about stability and late complications,” the study authors said.
Disclosure: The authors have no relevant financial disclosures.
Perspective
Back to TopJorge L. Alió, MD, PhD
This is an important report because it concerns the 5-year outcomes of a new refractive surgical technique, femtosecond lenticule extraction (FLEx).
FLEx is the initial all-femtosecond LASIK in the format reported by the authors. Further to this, SMILE (the same but extracted through a small incision of about 4 mm to 6 mm in length) fully achieves this femtosecond refractive surgery.
This paper basically reports that the outcomes are at least the same as in LASIK but without using an excimer laser. For corneal refractive surgery to be all-femtosecond surgery rather than microkeratome or femtosecond plus excimer laser can make a tremendous step forward in the approach to refractive surgery of myopia by using lasers, simplifying the surgical equipment and probably reducing costs.
The stability of the outcomes obtained by the authors in FLEx is not reliable because the main source of biomechanical changes should be the flap creation. It is probable that in the future SMILE will provide better outcomes at 5 years than those reported here by the authors.
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