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. 2021 Sep 23;16(9):e0257667.
doi: 10.1371/journal.pone.0257667. eCollection 2021.

Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism

Jing Zhang  1   2   3 , Yuehua Zhou  1   2   3
Affiliations

Small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism

Jing Zhang et al. PLoS One. .

Abstract

Purpose: To quantitatively evaluate outcomes after small incision lenticule extraction (SMILE) combined with allogeneic intrastromal lenticule inlay for hyperopia with astigmatism.

Methods: It's a retrospective cohort study. Twenty-four eyes of 15 patients with more than 0.75 diopters (D) of astigmatism in hyperopic eyes were enrolled in this study. The hyperopic eye with astigmatism was first treated with SMILE to correct astigmatism; then a lenticule was extracted from a donor myopic eye and subsequently implanted into the hyperopic eye with astigmatism. Patients were examined preoperatively and 1 day, 1 week, 1,3 months and 1 year after surgery. The main outcome measures were the uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected near visual acuity (UNVA), spherical equivalent (SE), corneal topography, anterior segment optical coherence topography (OCT) and ocular response analyzer (ORA) parameters: corneal hysteresis (CH) and corneal resistance factor (CRF). Repeated-measures analyses of variance (ANOVA) and post hoc tests were used to analyze data of different follow-up visits.

Results: The mean preoperative cylinder was 1.95±1.04(D). The UDVA (from 0.37±0.23 to 0.09±0.09), UNVA (from 0.49±0.21 to 0.08±0.06), SE (from +7.42±3.12 to -0.75±0.79) and astigmatism (+1.95±1.04 to -0.65±0.63) postoperatively were obviously better than those before surgery. Five eyes (26.3%) gained one line of CDVA, and 3 eyes (15.8%) gained two lines of CDVA one year after surgery compared with preoperative levels. The average corneal curvature was changed from (43.19±4.37) D to (49.19±3.87) D one year after surgery. The anterior segment OCT images of corneas with lenticule inlays at each follow-up visit showed that the implanted lenticule was shaped like a crescent in the corneal stroma. The CH and CRF didn't change significantly after surgery (p = 0.189 and p = 0.107respectively).

Conclusions: SMILE combined with intrastromal lenticule inlay can be used to correct high hyperopia with astigmatism with good safety, efficacy and reproducibility.

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Conflict of interest statement

The authors have declared that they have no competing interests exist. Beijing Ming Vision and Ophthalmology is an affiliated teaching clinic for Eye School of Chengdu University of TCM. The author Zhang is a doctor of Eye School of Chengdu University of TCM and now is interning in the Beijing Ming Vision and Ophthalmology. Beijing Ming Vision and Ophthalmology only provided support in the form of internship allowance for the author [JZ], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. The change of CDVA before and one year after surgery.
Fig 2
Fig 2. Anterior segment OCT images of corneas with lenticule implantation at each follow-up visit.
Pictures a-e respectively represents OCT images 1 day, 1 week, 1 month, 3 months and 1 year after surgery. The implanted lenticule was in the center and shaped like a crescent in the corneal stroma, with no offset and wrinkles at each visit. The lenticule demarcation line blurred at 1 year after surgery.
See this image and copyright information in PMC

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